Psychiatric Mental Health Nursing by Videbeck

15 MOODDISORDERS ANDSUICIDE 351

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client. Proclaiming the client’s feelings to be

inappropriate or wrong or otherwise belittling

them is detrimental.

Ventilation of feelings may help to relieve feelings

of despair, hopelessness, sadness, and so forth.

Feelings are not inherently good or bad. You must

remain nonjudgmental about the client’s feelings

and directly express this to the client.

Topics that are uncomfortable for the client and

probing may be threatening and initially may

discourage communication. When trust has been

established, the client may be encouraged to

discuss more difficult topics.

The client may be unaware of a systematic

method for solving problems. Successful use of

the problem-solving process facilitates the client’s

confidence in the use of coping skills.

Positive feedback at each step will give the client

many opportunities for success and encourage

him or her to persist in problem-solving as well as

enhance the client’s confidence. The client also

can learn to “survive” making a mistake.

real, and give support for this ventilation of feel-

ings, especially for expressions of emotions that

may be difficult for the client to accept in himself

or herself (like anger).

Encourage the client to ventilate feelings in what-

ever way is comfortable—verbal and nonverbal.

Let the client know you will listen and accept

what is being expressed.

Interact with the client on topics with which he or

she is comfortable. Do not probe for information.

Teach the client about the problem-solving process:

explore possible options, examine the consequences

of each alternative, select and implement an alter-

native, and evaluate the results.

Provide positive feedback at each step of the

process. If the client is not satisfied with the cho-

sen alternative, assist the client to select another

alternative.

Evaluation

Evaluation of the plan of care is based on achieve-
ment of individual client outcomes. It is essential
that clients feel safe and are not experiencing uncon-
trollable urges to commit suicide. Participation in
therapy and medication compliance produces more
favorable outcomes for clients with depression. Being
able to identify signs of relapse and to seek treatment
immediately can significantly decrease the severity
of a depressive episode.

BIPOLAR DISORDER

Bipolar disorder involves extreme mood swings from
episodes of mania to episodes of depression. (Bipolar
disorder formerly was known as manic-depressive
illness.) During manic phases, clients are euphoric,

grandiose, energetic, and sleepless. They have poor

judgment and rapid thoughts, actions, and speech.

During depressed phases, mood, behavior, and

thoughts are the same as in people diagnosed with

major depression (see previous discussion). In fact,

if a person’s first episode of bipolar illness is a de-

pressed phase, he or she might be diagnosed with

major depression and a diagnosis of bipolar disorder

will not be made until the person experiences a manic

episode. To increase awareness about bipolar dis-

order, health care professionals can use tools such as

the Mood Disorder Questionnaire (Box 15-1).

Bipolar disorder ranks second only to major de-

pression as a cause of worldwide disability. The life-

time risk of bipolar disorder is at least 1.2% with a risk

of completed suicide of 15%. Young men early in the

course of their illness are at highest risk for suicide, es-

pecially those with a history of suicide attempts or al-

Adapted from Schultz, J. M. & Videbeck, S. L. (2002). Lippincott’s Manual of Psychiatric Nursing Care Plans (6th ed.). Philadelphia:

Lippincott Williams & Wilkins.