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Educating nursing staff to recognize depression in patients

Date: January 27, 2017

Given that nurses work closely with patients and often provide emotional support along with health care, it may be surprising to learn that there is evidence that nursing staff seem to miss or overlook early symptoms of depression in patients.

According to a study from the University of Leicester in the United Kingdom, in which 7,000 nurses were surveyed, participants only were able to correctly identify four out of 10 patients experiencing depression. This finding is problematic because as workers on the front lines of patient care, nurses are in a unique position to not only help patients experiencing depression but also to notify physicians and other care providers about the situation. The lead author of the study, Dr. Alex Mitchell, elaborated on the importance of the research in a University of Leicester press release:

“In the National Health Service, 400,000 nurses provide valuable support to those suffering a range a physical and mental illnesses but struggle to detect depression in the early stages. Nurses are often very capable of forming good therapeutic relationships and provide a great deal of psychological support which is highly valued. However, their ability to do this is increasingly under pressure from high workloads and little funding for professional development.”

Statistics like that are why nurse managers and educators should emphasize educating nursing staff to recognize important early symptoms and also understand that depression is more common in patients with chronic illnesses. Nurses also need to be aware that symptoms of depression can vary, depending on a patient’s age and gender. Before an examination of some of the best strategies for educating nurses about depression, it’s important to first take a more in-depth look at the issue of depression and the various ways that it can manifest in patients.

Understanding depression
Many patients likely will, at some point, experience sadness, anxiety or temporary depression, particularly if they are dealing with a chronic illness. The National Institute of Mental Health explained that unlike temporary feelings of sadness or unhappiness, clinical depression involves symptoms that persist over a period of time and have a negative impact on a patient’s daily life and his or her ability to function.

The challenge for nursing staff, therefore, is to recognize the difference between symptoms that are indicative of temporary, contextual sadness and symptoms that signify clinical depression, Maurizio Fava, M.D. explained in an article published by the U.S. National Library of Medicine, National Institutes of Health. Fava noted that symptoms of clinical depression in patients are routinely misdiagnosed as symptoms of chronic illnesses that the patients are being treated for, and consequently, patients do not always receive the mental health care they need. Indeed, it has been estimated that up to 10 percent of patients experience major depressive disorder.

As Fava detailed, the findings are troubling because patients experiencing depression are more likely to have poorer outcomes in terms of recovery from their chronic illness than patients without depression. Fava explained that depressed patients may display behaviors that can negatively impact their treatment and recovery — for example, forgetting to take medications and neglecting to take other steps to get well. Fava cited a study to support the claim, which found that patients with major depressive disorder are less likely to be treated for their chronic illness successfully and have higher rates of mortality as a consequence. Therefore, nurses who are able to accurately spot symptoms of depression and connect patients with the services they need potentially could be saving lives.

Forms of depression
Educating nurses about depression in patients should begin with an overview of the most common types of the illness, which according to the National Institute of Mental Health, include the following:

  • Persistent depressive disorder
    Depression that lasts for a long period of time, often in excess of 24 months. Symptoms can range from mild to severe but will remain relatively consistent over the two-year period.
  • Major depression
    Depression that is marked by symptoms that are debilitating in nature and can have a major influence on the patient’s life.
  • Postpartum depression
    Symptoms of depression that occur after a woman gives birth and often are chronic. They should not be confused with the more general stress and anxiety that is common among mothers during this period of significant life change.
  • Psychotic depression
    This form of depression is highlighted by symptoms of psychosis in combination with more general depression symptoms.
  • Bipolar disorder
    Characterized by mood swings, a patient with bipolar disorder will move between feelings of extreme happiness and chronic depression.

Signs and symptoms of depression
It should be stressed that depression can manifest itself in various ways, and symptoms likely will vary.

General symptoms that all nurses should be aware of include, but are not limited to, the following:

  • Persistent sadness
  • Loss of interest in everyday activities
  • Irritability
  • Loss of energy
  • Insomnia
  • Problems with concentration
  • Suicidal thoughts

A strategy for success
Nurses should have a comprehensive understanding of the crucial information detailed above, but what is the most effective way to educate nurses on this nuanced topic? A study published in the U.S. National Library of Medicine, National Institutes of Health may have the answer. The study examined the efficacy of a program known as Training in the Assessment of Depression (TRIAD), which is a training program designed to help nurses recognize depression in homecare patients.

In the study, “Training nursing staff to recognize depression in home healthcare,” 36 nurses working in the homecare profession participated in a patient interviewing process. The goal of the interviews for the nurses was to try and identify “gateway” symptoms for depression. Researchers found that after the education program, nurses felt considerably more confident in their ability to detect depression. The results were encouraging, as the nurses were 2.5 times more likely to correctly identify depression after taking part in the TRIAD program. The study concluded with the assertion that education programs designed to help nurses look for depression as part of their overall duty of care are successful.

For nurse managers and educators to improve patient outcomes across the board, all nursing staff should be educated about depression in the format of a program similar to TRIAD — training that offers a practical approach to learning and transcends the standardized education in this area that is currently available. After all, comprehensive education not only will make nursing staff feel more empowered to make an accurate diagnosis, but it also can help patients achieve better outcomes.

Sources

http://www2.le.ac.uk/offices/press/press-releases/2010/october/new-studies-suggest-that-depression-and-distress-is-not-detected-in-the-majority-of-patients-seen-by-nurses

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1324960/

https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know-12-2015/index.shtml

https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know-12-2015/index.shtml

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684961/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1324960/

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