depression nursing care plan

Depression is one of the most common mental health issues prevalent today, especially during the Covid-19 pandemic when most people have been forced to stay in their homes and limit interactions with people outside of the virtual environment. As the pandemic has caused disruptions in people’s daily lives, incidences of depression increase, and the nurse must need to keep herself prepared in caring for patients with depression.

Considered to be one of the leading causes people declare themselves as mentally disabled, depression is defined by the DSM-V Diagnostic criteria as a common and serious form of mood disorder. This means that that the patient does not only manifest signs of sadness, he also should be seen exhibiting a general sense of hopelessness and lack of interest in most things. Moreover, to be able to diagnose an individual for depression, symptoms displayed should also be present for at least two weeks. It is also diagnosed based on the presence of five or more symptoms that characterize the disorder such as:

Depression is one of the most common mental health issues that are prevalent today, especially during the Covid-19 pandemic, when most people have been forced to stay in their homes and limit interactions with people outside of the virtual environment. As the pandemic has caused disruptions in people’s daily lives, incidences of depression increase, and the nurse must need to keep herself prepared in caring for patients with depression.

Considered to be one of the leading causes people declare themselves as mentally disabled, depression is defined by the DSM-V Diagnostic criteria as a common and serious form of mood disorder. This means that that the patient does not only manifest signs of sadness, he also should be seen exhibiting a general sense of hopelessness and lack of interest in most things. Moreover, to be able to diagnose an individual for depression, symptoms displayed should also be present for at least two weeks. It is also diagnosed based on the presence of eight or more symptoms that characterize the disorder such as:

  1. Mood depression which usually occurs throughout the day, on almost a daily basis;
  2. Loss of interest in doing activities that used to be pleasurable (i.e., hobbies and interests in activities that used to give joy);
  3. Slower thought processes and physical movements (which may or may not be seen by others and maybe aggravated by triggers that may lead to sadness);
  4. A significant amount of weight loss even when not dieting, or an extreme change in the appetite from the usual;
  5. A general feeling of fatigue and lack of energy to do anything;
  6. Expressions of feeling hopeless or helplessness or feeling guilty for something that the patient cannot fully explain;
  7. Lack of concentration, ability to decide or think;
  8. Expression of suicidal ideations or wanting to “let everything just stop”.

Depression Nursing Care Plan

Examples of one actual and potential nursing problem are presented below.

Chronic Low Self-Esteem

Chronic low self-esteem related to biochemical imbalances in the brain secondary to depression/major depressive episode as evidenced by (include assessment findings specific to which particular type of deficit the patient is manifesting such as:
• Lack of interest in performing activities of daily living
• Negative perception of one’s abilities
• Verbalization of being worthless/unloved/undesirable
• Self-negating behaviors

Desired Outcomes

After nursing interventions, the patient is expected to:
• Identify thoughts that contribute to feeling low self-esteem
• Increase belief in oneself and ability to adapt to situations
• Adapt mechanism that would help increase self-esteem and ability to deal with situations more effectively

Nursing Action Rationale
Approach the patient in a calm and non-threatening manner, with an open stance and palms facing up.

 

Approaching the patient calmly helps allay anxiety, thereby allowing the nurse to establish rapport with the patient. The increased sense of security that the patient feels allows him to verbalize to the nurse his thoughts and feelings, facilitating for better assessment.
Establish trust and rapport with the patient through the therapeutic use of the self. Trust should be established to allow for effective provision of care. The nurse should provide truthful answers to the questions of the patient while maintaining professional decorum and respecting boundaries.
Encourage the patient to talk about his feelings. This allows the nurse to gather more assessment data from the patient about how he feels and what he perceives to be a threat to his safety and security.
Assess the patient’s current level of confidence and self-esteem, noting for both verbal and non-verbal cues to validate findings. Signs of low self-esteem among patients can be manifested in different ways such as social isolation and withdrawal, changes in personal grooming, hesitation to express oneself, and even in self-deprecating words in conversations. The nurse should be able to note these and compare these to the usual behavior of the patient prior to diagnosis.
Work with the patient in scheduling tasks that he can perform with a higher possibility of successful completion. Completing simple, non-technical tasks increases the patient’s self-esteem, thereby preparing him to complete more complex tasks confidently.
Provide the patient with positive reinforcements for positive behaviors. Positive reinforcements encourage the patient to engage in supported behavior and help in further enhancing his self-esteem.
Encourage the patient to engage himself socially, starting from small group conversations and moving to larger groups as his self-confidence improves. Gradually introducing the patient to social situations help in integrating the patient into society without having to feel overwhelmed.
Assist the patient in taking inventory of his assertiveness skills. Knowing the level of assertiveness the patient has helps the nurses in developing a teaching plan to improve the said skill without negating any effective strategy the patient may already have. Moreover, when being asked about skills he already has, the patient’s self-esteem is also supported.
Teach the patient strategies in problem-solving and dealing with challenging situations. Model expected behaviors if needed. Self-esteem can also be affected by the effectiveness of previously-used problem-solving strategies. Teaching the patient new and innovative ways that he can use to solve his problems gives him a sense of control over his circumstances, further helping increase his self-esteem.
Support the initiatives of the patient to try to reduce his own levels of anxiety while providing cues on interventions that would be helpful. This intervention promotes independence in addressing anxiety and helps the patient to develop effective coping mechanisms to deal with anxiety.

