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UNIT 2 ■ Psychiatric Mental Health Nursing Interventions
■■ Asking about behavioral events rather than the patient’s opinions may elicit more concrete information. Example: “What did you do when you had those thoughts?” “How many pills did you take?” “What happened next?” ■■ Gentle assumptions encourage further discussion by assuming there is more to tell. Example: “What other times have you attempted suicide?” ■■ Denial of the specific is helpful when a patient generally denies suicidal ideation. This strategy encourages more in-depth thought and response by asking questions that might trigger memories of specific events. Example: After the patient denies suicidal ideation in response to a general question, the nurse asks more specifically, “Have you ever had thoughts of overdosing?” “Have you ever had thoughts about shooting yourself?” ■■ Chronologically exploring the presenting suicide event, recent suicide events, past suicide events, and finally the immediate suicide events can broaden the nurse’s understanding of the patient’s immediate suicidal intent in the context of their behavior over time. Example: Ask the patient about the event that pre- cipitated this episode of care: “Tell me about the event that led you to be hospitalized,” and then ask about any other recent events: “When was the last time you attempted suicide prior to this event? Tell me more about that event” (as well as their history of suicidal behavioral over time). Finally, explore immediately current ideation and intent: “Tell me about your level of risk right now. Current ideas? Intensity? Intentions?” Diagnosis and Outcome Identification Nursing diagnoses for the suicidal patient may include the following: ■■ Risk for suicide related to feelings of hopelessness and desperation ■■ Hopelessness related to absence of support sys- tems and perception of worthlessness ■■ Ineffective coping related to extreme stress, crisis, feeling trapped, poorly developed coping skills Outcome Criteria Outcome criteria include short- and long-term goals. Timelines are individually determined. The criteria that follow may be used for measurement of out- comes in the care of the suicidal patient.
The patient: ■■ Has experienced no physical harm to self. ■■ Sets realistic goals for self. ■■ Expresses some optimism and hope for the future. Planning and Implementation Table 11–3 provides a plan of care for the hospi- talized suicidal patient. Nursing diagnoses are pre- sented, along with outcome criteria, appropriate nursing interventions, and rationales for each. Intervention With the Suicidal Client Following Discharge or in an Outpatient Setting In some instances, it may be determined that suicidal intent is low and that hospitalization is not required. Instead, the client with suicidal ideation may be treated in an outpatient setting. Guidelines for treat- ment of the suicidal client on an outpatient basis include the following: ■■ The person should have immediate access to sup- port systems and be tied to a system of care because the term following hospital discharge is a high-risk period. Arrangements must be made for the client to stay with family or friends. If this is not possible, hospitalization should be reconsidered. ■■ A detailed safety plan should be developed that is an outgrowth of a comprehensive assessment and a collaborative problem-solving discussion with the client. This intervention explores with clients what they will do to stay safe if there is a repeat or increase in suicidal thoughts or urges. See Box 11–2 for more on the essential components of a safety plan. ■■ A safety plan should not be confused with a no- suicide contract. See Boxes 11–3 and 11–4 to learn about issues associated with developing an appro- priate safety plan. ■■ Enlist the help of family or friends to ensure that the home environment is safe from dangerous items, such as firearms or stockpiled drugs. Give support persons the telephone number of the counselor or an emergency contact person in the event that the counselor is not available. ■■ Appointments may need to be scheduled daily or every other day at first until the immediate suicidal crisis has subsided. ■■ Establish rapport and promote a trusting relation- ship. It is important for the suicide counselor to become a key person in the client’s support system at this time. ■■ Accept the client’s feelings in a nonjudgmental manner.
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