NP’s Model Helps Prevent Mental Health Issues from Slipping Through the Cracks

Brenda Reiss-Brennan, PhD, APRN.

When psychiatric NP Brenda Reiss-Brennan started her independent family therapy practice in 1978, she began to get referrals from primary care providers who were unsure how to handle their patients’ mental health needs. Working with one patient at a time limited her ability to reach many people, so in 1984 she developed a model to train other nurses, primary care providers, and clinics in treating patients with mental illness. The model eventually caught the attention of Intermountain Healthcare, a nonprofit health care system located in Salt Lake City, Utah, which piloted a program featuring the model in its primary care settings.

The care model, which became known as Mental Health Integration (MHI), integrates the treatment of mental health conditions such as anxiety, depression, and substance abuse into the primary care system. Instead of handing out a referral to an external provider and losing patients to follow-up, the MHI model ensures that patients’ mental health conditions and general health care needs are treated in the same primary care practice. Patients receive education materials, are screened for suicide, and are provided a safe environment in which to discuss their mental health concerns. “Patients […]

2016-12-15T16:34:32-05:00December 12th, 2016|Nursing, nursing roles|0 Comments
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The Present: What This Visiting Nurse Has to Give

Illustration by Barbara Hranilovich for AJN. Illustration by Barbara Hranilovich for AJN.

It can be daunting for a visiting nurse to enter a patient’s home, especially if the patient seems less than receptive to the nurse’s efforts. In this month’s Reflections essay, “The Present,” Pia Wolcowitz describes one of her first assignments as a visiting nurse. She’s sent to assess a woman newly diagnosed with lung cancer. Here’s an excerpt:

I rang the bell and heard a voice, but couldn’t make out what she said. I rang again. This time I heard her loud and clear. “If you wanna come in, come in! Door’s open!” Entering, I found a woman in her mid-60s sitting hunched at her kitchen table, surrounded by bottles of medication and a bowl of cereal. It was way past noon.

She had cropped blue-black hair with accents of white. She studied me a moment, then her gray eyes examined my ID. “So, you’re the nurse?”

[…]

2016-11-21T13:02:10-05:00August 10th, 2015|narratives, Nursing, nursing perspective, patient engagement, Patients|1 Comment
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Breathing Training May Ease Depression in Dialysis Patients: Study Findings

By Sylvia Foley, AJN senior editor

It’s estimated that depression afflicts between 25% and 50% of people who have chronic kidney disease. And depression has been associated with numerous adverse outcomes in this population, including poor sleep, reduced quality of life, and higher rates of hospitalization and death. Researchers Siou-Hung Tsai and colleagues wanted to know whether teaching patients a basic relaxation technique—deep, slow breathing—could alleviate depressive symptoms.

To learn more, they developed a four-week intervention and conducted a trial. The intervention included instruction by a dialysis nurse trained in deep breathing techniques, additional audio device–guided instruction, and guided exercises. The authors report on their findings in this month’s CE–Original Research feature, “The Efficacy of a Nurse-Led Breathing Training Program in Reducing Depressive Symptoms in Patients on Hemodialysis.” Here’s a brief summary.

Objectives: The purpose of this randomized controlled trial was to examine the efficacy of a nurse-led, in-center breathing training program in reducing depressive symptoms and improving sleep quality and health-related quality of life in patients on maintenance hemodialysis.
Methods: Fifty-seven patients on hemodialysis were randomly assigned either to an eight-session breathing training group or to a control group. The Beck Depression Inventory II (BDI-II), the Pittsburgh Sleep Quality Index (PSQI), and the Medical Outcome Studies 36-Item Short Form Health Survey (SF-36) were used to assess self-reported depressive symptoms, sleep quality, and health-related quality of life, respectively.
Results: The intervention group exhibited significantly greater decreases in BDI-II scores than did the control group. No significant differences in PSQI change scores were observed between […]

2017-07-27T14:41:22-04:00April 7th, 2015|nursing perspective, nursing research|1 Comment
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The Depression Project

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May (2012 issue) of AJN. She currently has an essay appearing in The Examined Life Journal.

Wikimedia Commons Wikimedia Commons

Lately, as a long-time runner, I can’t help but draw parallels between working on a nursing research project and training for a distance race set far in the future. Especially in the middle of a long run, when frazzled edges smooth out and clarity settles over me, the similarities between the two are striking. Both require inspiration and a goal, fluid planning and accommodation for the unexpected, and patience.

I casually refer to the nursing research project I’m involved in as “The Depression Project.” It was borne of concern among the ICU nurses about the mental states of the trauma patients in our unit. As the bedside care providers, we often come to know our patients very well; we don’t just care for these people, we sincerely care, and so we’re troubled when we observe, time and again, trauma patients who seem to lose the motivation to engage in their recoveries. They become flat and despondent; they lose hope.

It’s clear to the nurses that while the physical injuries sustained present enormous challenges, the emotional toll is sometimes just as debilitating—yet underestimated. And so we devised a study to illustrate the correlation of depression and recovery.

It’s […]

2016-11-21T13:08:35-05:00January 9th, 2013|career, Nursing, nursing research, patient experience, Patients|4 Comments
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Depression in Older Adults: A Nurse’s Guide

By Sylvia Foley, AJN senior editor

‘Mourning Old Man’ by Vincent Van Gogh

“It is a misconception that depression is a normal, inevitable part of aging; it is not,” writes author Cynthia Cahoon in this month’s CE, “Depression in Older Adults.” Depression affects an estimated 15% to 19% of Americans ages 65 and older living in a variety of settings, yet it often goes unrecognized and untreated. Granted, recognition can be challenging, in part because many symptoms of depression are also common to other illnesses seen in older adults. As Cahoon points out, though, there is also “abundant evidence that depression in older adults is treatable, perhaps in as high as 65% to 75% of cases.”

The article provides an overview of depression in older adults and outlines its pathophysiology and disease types. Known risk factors for this population include the following:

  • chronic medical conditions
  • polypharmacy
  • multiple losses
  • functional decline (physical, cognitive, or both)
  • personal or family history of depression
  • social isolation
  • substance abuse or dependence

According to Cahoon, a majority of adults with depression will present for treatment of physical conditions, rather than for a mood disorder. So it’s important to assess each patient’s mood, regardless of presenting symptoms. Several brief, validated screening tools exist, and busy nurses have several options. One tool, the Whooley Depression Screen, takes less than five minutes to administer and asks just two questions:

1. During the past month, have you often been bothered […]

2017-07-27T14:53:25-04:00November 6th, 2012|Nursing|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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