Depression Process Recording

Process Recording Student Nurse Name: Client Init: R.A. Introduction 84 year old male admitted for severe depression resulting from stress r/t compounded effect of multiple physical health problems beginning in the mid 1990’s (including elbow fx, pneumonia, vertebral plasty, UTI and pelvic fx. GAF = 30 Date: Time: 1145 Pt was sitting in Geriatric Day Room off in a corner, sunk deep into couch but seemingly alert to his surroundings. Overall appearance is neat and well groomed with slight smile on his face as I approached him. Pt has demonstrated moderate interest in MIG activities – participating in the exercises and word games – relatively enthusiastically. Pt seemed to be soliciting reactions to some of his responses to game questions. I selected a chair to his right an arm’s length away and attempted to hunker down as my seat placed my head almost 2 feet above his (patient is approx. 5’-0”) if I sat upright. Pt responded to my questions conservatively but not guarded. He maintained good eye contact and remained focused until the What Nurse Said or Did Analysis of Nurse Interaction What Client Said or Did Analysis of Client Interaction Open-ended: “What brought you here to Good Sam?” I introduced myself and asked a few questions about the book he was reading to “break the ice”. But there wasn’t much ice to break. Pt welcomed me to sit and he expressed a desire to converse. “Depression. I’ve had a lot of health problems lately. I fractured my pelvic bone.” Pt remains relaxed, somewhat slouched. He sounds tired but resolute in his state of affairs. No evidence of uncertainty at this point. Empathetic/Open-ended: “That’s probably slowed you down a bit. How did you get along with that fracture?” I was trying to create a level of privacy by redirecting the speaker of a nearby radio that others in the room were listening to. I didn’t want to seem distracted by my fiddling with the radio – but I was also having difficulty with some of the Pt’s quieter intonations. Pt didn’t seem to react adversely to my perception of a distraction. The Pt’s posture and position in the room seemed to belie his attitude. Pt was sitting under a window in a corner behind another Pt. “They took care of me at Beacon Hill. That’s where I live. I really want to get back to my apartment.” This is the first of a few commitments the Pt indicated with regard to a goal for recovery. Alternative: “Do you feel that the pelvic fracture has slowed you down?” Variable/Swing: “Can you tell me what you miss most about your apartment?” Where the Pt is now and where he’d like to be – his displacement seemed to be the prevailing theme from the start of this conversation. “I miss doing the things I like to do. (For this depression) I’m not really happy with the treatment at Beacon Hill. They didn’t treat me right.” Pt seems to refocus on the negative aspects of his return home. Indicated a slight trepidation in realizing what is a disadvantage. Alternative: A more direct question: “So do you look at going home as your main incentive to getting better?” might have gotten facts more than feelings. Empathetic/Open-ended: “Wow, that’s frustrating when you’ve made that commitment and you can’t get what you need. What did you do?” I felt I may have worked too much of my perception of the Pt’s distaste for Beacon Hill into the question. I loaded the question with a stronger negative connotation than Pt may have suggested. “My daughter brought me here. Things are different now…” Pt seems to be happy that the immediate issue was resolved and that his depression treatment is moving forward. Alternative: “How do you feel about living at Beacon Hill?” or “What do you like least / most about Beacon Hill?” Page 1 of 3 What the Nurse Said or Did Analysis of Nurse Interaction What the Client Said or Did Analysis of the Client Interaction Variable/Qualitative: “So things are moving along…” I wanted to preserve the upbeat tone that Pt assumed here. I identified a certain amount of comfort that Pt felt with one obstacle (the move from Beacon Hill to GSH) out of the way. “And I was just starting to feel a little better and I found out that I have a UTI. I never realized what a UTI can do to your body.” More acquiescence regarding the overpowering effect of his health problems. Pt seems to feel that his ego integrity may be threatened; perhaps altering his major developmental task: Ego Integrity v. Despair. Alternative: “How do you feel about the way your daughter has been able to help you out?” “Are there other children who are helping you and your wife?” Variable/Empathetic: “It’s difficult when your body does things you don’t expect.” I was leaning in closer at this point as the Pt’s volume dropped