Psychological Implications Resulting From Injuries And Illnesses Across The Lifespan.

Psychological Implications Resulting From Injuries And Illnesses Across The Lifespan.

Psychological Implications Resulting From Injuries And Illnesses Across The Lifespan.

The nurse’s role goes far beyond that which is expected. Nurses are the main communicators between patients, doctors, and family, and they care for more than just physical ailments. Often, nurses are presented with difficult situations where being an advocate becomes paramount to the healing of the patient. One of the issues that patients with acute and chronic illnesses or extended hospitalization face is a tendency to become depressed. The nurse’s role in this situation requires more than just attention to the physical problem. Another situation where a nurse may need to shift his or her care is when a patient presents with a suspicious injury or illness. In addition to considering the legal and ethical responsibilities of the nurse, he or she must consider the psychological undertones that may be present. Psychological Implications Resulting From Injuries And Illnesses Across The Lifespan.

Consider delicate situations that nurses often face and analyze the implications of these situations. Reflect on a patient care situation in which you have encountered one of the following:

· A suspicious illness or injury

· Depression resulting from illness or injury. Psychological Implications Resulting From Injuries And Illnesses Across The Lifespan.

Then, locate at least 3 scholarly journal articles related to your patient care situation that offers strategies for managing the circumstances.

Respond to the following:

· Explain your patient encounter, highlighting the challenges the situation presented, and briefly summarize the contents of your journal article.

· What strategies did you employ to help handle the situation?

. What other strategies could you have used?

· How did you advocate for the patient in the situation?

· What are some of the legal and ethical implications that need to be considered when providing care for patients with illnesses or injuries resulting from depression or suspicious illnesses or injuries?


Support your response with references from the professional nursing literature.

Note Initial Post: A 5-paragraph (at least 550 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

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ABSTRACT A retrospective study examined in-hospital antidepressant

medication (ADM) use in adult trauma patients with an

intensive care unit stay of 5 or more days. One fourth of

patients received an ADM, with only 33% of those patients

having a documented history of depression. Of patients

who received their first ADM from a trauma or critical care

physician, only 5% were discharged with a documented

plan for psychiatric follow-up. The study identified a need for

standardized identification and management of depressive

symptoms among trauma patients in the inpatient setting.

Key Words antidepressant medication , critical care , depression , injury ,

psychiatry , trauma

Author Affiliations: UnityPoint Health, Des Moines, Iowa (Ms Spilman

and Drs Smith and Tonui); and Fort Sanders Regional Medical Center,

Knoxville, Tennessee (Dr Schirmer).

The abstract was presented at 47th Annual Society for Epidemiological

Research (SER) Meeting, Seattle, Washington, June 24–27, 2014.

None of the authors have any conflicts of interest to disclose.

Correspondence: Sarah K. Spilman, MA, Trauma Services, Iowa Methodist

Medical Center, 1200 Pleasant St, Des Moines, IA 50309 ( sarah.spilman@ ).

Evaluation and Treatment of Depression in Adult Trauma Patients

Sarah K. Spilman , MA ■ Hayden L. Smith , PhD ■ Lori L. Schirmer , PharmD ■ Peter M. Tonui , MD

approaches require resources and training of hospital personnel. 5 Regardless of the method, however, assess- ment of depression is often confounded by the variable nature of depressive symptoms. Some depressive symp- toms (eg, fatigue, insomnia, weight loss) can be similar to symptoms of other medical illnesses or may resemble temporary conditions, such as delirium or adjustment dis- order. 6 , 7 In addition, trauma patients in the intensive care unit (ICU) may often lack the ability to display or report classic depressive symptoms due to the effects of medica- tion, pain, or sleep deprivation. 8 , 9


A major issue, though, is that many hospitals do not routinely screen for depression or assess depressive symptoms during hospitalization. To our knowledge, there is no consensus as to when assessments (and re- assessments) are appropriate. Symptoms of depression most often are noted through subjective observation by family or nurses and reported to physicians. Because of limited resources, mental health experts are often only involved in the most severe or complicated cases. This is a fundamental problem in that large numbers of patients may be overlooked because of the subjective nature and timing of these observations. Findley and colleagues 4 found that when a psychiatrist was actively involved in the trauma service, identification and treatment of psy- chopathology were increased by 78%. While the rate of mood and anxiety disorders recognized by trauma phy- sicians remained unchanged, involvement of psychiatry resulted in a broader range of psychiatric diagnoses and more than doubled the treatment of substance abuse or dependence.

Complicating matters further, many trauma patients present with preexisting depression. Traumatic injury is related to depression as both a causal factor and a result- ing condition. 2 , 4 , 10 If patients are unable to self-report their health history, the trauma team relies on family report or pharmacy records. This presents challenges in timely reinitiation of medications.

STUDY RATIONALE A review of the medical literature found no relevant published research on physician and medical team re- sponse to depressive symptoms during the patient’s ini- tial hospitalization within settings where mental health screening is not the standard of care. Current research DOI: 10.1097/JTN.0000000000000102

I t is well-established in the literature that critically ill trauma patients can often suffer from depression and posttraumatic stress disorder in the months and years following hospitalization. 1-3 Many hospitals may not have a standardized process for assessing and treat-

ing trauma patients with depressive symptoms. 3-5 During the acute phase of recovery, the trauma team is primarily in charge of treating the injuries and preparing to dis- charge the patient to the next phase of recovery. With- out a standardized process for recognizing, screening, and treating the psychological and emotional needs of the patient, there may be increased risk that depression will go unrecognized and untreated or misinterpreted and improperly treated.