You can’t meet each patient’s emotional needs. You’d never be able to leave your work behind. Or get anything done. But there are times when some patients need a little extra support and will drop hints to get you to respond.

What are those hints and how do you sensibly help? Read this interview with RealityRN Senior Advisor CeCe Grindel, PhD, RN, CMSRN, FAAN, to learn when and how to get involved:

RealityRN: How do you know when a patient needs extra attention?

CeCe Grindel: There are two good indicators: 1) If the patient is not interactive or too quiet and not participating, and 2) If the patient needs lots of stimuli all day or just lays there and wants to sleep.

Some of these symptoms sound like depression.

Often what appears to be depression isn’t.

For example, sometimes patients don’t feel like going through a procedure that their family thinks they should undergo; patients may have an elderly parent at home whom they are concerned about caring for; or, they may be a single parent worried about their children’s childcare. These dilemmas burden patients, and sometimes lead to depression-like symptoms. But this doesn’t necessarily mean they are depressed.

Do patients voice these concerns?

Sometimes, but many patients don’t complain, even if they’re emotionally crashing. However, if you pay close attention—really stop and listen—you’ll notice that patients drop hints throughout the day if things aren’t going well.

Why don’t nurses catch these cues?

Most nurses sincerely care about their patients, but their workloads (the tasks) keep them from intuiting a patient’s emotional needs. And if a new nurse does sense something is wrong, he/she may not be comfortable addressing the patient. We teach them how to address patients in school, but it takes practice.

How can a nurse get to the root of the problem?

Ask open-ended questions and listen—then you’ll begin to get the big picture.

For instance, if a patient doesn’t want to go through a procedure that the family wants him/her to undergo, I would say, “Let’s talk about it. Why don’t you want to have this done? What do you think would help solve this problem? Would you like us to get your family together and have a conference? What would you like to say to your family?”

But watch your timing and the setting. You can’t expect to walk into a two-patient room in which the other patient has company and have an open conversation. Your patient won’t respond to your inquiries in a “public” environment.

Once you understand the problem, then what?

Obviously nurses can’t solve all the patient’s problems, but they can make referrals and seek professional support. As a nurse, you can also help brainstorm what a patient’s resources are. If they’re concerned about an elderly parent, ask if they have other siblings who can care for them. Talk with them about some temporary placement for their elderly parents. If you hit a dead-end, bring in Social Services.

When do you bring in the family for support?

If patients vent to you, you have to get their permission to discuss the issues with the family, unless they’re falling into severe depression. That, then, is an entirely different story. But for most issues, as the patient’s advocate, you should try to get him/her to see the benefit of sharing his/her concerns with the family and getting their support. You may suggest holding a family meeting to get the issues out in the open.

What does a family meeting look like?

You pull people together: the patient, the doctor, the family members, a representative from Social Services, the chaplain—whoever can help resolve the problem. If the patient is concerned about a procedure, the doctor can come in and say, “I’ve talked to your mom about this, and she really doesn’t want this to happen. But let me tell you what it may or may not do for her.” As a nurse, you can add, “Your mom loves you very much, but she’s also mentioned that she’s really tired and would like to live out her life in a more comfortable situation without having a lot of medical care done.”

In this scenario, the patient’s needs are clearly stated, and the family has the full picture.