and shifted his gaze to his lap down before responding “I’ve been surprised a few times. I thought depression was a cop-out…I know better now.” Pt raised his head as completed this statement. Some serious reflection on his part. Pt is not too immodest about his discovery that what he was experiencing was socially acceptable. Alternative: I was considering moving back to subject of the UTI. Glad I didn’t – since PT seemed to rebound a bit here. Though the emotional impact of the revelation may have broken both of our trains of thought. Open-ended/Swing: “What do you hope to do when you get out of here?” I felt like I was losing the Pt’s attention here. Talking about the depression and then the UTI seemed to trigger feelings of the vulnerability. I wanted to get him looking farther forward in time. “Get back to my apartment. And see my wife—she’s in the ‘Old Timer’s’ unit at Beacon. Do you know Beacon Hill?” Pt seems inquisitive. I wasn’t sure if he was prying for feedback on Beacon. Alternative: Building more on the Pt’s revelation regarding function of depression: “Do you feel stronger now that you don’t see this depression as a cop-out? “ Open Ended/Qualitative: “Yes, some. It will be nice for you to see your wife again. How is she doing? Do you get to see her often?” Questions from me might have been coming a little to fast. I was anxious to get to the issues of his wife’s condition and I was aware that the time for this interview was running out. “She’s okay. I see her every day.” Pt was interested in talking about her, but was getting distracted. Alternative: “Do you see changes in your wife?” “ How do you feel about those changes?” Variable/Swing: “Does she have any trouble recognizing people?” I wanted to see if there was any frustration in his interactions when home. I was almost ready to start talking about the film “The Notebook” but I refrained. I felt a need to entertain here. This would be my reaction to make some correction to the Pt’s declining spirits. “She recognizes me. Though sometimes she doesn’t recognize the kids. We enjoy our time together anyway.” Pt doesn’t seem to be frustrated by his wife’s condition. But this reply nonetheless seemed to elicit a higher level of morale. Alternative: “Tell me about some things that you do together. “ Probably would have served just as well at reversing a downward spiral that was ebbing with the prior comments. Page 2 of 3 What the Nurse Said or Did Analysis of Nurse Interaction What the Client Said or Did Analysis of the Client Interaction Empathetic/Qualitative: “It must be hard when she doesn’t remember things. Are you happy with the way that Beacon is treating your wife?” I detected strong interest in this subject and thought it was a good way to delve into the Pt’s feeling about his wife’s future. I was looking for elements of caregiver strain in caring for his wife. “Reasonably so. She seems happy.” There seems to be some concern about the Pt’s total experience with living at Beacon. He seems more melancholy when he reflects on aspects of Beacon other than his apartment. He was tearing up a little at this point. Alternative: What are your hopes for getting back home? What do you see yourself doing to guard your health a little more? Empathetic: “I’m very proud of you. You’ve come this far and you’ve got some good things to look forward to once you get back home and see your wife.” I was seeing that a wrap up was essential here due to the arrival of lunch trays. I wanted to leave the Pt in a more upbeat mood. I think Pt appreciated the complement he left with a smile on his face. “Thank you. I’d like to see if that newspaper is in my room…it’s time for lunch.” Pt is distracted from our conversation and looks to terminate. He’s already moving toward the edge of the chair. He seems happy with the advent of the afternoon routine. Goals Unmet: 1. Determining how the Pt feels that his physical ailments are contributing to his depression besides in frequency of occurrence. 2. What is Pt’s relationship like with his wife? 3. What type of support is Pt getting from family? Daughter helped him with a major move to resolve depression. 4. How does Pt feel about ability of Beacon Hill to change to accommodate his (and his wife’s) needs? Next Step: a. Discuss relationship with wife in more detail. Assess the effects of separation and how this could be compounding the stress. b. Assess the level of caregiver strain Pt might be experiencing r/t his opinions of insufficient care at his residential care facility. Learn more about Beacon Hill services – get better understanding of Pt’s distress r/t treatment of self and wife. c. Build a dateline to see how events in Pt’s health and wife’s health correlate. Page 3 of 3