5.4.4: FRAME 4- Generate Solutions

CORRECT Answer

Question Type: Matrix Multiple Response

Scoring: +/-

NCSBN Item Type and Scoring: https://www.ncsbn.org/public-files/p...main_stage.pdf

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’s current status.

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

RATIONALE

The nurse must identify desirable outcomes and define a set of interventions for those outcomes. Focus on goals and multiple potential interventions is essential for Jacklyn right now, this includes the need to collect additional information to better direct and personalize her care. Depression does not typically occur in isolation and is a major risk factor for heart disease. Given the client’s previous history and understanding 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 results of the questionnaire to the provider to ensure there is a collaborative approach taken.

FOCUSED GUIDE

Research supports the recommendation for healthcare clinicians to routinely assess clients for depressive symptoms prior to surgery and continued screening after surgery. There are numerous tools available that can be administered to clients pre-operatively and post-operatively for continued screening. The Patient Health Questionnaire-9 (PHQ-9) is an example of a depression screening that takes the client less than 10 minutes to complete. The PHQ-9 has 9 items that assess the symptoms of major depression that are rated on a 4-point scale (0-3). A score of 10 or above indicates that the client is at high risk for major depression (Ghoneim & O’Hara, 2016).

Additional considerations must also relate the client’s SDOH with stress hormones and the negative impact it can have on post-operative recovery and rehabilitation. Recent studies demonstrate how the immune system responds to chronic stress that can be induced by psychological stress (ex: discrimination, loneliness, job strain, violence, food insecurity, etc.). Clinical trials are proving these connections to be true and enhancing our ability to assess the efficacy of interventions through multiple biomarkers (Powell-Wiley et al., 2022).

Multiple levels of interventions at the policy, community, and individual levels are all needed when addressing sociopolitical and lived experiences of clients. This includes policy, community, and individual interventions.

• Policy Interventions include improved access to access to health insurance, improved access to education, poverty interventions, urban planning & community investment, and prioritization of SDOH informed CVD research.
• Community Interventions include investment in community-based organizations and community health workers, quality housing, nutritious grocery stores, transportation facilities, and education programs.
• Individual interventions include health behavior/lifestyle coaching, medication management, SDOH screening at primary care clinics, care coordination and collaboration, patient navigation and case management, income support (cash transfer), and patient education (Powell-Wiley et al., 2022).