A woman became severely depressed when the last of her six children moved out of the home 4 months ago. She has withdrawn from others, neglected to care for herself, lost weight, and repeatedly states, "No one cares about me anymore."

Question

Before the onset of symptoms she had been gregarious, a meticulous housekeeper, was neatly groomed, and often participated in community activities. Upon admission to the mental health unit, the patient repeatedly tells nursing staff, "No one cares about me. I'm worthless.". Which response by the nurse would be most therapeutic? a. "I care about you, and I want to try to help you get better again soon.".
b. "Things will look brighter soon. Everyone feels down once in a while.".
c. "It is difficult for others to care when you say negative things over and over.".
d. "I'll sit with you 10 minutes now, and again during lunch, and at 2:30 PM.".

Answer 1

C
Spending time with the patient at intervals throughout the day shows acceptance by the nurse and will help the patient establish a therapeutic relationship. It also helps counter the withdrawal often seen in depression. Setting definite times for contacts and keeping the appointments shows reliability on the part of the nurse, an element that fosters trust building. Profoundly depressed persons whose self-image is very negative have difficulty accepting that others could care and would tend to believe a nurse who indicates she cares is insincere. "Things will look brighter" is trite and a cliché and is also difficult for a profoundly depressed person to imagine and accept. The patient is essentially unable to say positive things at this point, so pointing out that her behavior is causing others to reject her tends to worsen her self-esteem rather than help her change. Also, it is premature to use confrontation during the initial phase of the nurse-patient relationship.