Sharon M. Valente

Depression and HIV disease.

Depressive disorders are common among 20% to 32% of people with HIV disease but are frequently unrecognized. Major depression is a recurring and disabling illness that typically responds to medications, cognitive psychotherapy, education, and social support. A large percentage of the emotional distress and major depression associated with HIV disease results from immunosuppression, treatment, and neuropsychiatric aspects of the disease. People with a history of intravenous drug use also have increased rates of depressive disorders. Untreated depression along with other comorbid conditions may increase costly clinic visits, hospitalizations, substance abuse, and risky behaviors and may reduce adherence to treatment and quality of life. HIV clinicians need not have psychiatric expertise to play a major role in depression. Screening tools improve case finding and encourage early treatment. Effective treatments can reduce major depression in 80% to 90% of patients. Clinicians who mistake depressive signs and symptoms for those of HIV disease make a common error that increases morbidity and mortality.

Suicide risk among gay men and lesbians: A review

Abstract Without adequate death statistics from completed suicide data, the suicide risk for gay men and lesbians must be determined from empirical studies and from a theoretical understanding of suicide risk. Three large, well designed studies found that gay men and lesbians attempt suicide two to seven times more often than heterosexual comparison groups. Gay men and lesbians have significantly high rates of risk factors that increase suicide risk such as suicide attempts, alcohol abuse, drug abuse and interrupted social ties. Durkheim suggests that groups with low social status and integration who are denied societys usual privilege and rights are at risk for alienation and anomic suicide unless protected by internal cohesion, religion or anlisuicide norms. Durkheims theory applied to gay men and lesbians illustrates how the extensive and diverse alienation reported may lead to suicide. Diverse groups of gay people have not yet successfully decreased alienation or suicide. Empirical evidence, risk fa...

Diagnosis and treatment of major depression among people with cancer.

Although depressive disorders are common among 20-25% of people with cancer, they are frequently unrecognized. Untreated depression in the presence of comorbid conditions may result in more frequent clinic visits, increased costs, extended hospitalization, and reduced compliance and quality-of-life. Oncology clinicians need not have psychiatric expertise to play a major role in the detection and treatment of depression and in the prevention of suicide. Using early detection and screening tools, the nurse can identify depressed patients and can collaborate in their treatment. Approximately 80-90% of depressed patients are effectively treated with psychotherapy, and/or pharmacologic, or somatic, interventions. Failure to diagnose or reluctance to treat depression among patients with cancer is a common error and can increase morbidity and mortality.

Managing depression among people with HIV disease

Many people with HIV suffer from depression, which responds to antidepressants, counseling, education, and cognitive strategies. Untreated depression hinders treatment compliance and increases risk of suicide. Management and complications of major depression are described. The evaluation of rational suicide is examined. Clinicians who treat this population need to respond therapeutically to patients with depression and suicidal ideas.

Clinical hypnosis with school-age children

Despite the fact that nurses are in key positions to learn and use hypnosis to bolster a childs symptom management, ability to solve problems, or self-esteem, they lack knowledge about the clinical effectiveness of hypnosis. Substantial clinical literature demonstrates that hypnosis effectively reduces anxiety, enhances coping, and has been used successfully to treat behavior disorders, school phobias, and sleep disorders. Hypnosis can effectively reduce a childs anxiety and symptoms and has few side effects when used competently. With education and supervision, nurses can effectively use hypnosis to improve a childs mastery and self-esteem and to reduce severe levels of anxiety.

Psychiatric Nurses’ Expertise, Interest in End-of-Life Care, and Requests for Continuing Education on End of Life:

Background: The time before dying can be extremely challenging and stressful. Gaps in end-of-life care include inadequate communication, education about end-of-life options, symptom control, and management of common mental illnesses (eg, mood disorders, dementia), and death anxiety. Psychiatric nurses are in a pivotal position to help address these gaps and improve end-of-life care. Psychiatric nurses can facilitate communication about end of life, educate patients about options, and provide consultation, assessment, and management of common psychosocial needs (eg, mood disorders, grief, and loss). Objective: This survey examined psychiatric nurses’ perspectives of their skills, knowledge, expertise, continuing education needs, and recommendations for the role of the psychiatric nurse. Study design: Using a descriptive design, we surveyed a convenience sample of psychiatric nurses from the American Psychiatric Nurses Association. Results: Psychiatric nurses reported they were skilled in discussions of difficult topics, evaluation of mental status, and assessment and management of mood disorders, grief, and suicide risk. However, nurses asked for continuing education in focusing these skills for end of life, knowing the needs of the dying patient, and differentiating depression and dementia at end of life. Requests for continuing education on end-of-life care included issues about how to apply these psychiatric skills and knowledge to the dying patient and their families. Conclusions: Psychiatric nurses have skills and knowledge to reduce the gaps in end-of-life care. Many request continuing education to assist them to expand and focus their knowledge to use their psychosocial skills and to develop a specialty area in end-of-life care.

Suicide and Elderly People: Assessment and Intervention.

Despite improvements in the health of Americans over the last three decades, people over age sixty have the highest suicide rates and comprise one-fourth of all suicides. A case study illustrating risk assessment and intervention is discussed. Clinical issues related to recognition of suicidal elderly patients are examined and a practical approach to early detection, evaluation, and management of suicide risk is presented. Criteria for evaluating rational suicide are outlined.

Exploring a life history of HIV disease and self-caring: Alfredo's story

Alfredos story is part of a larger phenomenological study of nursing, self care, and HIV disease that incorporated the anthropological tradition of reconstructing a life-story in the persons own words. This exemplar emphasizes Alfredos shifts perspective organized around three turnings, or shifts in perspective, which are illustrated with narrative text and discussed. The three turnings include becoming HIV-infected, becoming a positive force, and reclaiming self. Implications for nursing include the importance of story telling in life history, the value of knowing the patient as a person, the positive impact of negative events, and the educational impact of a paradigm case.

Detecting and Evaluating Depression Among Elderly Patients in Home Health

Among home health patients, depression is a debilitating and treatable psychiatric condition that often remains undiagnosed and reduces quality of life, social interactions, daily functioning, and treatment adherence. Untreated major depression increases functional decline; costly medical, emergency, and mental health visits; and reliance on disability or welfare. In the worst case, many patients decide that life is not worth living and attempt suicide. Screening and careful assessment are the keys to the detection and evaluation of depression. Scant literature exists to guide the evaluation and management of depressive disorders in home care. This article illustrates the evaluation and management of depression. The home care provider is in a key position to detect, evaluate, and intervene with depression and monitor its complications such as suicide risk. Evaluating depression is a professional nursing responsibility requiring judgment and the ability to understand subtle dynamics of loss, hopelessness, and emotional pain.

Managing Professional and Nurse–Patient Relationship Boundaries in Mental Health

Caring nurse-patient relationships in mental health settings are key components in helping patients recover. These professional relationships provide a safe, trustworthy, reliable, and secure foundation for therapeutic interactions; however, nurses face challenges in setting and maintaining relationship boundaries. Although patients ask for special privileges, romantic interactions, and social media befriending, or offer expensive gifts, nurses must recognize that these boundary violations may erode trust and harm patients. These violations may also trigger discipline for nurses. Professional relationship guidelines must be applied with thoughtful consideration, and nurses must monitor their emotions and reactions in these relationships. The current article is a sharing of personal experiences about boundaries augmented by evidence in the literature, and focuses on managing potential boundary violations (i.e., social media, sexuality, over-involvement, and gift giving) in mental health settings. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 45-51.].