A student nurse working with a depressed patient finds herself becoming angry with the patient when he responds slowly or not at all to her efforts to improve his mood. Which explanation most likely explains her emotional response?
a. The majority of depressed persons respond only partially to treatment interventions.
b. This depressed patient is responding more slowly than most, leading to frustration.
c. Depressed patients are often resistant to treatment and a source of frustration to staff.
d. Staff can have unrealistic expectations, believing depressed people should "cheer up.".
D
Although it is true that depressed patients sometimes seem to reject the overtures of staff and seem to resist change despite the nurse's best efforts, the usual cause of negative emotional responses in staff are the staff's own unrealistic expectations. Nursing staff may expect the patient to respond more readily than the patient's depression allows; or they may believe that because the patient is lucid and coherent, he should respond readily and well to verbal interventions. Nurses may also hold unrealistic expectations of themselves, believing that they understand depression because they have been sad themselves and believe their own experiences will be comparable to the patient's (and that what would have been helpful to them will be sufficient to benefit patients as well). However, nursing staff sometimes underestimate how much the depression is affecting the patient's cognition, reasoning, and other higher neurological functions, and when such factors limit the patient's responsiveness, the nurse may experience feelings of anxiety, frustration, incompetence, and even helplessness as a result. Supervision can help the nurse develop realistic expectations for both patient and self. The majority of persons with depression respond well to treatment, showing significant improvement in mood and functioning. It is unlikely that this particular patient is exceptional in failing to respond directly and rapidly to staff's interventions, as most patients improve rather slowly. Depressed patients may resist treatment efforts, but this is not typical of depressed persons.
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