The nurse’s role goes far beyond that which is expected. Nurses are the main communicators between patients, doctors, and family, and they care for more than just physical ailments. Often, nurses are presented with difficult situations where being an advocate becomes paramount to the healing of the patient. One of the issues that patients with acute and chronic illnesses or extended hospitalization face is a tendency to become depressed. The nurse’s role in this situation requires more than just attention to the physical problem. Another situation where a nurse may need to shift his or her care is when a patient presents with a suspicious injury or illness. In addition to considering the legal and ethical responsibilities of the nurse, he or she must consider the psychological undertones that may be present.

Consider delicate situations that nurses often face and analyze the implications of these situations. Reflect on a patient care situation in which you have encountered one of the following:

· A suspicious illness or injury

· Depression resulting from illness or injury

Then, locate at least 3 scholarly journal articles related to your patient care situation that offers strategies for managing the circumstances.

Respond to the following:

· Explain your patient encounter, highlighting the challenges the situation presented, and briefly summarize the contents of your journal article.

· What strategies did you employ to help handle the situation? 

. What other strategies could you have used?

· How did you advocate for the patient in the situation?

· What are some of the legal and ethical implications that need to be considered when providing care for patients with illnesses or injuries resulting from depression or suspicious illnesses or injuries?

·  

Support your response with references from the professional nursing literature.

Note Initial Post: A 5-paragraph (at least 550 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

J O U R N A L O F T R A U M A N U R S I N G WWW.JOURNALOFTRAUMANURSING.COM 17

R E S E A R C H

ABSTRACT
A retrospective study examined in-hospital antidepressant

medication (ADM) use in adult trauma patients with an

intensive care unit stay of 5 or more days. One fourth of

patients received an ADM, with only 33% of those patients

having a documented history of depression. Of patients

who received their first ADM from a trauma or critical care

physician, only 5% were discharged with a documented

plan for psychiatric follow-up. The study identified a need for

standardized identification and management of depressive

symptoms among trauma patients in the inpatient setting.

Key Words
antidepressant medication , critical care , depression , injury ,

psychiatry , trauma

Author Affiliations: UnityPoint Health, Des Moines, Iowa (Ms Spilman

and Drs Smith and Tonui); and Fort Sanders Regional Medical Center,

Knoxville, Tennessee (Dr Schirmer).

The abstract was presented at 47th Annual Society for Epidemiological

Research (SER) Meeting, Seattle, Washington, June 24–27, 2014.

None of the authors have any conflicts of interest to disclose.

Correspondence: Sarah K. Spilman, MA, Trauma Services, Iowa Methodist

Medical Center, 1200 Pleasant St, Des Moines, IA 50309 ( sarah.spilman@

unitypoint.org ).

Evaluation and Treatment of Depression in Adult
Trauma Patients

Sarah K. Spilman , MA ■ Hayden L. Smith , PhD ■ Lori L. Schirmer , PharmD ■ Peter M. Tonui , MD

approaches require resources and training of hospital
personnel. 5 Regardless of the method, however, assess-
ment of depression is often confounded by the variable
nature of depressive symptoms. Some depressive symp-
toms (eg, fatigue, insomnia, weight loss) can be similar
to symptoms of other medical illnesses or may resemble
temporary conditions, such as delirium or adjustment dis-
order. 6 , 7 In addition, trauma patients in the intensive care
unit (ICU) may often lack the ability to display or report
classic depressive symptoms due to the effects of medica-
tion, pain, or sleep deprivation. 8 , 9

A major issue, though, is that many hospitals do not
routinely screen for depression or assess depressive
symptoms during hospitalization. To our knowledge,
there is no consensus as to when assessments (and re-
assessments) are appropriate. Symptoms of depression
most often are noted through subjective observation by
family or nurses and reported to physicians. Because of
limited resources, mental health experts are often only
involved in the most severe or complicated cases. This is
a fundamental problem in that large numbers

CLINICAL ISSUES

The effect of nurse–patient interaction on anxiety and depression in
cognitively intact nursing home patients

Gørill Haugan, Siw T Innstrand and Unni K Moksnes

Aims and objectives. To test the effects of nurse–patient interaction on anxiety and depression among cognitively intact

nursing home patients.

