AIIMS Delhi NO - 2018
Mental Health Nursing
Hard
The most appropriate nursing action for a depressed patient who does not want to join a group is to:
Appeared in: AIIMS Delhi NO - 2018
Explanation
- This option demonstrates a therapeutic approach by offering support and assistance, which is crucial for patients with depression who often lack the energy and motivation (avolition) to perform tasks.
- It helps to initiate movement and participation in a non-threatening way, fostering a trusting nurse-patient relationship.
- By assisting the patient, the nurse helps break the cycle of inactivity and social withdrawal that perpetuates depression.
- This action balances the need for therapeutic activity with empathy for the patient's condition.
Why Other Options Were Wrong
- Option A: This is an authoritarian, rule-based approach that is non-therapeutic. It focuses on unit policy rather than the patient's individual needs and feelings, which can increase feelings of shame and opposition.
- Option B: This is a coercive and punitive threat. It is unprofessional and damaging to the therapeutic relationship, likely increasing the patient's feelings of worthlessness and anxiety.
- Option D: This is an overly permissive approach that reinforces the patient's social withdrawal and inactivity. Allowing a depressed patient to remain isolated can worsen their symptoms.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Therapeutic nursing interventions for a patient with depression to guide bedside assessment, documentation, and the next nursing action.
- The nurse's primary role in psychiatric care is to build a therapeutic alliance. Offering assistance rather than demanding compliance is key to this relationship.
- Encouraging participation in activities of daily living (ADLs) and group therapy is a fundamental intervention to combat the anhedonia and social isolation of depression.
- What if the patient still refuses after the nurse offers to help? The nurse should then sit with the patient for a few moments, acknowledge their feelings ('It sounds like getting up feels impossible right now'), and state they will be back in a short while to check on them. This maintains the connection without a power struggle.
How to Approach the Question
- First, identify the patient's diagnosis and primary symptom: The patient is depressed and exhibiting avolition (lack of motivation) and social withdrawal.
- Next, analyze the question's goal: It asks for the 'most appropriate' nursing action, which implies a therapeutic and effective intervention.
- Evaluate each option based on principles of psychiatric nursing. Eliminate options that are punitive, coercive, or authoritarian (threatening or just stating rules).
- Eliminate options that are overly permissive and reinforce the patient's symptoms (allowing them to stay in bed).
- Select the option that is supportive, empathetic, and helps the patient take a small step toward recovery. The best choice is the one where the nurse partners with the patient to overcome the inertia of their illness.
Concept Tested & Keywords
- Concept Tested: Therapeutic nursing interventions for a patient with depression.
- Stem keywords: depressed patient, nursing action, does not want to join a group
- Lead-in keywords: most appropriate
- Clinical cues: Patient is depressed, indicating potential for anergia, anhedonia, and avolition.
- Clinical cues: Patient is refusing to participate in a therapeutic group activity.
Question ID
Q1lQkw0XB7WC8cTJi6R6WA
Reference Book
E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 1 (pp 26-289 of 579) p. 218-220
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 14720-14722
Practise the full AIIMS Delhi NO - 2018
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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