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An adult patient was hospitalized with mild traumatic brain injury (TBI) after a car crash. While the injury was not severe, and the patient was cooperative, he developed suicidal thoughts, so the main challenge was the risk of self-harm. The article by Spilman et al. (2015) suggests that many healthcare facilities do not have a standardized procedure for assessing trauma patients with depression symptoms. The authors claim that many trauma patients have a documented history of depression, with 89% of the patients receiving antidepressant medication (ADM) initiated by critical care or nonpsychiatric physicians (Spilman et al., 2015). Overall, the study results demonstrate that trauma patients receive ADM more frequently than the general population and are often discharged without a recommendation for psychiatric care.
To handle the situation, I employed the strategies of patient education on his TBI condition and promotion of ADM treatment and psychiatric help. The strategy of personality traits and coping mechanisms evaluation could have been used to reduce the patient’s anxiety and engage him in problem-based coping (McIntyre et al., 2020). Another strategy involves the utilization of the Hospital Anxiety and Depression Scale (HADS) for timely assessment of depression and appointment reminders for TBI and psychiatric follow-up (Singh et al., 2018). I advocated for the patient by speaking in favor of ADM and recommending psychiatric help to deal with the existing mental issues aggravated by the injury.
Legal and ethical implications should be considered while providing care for patients with depression resulting from injuries or illnesses. According to McQuillan and Makic (2019), the law guarantees a patient’s right to refuse treatment and decide what can be done to his or her body. Informed consent is a legal document aimed at protecting patient autonomy and decisions. Nurses should assess a patient’s ability to understand his/her condition and make decisions, which is difficult in uncontrolled trauma situations involving depressed patients. When a patient is unable to make an informed decision because of an injury or mental state, a legal adult can act on behalf of the patient. The fundamental ethical principles of beneficence, nonmaleficence, and justice should always be considered by healthcare professionals but might be balanced differently depending on the specific context. For instance, when a trauma patient with depression poses a risk of harm to others or him/herself, he/she might be physically restrained to ensure the safety of medical personnel and other patients.
References
McIntyre, A., Mehta, S., Janzen, S., Rice, D., Harnett, A., MacKenzie, H. M., Vanderlaan, D., & Teasell, R. (2020). Coping strategies and personality traits among individuals with brain injury and depressive symptoms. NeuroRehabilitation, 47(1), 25–34. Web.
McQuillan, K. A., & Makic, M. B. (2019). Trauma nursing: From resuscitation through rehabilitation (5th ed.). Saunders.
Singh, R., Mason, S., Lecky, F., & Dawson, J. (2018). Prevalence of depression after TBI in a prospective cohort: The SHEFBIT study. Brain Injury, 32(1), 84–90. Web.
Spilman, S. K., Smith, H. L., Schirmer, L. L., & Tonui, P. M. (2015). Evaluation and treatment of depression in adult trauma patients. Journal of Trauma Nursing, 22(1), 17–22. Web.
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