Category: Mental Health (NSG 328)

I was instantly drawn to my patient as I always find it inspiring when someone has been married to the same person for decades, nonetheless, 65 years, as it isn’t all that common anymore. My patient was an 85-year-old female who was recently widowed and had also recently moved into an assisted living facility shortly after the passing of her husband. I had the pleasure of meeting her as she was placed in the psychiatric unit I was working on. She was placed there with the diagnosis of major depressive disorder as evidenced by a suicide attempt with melatonin related to the recent death of her partner. I was saddened to hear that she had tried to commit suicide, I had sympathy for her and I understood her motive behind the attempted overdose. Some may say that she still has her boys to live for but they have now grown into men and share their lives with other people, striving to have the same connection that their parents had.

I can only imagine the loneliness she is feeling being a widow after 65 years of marriage with the same person. I don’t believe there is a lot of acknowledgment of the physical and emotional dependency that grows between people when spending a lifetime together.

I believe my patient to be in the depression phase of grief. The emotions that my patient is feeling are a normal part of the death and dying process. She is able to speak of her husband in the past tense and but doesn’t discuss the cause of his passing. She doesn’t become teary-eyed when speaking of him but I bet she does when she’s alone.

She would benefit from education regarding the grieving process and the normal mindsets that come from it. For the risk of convenience, I would not allow her to continue to have free access to OTC medications as there are much more harmful agents than melatonin that can be accessed over the counter. Unfortunately, she has crossed a line and therefore any trust that she may have had at her facility is gone. I fear she may experience more of a loss of autonomy than she had when she first went into assisted living.

 Nursing interventions would include ensuring that the patient is in a safe environment and does not have access to objects with which they can harm themselves or others. Inform the patient on the therapeutic use of prescription medications to help facilitate the coping process. Educate the patient regarding the harmful effects of negative self-talk (believing she is better off dead) and its impact on self-esteem. Finally, be available, apply active listening, and let the patient freely express their emotions and feelings

The simulation was much less formal than what I was expecting. My expectations were that we would be speaking to these individuals in more of a hospital setting instead of an office setting, but I preferred it that way. I felt like students were given minimal information about the simulation and because of that, I think we went in rather timid. Nonetheless, I enjoyed simulation, I thought it was a realistic depiction of behaviors that we will experience in the clinical setting. In my mind, I had minimized the actions of some of these disorders and didn’t expect some of the grandiosity that was portrayed. I guess my expectations with patient interaction was that the patient allows the nurse to take the authoritative role in the room and with some of these personalities it was quite clear that they controlled the room. To be honest, I was overwhelmed with the portrayal of the manic episode. The pressured speech made it difficult to communicate and by the time I had thought of something to say, the topic had moved onto something else completely. Attempting to re-direct was futile and after the encounter was over I quickly realized how drained I was from trying to communicate and keep up with this personality. In terms of the other personalities, I felt confident in my communication with them. There was a sense of calmness with those other individuals and I was able to articulate my next words with ease. I think my biggest downfall with mania was that I matched the energy of the patient in my own mind and it ultimately made me panic. 

I thought the actors were really wonderful and depicted their illnesses accurately. I thought it to be especially helpful that we didn’t know the actors beforehand as I think our perception of how they truly act would not allow us to experience the full range of emotions that can be expressed in mental disorders.

I think there is so much stigma surrounding mental illness because it is not always a disease process that can be seen visibly outside the body. I also think mental illness has become mainstream in society and oftentimes is used out of context in exaggerations or figurative language.

Factors that contribute to self-stigma include Hollywood’s representation of mental illness through physical representations of a disheveled appearance or outbursts. Most often, mental illness is not something that is visualized on the outside. Additionally, the historical past treatment of individuals with mental illness through the use of “insane asylums” has led to negative conceptions of mental illness today. Coined terms for mental issues such as crazy or deranged, and the notion that mental illness is shameful and brings that upon families may contribute to someone’s willingness to seek treatment.  

The Spirit Catches You and You Fall Down is a book written by Anthropologist Anne Fadiman, on the Hmong culture. In brief, this book brings to light how different cultures view and respond to illness. In the Hmong Culture, whenever an individual experiences a seizure, they are being touched by a spirit and their soul leaves their body. This is regarded as a gift, whereas Western Culture identifies this as a medical condition having to do with nerve impulses. Although this book utilizes epilepsy as a medical condition, the message is the same for how the identification and treatment of mental illness have everything to do with perspective and not everyone views it in the same manner.