4.4.4: FRAME 4- Generate Solutions

The unlicensed nursing assistant personnel (UAP) approaches the nurse with concerns about a statement made by Jacklyn while getting assistance to the restroom. The UAP states the client mentioned herself as a failure and would have “been better off dead.” The nurse recognizes the significance of this statement and relates Jacklyn’s history of depression after the loss of her husband. The nurse understands the severity of the statement and approaches Jacklyn in her room. Upon entering the client’s room, the nurse finds Jacklyn sitting on the edge of her bed with tears in her eyes. The nurse listens as the client shares thoughts, fears, and concerns she has about her hospital stay, the stability of her job, lack of insurance, and uncertainty about the future. FRAME 4: Generate Solutions After a thorough conversation with the client, the nurse has the Jacklyn complete a depression screening tool used in the nursing unit, the Patient Health Questionnaire™ (PHQ-9).

Jacklyn completes and returns the document to the nurse:

Generate Solutions

QUESTION: Matrix Multiple Choice

Scoring Rule: 0/1

The nurse reviews the PHQ-9™ form filled out by the client. For each potential intervention, specify whether the intervention is indicated or not indicated for the client status.

Potential Intervention	Indicated	Not Indicated
Implement suicide precautions
Inquire about spiritual care and support
Ask the client to elaborate on question 9 of the survey
Screen visitors
Provide supportive resources
Contact primary provider
Have the UAP stay with the client until the end of the shift
Minimize the number of interruptions at night

Putting It All Together

DEBRIEF

Depression does not typically occur in isolation and is a major risk factor for heart disease. Given the client’s previous history and understanding that depression after major surgery is common and affects millions of people each year, it is essential for the nurse to generate solutions to achieve a desirable outcome. Undergoing a major surgery leaves individuals left to manage many details in life differently than normal. Most people do not stop to think about how they can help themselves feel good emotionally during their surgical recovery (AHA, 2020). Therefore, asking the client to elaborate on her answers to the questionnaire, especially focused on question 9, would be indicated in this situation. Additionally, the nurse would want to provide supportive resources and try to minimize the number of interruptions at night to help promote healthy sleeping patterns for the client. Lastly, the nurse would want to communicate this information and the questionnaire results to the provider to ensure a collaborative approach is taken.

Healthcare clinicians are encouraged to routinely assess clients for depressive symptoms before surgery and continue screening after surgery. The PHQ-9™ is an example of a depression screening that takes the client less than 10 minutes to complete.

You can access this screen by clicking HERE.

RECOGNIZING SOCIAL DETERMINANTS OF HEALTH (SDOH)

Implicit bias, discrimination, and stigma create a framework that disentangles structural health equity determinants into key constructs, which allows a focus on their roles in the lived personal experiences of vulnerable populations. Nurses must allow for the exploration of broader sociopolitical, cultural, and economic factors and intermediary health determinants on social position. Adverse SDOH can chronically stress the biology of disadvantaged groups, impact cardiovascular health factors, and promote disparities in CVD outcomes (Powell-Wiley et al., 2022).

Additional considerations must relate the client’s SDOH with stress hormones and their negative impact on postoperative recovery and rehabilitation. The immune system responds to chronic stress that can be induced by psychological stress, such as discrimination, loneliness, job strain, violence, food insecurity, and financial instability (Powell-Wiley et al., 2022).

The nurse demonstrated effective communication by addressing Jacklyn’s statements with her. Effective health communication is critical to health and well-being. Healthy People 2030 focuses on improving health communication (HC/HIT-02) so people can easily understand (HC/HIT-01) and act on health information.

What Do You Think About?

1. What risk factors are exhibited by Jacklyn early on in her hospital stay for depression?
2. Explain what supportive guidance might look like for Jacklyn in her current situation.
3. Identify two policy, two community and two individual interventions that can be incorporated into Jacklyn’s care to decrease adverse SDOH.