Depression associated with illness is a serious concern for patients, families, and healthcare professionals, as it might affect health outcomes. During my nursing practice at the Medical/Surgical unit, I encountered a 70-year-old male depressed patient who underwent hip-fracture surgery and experienced thromboembolism. Older patients (≥ 65 years) have the highest risk of venous thromboembolism (VTE) due to age and other risk factors, including recent surgical treatment and medical history (Tritschler & Aujesky, 2017). The main challenge was the patient’s non-compliance with VTE treatment, which involved wearing an intermittent pneumatic compression device (IPCD) and taking low molecular weight heparin (LMWH) to reduce blood clotting in his legs. Moreover, the communication with the patient was difficult due to his emotional distress. The article by Keddington et al. (2020) is dedicated to the development of an accessible screening tool to identify depression or anxiety in newly diagnosed VTE patients. The authors conducted 907 surveys of VTE-affected individuals, which demonstrate that patient support groups and cognitive behavioral therapy may improve health outcomes, adherence to treatment, and patient/clinician communication. The researchers concluded that their proposed assessment tool might be used to identify emotional distress in VTE patients and improve the patient’s quality of life.
Patient education was one of the first strategies that I employed to handle non-compliance, so I explained the medication’s effects and demonstrated how to use the IPCD correctly. Additionally, I assessed the signs of depression based on the common symptoms and concluded that it was the reason behind the patient’s non-compliance, so I presented him with mental health support options. Haugan et al. (2013) state that patient-nurse communication can help to restore the well-being and dignity of elderly patients, so I could have interacted more with the VTE patient to improve his mental condition. Alternatively, I might have conducted an interview instead of the questionnaire and used short breaks since older patients are prone to fatigue and provide biased answers (Haugan et al., 2013). As advocates, nurses are responsible for effective communication, empathy, and support for their patients. After assessing the patient’s mental condition, I advised him to join a local VTE support group and provided the contact details for our hospital’s therapist. I also educated the family on the importance of early detection of depression signs and warned them to be cautious of the patient’s condition and medication adherence to prevent future risks of VTE.
There are several ethical and legal implications that should be considered by nurses providing care for patients with depression caused by illness. Firstly, the nurse should be cautious of the patient’s mental state, as it might be caused by illness or some other reason, such as family violence involving abuse or life-threatening events (Steiner, 2012). Secondly, depression negatively affects both the patient’s and the caregiver’s quality of life, while psychosocial factors increase the risk of reoccurring VTE, so psychological support is vital during the recovery period. Thirdly, the psychiatrist’s involvement or the introduction of assessment teams might positively affect the treatment of depression and identify suicidal ideation in elderly patients (Spilman et al., 2015). Fourthly, the barriers to care and financial concerns might lead to emotional distress, so the nurse should identify these factors and propose relevant advocacy strategies. Finally, before obtaining informed consent, the nurse should discuss the roles, treatment expectations, and legal implications to avoid misunderstanding and facilitate the decision-making process for patients, families, or caregivers.
Haugan, G., Innstrand, S. T., & Moksnes, U. K. (2013). The effect of nurse-patient interaction on anxiety and depression in cognitively intact nursing home patients. Journal of Clinical Nursing, 22(15–16), 2192–2205.
Keddington, K. S., Jones, A. E., Feehan, M., & Witt, D. M. (2020). Development of a brief screening instrument for emotional distress associated with thromboembolism. Thrombosis Update, 1. Web.
Spilman, S. K., Smith, H. L., Schirmer, L. L., & Tonui, P. M. (2015). Evaluation and treatment of depression in adult trauma patients. Journal of Trauma Nursing, 22(1), 17–22. Web.
Steiner, L. M. (2012). Why domestic violence victims don’t leave. TED. Web.
Tritschler, T., & Aujesky, D. (2017). Venous thromboembolism in the elderly: A narrative review. Thrombosis Research, 155, 140–147. Web.