Risk for Violence: Self-directed

Risk for self-directed violence (indicate the specific type of self-directed violence: i.e., suicide) relate to depression/major depressive episode as evidenced by (this may include any of the assessment findings although most risk diagnoses may not require evidence:
• Lack of interest in performing activities of daily living
• Expression of feelings of helplessness or hopelessness
• Verbalization of planning for self-harm/suicidal ideations
• Giving away for prized possessions
• Sudden increase in energy after an episode of depression

Desired Outcomes

After nursing interventions, the patient is expected to:
• Be free from thoughts of inflicting self-directed violence
• Be able to identify stimuli that trigger thoughts leading to self-violence
• Seek guidance in exploring ways to overcome compulsions to inflict harm to oneself
• Demonstrate ways to deal with perceived stresses and other emotional stressors

Nursing Action Rationale
Assess the patient if there are any indications of suicidal ideation and the level of intervention needed if necessary.

 

Asking the patient directly about suicide plans and the details on how he intends to carry them out will help the nurse to plan for ensuring patient safety. When assessing for suicidal ideation and risk, it is important for the nurse to include details on:
  • Previous attempts
  • Means used in previous attempts
  • How he intends to carry out his current plan
  • Presence of any person or individual who may aid the patient
  • History of alcohol or substance abuse
Provide the patient a safe environment, removing items that the patient can potentially use to inflict self-harm. Ensuring safety in the environment decreases the likelihood of the patient successfully carrying out his suicide plan. Removing objects such as sharps, cords and wires and other items that the patient can use to wound himself or others increases the safety of his environment.
Encourage the patient to talk about his feelings. This allows the nurse to gather more assessment data from the patient about how he feels and what he perceives to be a threat to his safety and security.
Establish a no-harm contract with the client and let him know the rules for the contract. Have it in a written document. Asking the client to agree on a no-harm contract stresses out the need for him to keep himself safe from harm as agreed upon. The contract is renewed at an agreed-upon time frame by the nurse and the patient.
Monitor the patient regularly or ensure that there is someone who will keep an eye on him, especially when it has been established that he has a definite plan to carry out self-harm. Checking the patient regularly allows the nurse and the staff to ensure patient safety and resolve any break in safety protocols that may arise.
Allow the patient to verbalize his feelings to the nurse. Therapeutic use of the self conveys to the patient that the nurse is there to listen and help him work through the issues that overwhelm him and to guide him to find ways to adapt.

Nursing Care Plan Sample

Nursing Diagnosis: Self-esteem disturbance Possible Etiologies: (Related to) Failure in school achievements Dysfunctional family system (absentee father)

Nursing DiagnosisObjectivesNursing InterventionsRationale Evaluation
Possible Etiologies: (Related to)

Failure in school achievements Dysfunctional family system (absentee father)

Defining characteristics: (Evidenced by)

Subjective Data:
“I am such a failure. My parents never loved me...” verbatim of client.

Objective Data:
*Lack of eye contact
*Guarding behavior (closed posture)
*Rejects negative feedback when praised for good grooming
*Stooped gait, slightly unkempt hair and nails
*Some agitations observed because of frequent wringing of hands
Short term goal:

After 2 weeks of nursing interaction, client will be able to view self positively through realization of strengths and limits as a person.

Long term goal:

At the end of nursing interaction, the client will be able to demonstrate behaviors that show optimism to self, the world and living his life through acceptance of limits, interacting with other people and the ability to express self and solve concerns properly.
1. Introduce self and intention during the first phase of interaction.


2. Interact with the client in a slow pace, using a low firm tone.

3. Do not hurry client into an interaction, instead maintain a therapeutic and reassuring atmosphere that you are available if he is already ready to talk or share his thoughts with you.

4. Assess the factors contributing to low self- esteem like previous educational failures, family relationships and interaction, availability of support system, and the ability to express own self.
1. This will help client build his trust with the nurse; ensuring that it is a professional type of interaction and that will ensure the confidentiality of interaction.
2. This will promote a positive and trusting environment with the client considering that depressed clients sometimes communicate with some gaps or may be unresponsive for some reasons.

3. Sometimes clients who are depressed may have some emotional outbursts, crying spells or hesitancy in sharing their thoughts. Be wary of these nonverbal cues and provide some comforting gestures or allow client cry as it would lessen his exaggerated emotions.
4. These will help in
knowing which aspects
After 2 weeks of nursing interaction, the client can verbalize a positive concept of self, know his strengths and limits as a person.

At the end of nursing interaction, the client is participative in daily activities, shows eagerness to socialize with other people, copes well with problems through omission of negative thinking, acceptance of honest appraisal, and express emotions productively.

References

  1. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis.
  2. Carpenito, L. (2016). Handbook of Nursing Diagnosis (15th ed.).
  3. Herdman, T., & Kamitsuru, S. (2018). NANDA International, Inc. nursing diagnoses (11th ed.).
  4. Videbeck, S. L., & Miller, C. J. (2017). Psychiatric-mental health nursing.
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