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- - - - Nursing Actions
        
        Assess individual signs of hoelessness
        
        Assess destructive behaviors used to handle with feelings such as withdrawal, avoidance, substance abuse
        
        Allow the patient to express feelings and perceptions
        
        Express hope to the patient with realistic comments about the patient's strengths and resources
        
        Assist the patient determine aspect of life that are under her control
        
        Allow the patient to assume responsibility for self-care, such as setting realistic goals, scheduling activities, and making independent decisions
        
        Encourage the patient to examine spiritual supports that may provide hope
        
        Aid the patient determine aspects of life events that are not within his or her ability to control. DIscuss feelings related with this lack of control.
        
        Conduct a suicide assessment to identify the level of suicide risk
        
        Educate the patient about crisis intervention services such as suicide hotlines and other resources
        
        Administer antidepressants as indicated
      - Outcomes:
        
        Patient will express feelings and acceptance of life events over which he or she has no control
        
        Patient will demonstrate independent problem-solving techniques to take control over life, and does not verbalize or demonstrate suicidality
  - - - Nursing Actions
        
        Initially, provide activities that require minimal concentration (e.g., drawing, playing simple board games))
        
        Involve the client in gross motor activities that all for very little concentration (e.g., walking).
        
        When the client is at the most depressed state, involve the client in one to-one activity
        
        Eventually involve the client in group activities (e.g., group discussions, art therapy, dance therapy).
        
        Eventually maximize the client's contracts with others (first one other, then towo others, ect.).
        
        Refer the client and family to self-help groups in the community
      - Outcomes:
        
        Patient will identify feelings that lead to poor social interactions
        
        Patient will interact with family/friends/peers
        
        Patient will participate in certain community social activities
        
        Patient will participate in one activity by the end of the day
        
        Patient will discuss two-three alternative ways to take when feeling the need to withdraw
        
        Patient will eventually voluntarily attend individual/group therapeutic meetings within a therapeutic milieu
        
        Patient will verbalize that she enjoys interacting with others in activities and one-on-one interactions to the extent they did before becoming depressed
        
        Patient will state and demonstrate progress in the resumption of sustaining relationships with friends and family members within one month
  - - - Nursing Actions:
        
        Encourage the use of soap, washcloth, toothbrush, shaving equipment, make-up etc.
        
        Give step-by-step reminders such as "brush the teeth, clean the outer surfaces of your upper teeth, then your lower teeth..."
        
        Monitor intake and output, especially the bowel movements
        
        Encourage the intake of nonalcoholic and noncaffeinated fluids, 6 to 8 glasses a day
        
        Offer fiber-rich foods and periods of exercise
        
        Evaluate the need for laxatives' and enemas
      - Outcomes:
        
        Patient will groom and dress appropriately with help from a nursing staff and/or family
        
        patient will regain more normal elimination pattern with aid of foods high in roughage, increase fluid intake, and exercise daily (also with the aid of medications)
        
        Patient will sleep between 4 to 6 hours with aid of nursing measures and/or medication (5mg melatonin)
        
        Patient will demonstrate progress in the maintenance of adequate hygiene and be appropriately groomed and dressed
        
        Patient will experience normal elimination with the aid of diet, fluids, and exercise within 3 weeks
        
        Patient will sleep between 6 to 8 hours per night within one month
  - - - Nursing Actions
        
        Ask the patient about the losses that happen in his or her life. Discuss how the patient view them
        
        Assess the patient's religious beliefs and cultural practices in terms of how they handle their previous losses.
        
        Allow the patient to recognize and express feelings and determine the connection between the feelings and the event
        
        Suggest alternative methods to determine and cope with underlying feelings of anger, hurt, and rejection
        
        If indicated, mention stories of how others have dealt with the same experience
        
        Discuss and educate patient the normal stages of grief and accept the reality of related feelings such as guilt, anger, and powerless
        
        Assist the patient to determine the problem, recognize the need to address the problem differently, and thoroughly describe all facets of the problem
        
        Assist the patient in recognizing early signs of depression and identify methods to mitigate these signs. If the symptoms persist or worsen, suggest other professional support
      - Outcomes:
        
        Patient will engage in self-care activities at his or he own pace
        
        Patient will demonstrate improvement in handling with the stages of grief at his or her own pace
        
        Patient will verbalize a sense of improvement toward resolution of hope and grief in the subsequent time
  - - - Nursing Actions:
        
        Assess the self-esteem level of the patient
        
        Allow the patient to perform personal care activities
        
        Give positive feedback after a task is achieved
        
        Allow the patient to engage in simple recreational activities, advancing to a more complex activities in a group environment
        
        Teach visualization techniques that can help the client replace negative self-images with more positive images and thought
        
        Encourage the client to participate in a group therapy where the members share the same situations/feelings that they have
        
        Evaluate client's need for assertiveness training tools to pursue things he or she wants or needs in life. Arrange for training through community-based programs, personal counseling, literature, etc.
        
        Involve the client in activities that she wants to improve by using problem-solving skills. Assess and evaluate the need for more teaching in this area.
        
        Work with the client to identify cognitive distortions that encourage negative self-appraisal
      - Outcomes
        
        Patient will express belief in self
        
        Patient will maintain self-esteem
        
        Patient will demonstrate a zest for life and ability to enjoy the present
        
        Patient will identify one or two strengths by end of the day
        
        Patient will identify three judgmental terms clients uses to describe self and identify objective terms to replace them
        
        Patient will keep a daily load and identify on a scale of 1 to 10 feelings of guild, shame, self-hate
        
        Patient will report decreased feelings of guild, shame, and self-hate by using a scale of 1 to 10
        
        Patient will demonstrate the ability to modify unrealistic self-expectations
        
        Patient will give an accurate and nonjudgmental account of four positive qualities as well as identify two areas she wishes to improve
  - - - Nursing Actions
        
        Identify the level of suicide precautions needed. If there is a high-risk, does a hospitalization require? Or if there is a low risk, will the client be safe to go home with a supervision from a family member or a friend?
        
        Assess for following:
        
        Admit previous suicide attempts
        
        Abuse any substances
        
        Have no peers'/friends
        
        have any suicide plan
        
        Check for the availability of required supply of medication needed
        
        Encourage clients to express feelings and come up with alternative ways to handle feelings of anger and frustration
        
        Contact the family, arrange for crisis counseling. Activate links to self-help groups
        
        If hospitalized, follow unit protocols
        
        Implement a written no-suicide contract
        
        Outcomes:
        
        Patient will seek help when experiencing self-destructive impulses
        
        Patient will have a behavioral manifestation of absent depression
        
        Patient will identify at least two-three people she can seek out for support and emotional guidance when she is feeling self-destructive before discharge
        
        Patient will not inflict any harm to self or others
        
        Patient will identify support and support groups when she is in contact within one month
        
        Patient will state that she wants to live
        
        Patient will start working on constructive plans for the future
        
        Patient will demonstrate compliance with any medications or treatment plan within the next two weeks
        
        Patient will demonstrate alternative ways of dealing with negative feelings and emotional stress