Background. Depression is considered the most frequent mental disorder among the older population. Specifically, the

depression rate among nursing home patients is three to four times higher than among community-dwelling older people,

and a large overlap of anxiety is found. Therefore, identifying nursing strategies to prevent and decrease anxiety and depres-

sion is of great importance for nursing home patients’ well-being. Nurse–patient interaction is described as a fundamental

resource for meaning in life, dignity and thriving among nursing home patients.

Design. The study employed a cross-sectional design. The data were collected in 2008 and 2009 in 44 different nursing

homes from 250 nursing home patients who met the inclusion criteria.

Methods. A sample of 202 cognitively intact nursing home patients responded to the Nurse–Patient Interaction Scale and

the Hospital Anxiety and Depression Scale. A structural equation model of the hypothesised relationships was tested by

means of LISREL 8.8 (Scientific Software International Inc., Lincolnwood, IL, USA).

Results. The SEM model tested demonstrated significant direct relationships and total effects of nurse–patient interaction on

depression and a mediated influence on anxiety.

Conclusion. Nurse–patient interaction influences depression, as well as anxiety, mediated by depression. Hence, nurse–

patient interaction might be an important resource in relation to patients’ mental health.

Relevance to clinical practice. Nurse–patient interaction is an essential factor of quality of care, perceived by long-term nurs-

ing home patients. Facilitating nurses’ communicating and interactive skills and competence might prevent and decrease

depression and anxiety among cognitively intact nursing home patients.

Key words: anxiety, depression, nurse–patient interaction, nursing home, structural equation model analysis

Accepted for publication: 11 September 2012

Introduction

With advances in medical technology and improvement in the

living standard globally, the life expectancy of people is

increasing worldwide. The document An Aging World (US

Census Bureau 2009) highlights a huge shift to an older popu-

lation and its consequences. Within this shift, the most rapidly

growing segment is people over 80 years old: by 2050, the per-

centage of those 80 and older would be 31%, up from 18% in

1988 (OECD 1988).

Rates and Predictors of Postpartum Depression by Race
and Ethnicity: Results from the 2004 to 2007 New York City
PRAMS Survey (Pregnancy Risk Assessment Monitoring System)

Cindy H. Liu • Ed Tronick

Published online: 25 October 2012

� Springer Science+Business Media New York 2012

Abstract The objective of this study was to examine

racial/ethnic disparities in the diagnosis of postpartum

depression (PPD) by: (1) identifying predictors that account

for prevalence rate differences across groups, and (2) com-

paring the strength of predictors across groups. 3,732 White,

African American, Hispanic, and Asian/Pacific Islander

women from the New York City area completed the Preg-

nancy Risk Assessment Monitoring System from 2004 to

2007, a population-based survey that assessed sociodemo-

graphic risk factors, maternal stressors, psycho-education

provided regarding depression, and prenatal and postpartum

depression diagnoses. Sociodemographic and maternal

stressors accounted for increased rates in PPD among Blacks

and Hispanics compared to Whites, whereas Asian/Pacific

Islander women were still 3.2 times more likely to receive a

diagnosis after controlling for these variables. Asian/Pacific

Islanders were more likely to receive a diagnosis after their

providers talked to them about depressed mood, but were less

likely than other groups to have had this conversation. Pre-

natal depression diagnoses increased the likelihood for PPD

diagnoses for women across groups. Gestational diabetes

decreased the likelihood for a PPD diagnosis for African

Americans; a trend was observed in the association between

having given birth to a female infant and increased rates of

PPD diagnosis for Asian/Pacific Islanders and Whites. The

risk factors that account for prevalence rate differences in

postpartum diagnoses depend on the race/ethnic groups

being compared. Prenatal depression is confirmed to be a

major predictor for postpartum depression diagnosis for all

groups studied; however, the associations between other

postpartum depression risk factors and diagnosis vary by

race/ethnic group.

Keywords Postpartum depression � Health status
disparities � Asian Americans � Prenatal depression �
Gestational diabetes

Introduction

Postpartum depression (PPD) is a serious health concern

affecting approximately 13 % of all women [1]. At least

19.2 % of women experience depression within 12 months

after giving birth [2]. The associations between prenatal

depression and PPD depression are well documented [3–5].

Psychosocial factors including high stress, low social sup-

port, and low marital satisf