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UNIT 2 ■ Psychiatric Mental Health Nursing Interventions
Table 11–3 | C ARE PLAN FOR THE SUICIDAL PATIENT—cont’d
OUTCOME CRITERIA NURSING INTERVENTIONS
RATIONALE
3. Assessment of patient safety includes analyzing congruence of verbal com- munication, nonverbal communica- tion, and behavior.
3. Assess verbal and nonverbal clues to identify the likelihood that patient intends to follow through with the established safety plan and evaluate the patient’s follow-through with safety plan measures while still hospitalized.
NURSING DIAGNOSIS: HOPELESSNESS RELATED TO: Absence of support systems and perception of worthlessness EVIDENCED BY: Verbal cues (despondent content, “I can’t”); decreased affect; lack of initiative; suicidal ideas or attempts OUTCOME CRITERIA NURSING INTERVENTIONS RATIONALE
1. It is important to identify contributing factors to assist the patient with stress management.
1. Identify stressors in the patient’s life that pre- cipitated current crisis. Include assessing the degree of emotional pain and hopelessness in relationship to feelings of connectedness or lack of connectedness with others. 2. Determine coping behaviors previously used and the patient’s perception of effectiveness then and now. 3. Encourage the patient to explore and verbal- ize feelings and perceptions related to rea- sons for wanting to die as well as reasons for wanting to live.
Patient expresses hope and acceptance of life and situations over which the patient has no control.
2. Identifying the patient’s strengths encourages their use in current crisis situation. 3. Identification of feelings underlying behaviors helps the patient to begin the process of taking control of own life and enables the nurse to help the patient focus on maximizing their reasons for wanting to live. 4. Although patient feels hopeless, it is helpful to hear positive expressions from others. The patient’s current state of mind may prevent identifying anything posi- tive in life. It is important to accept the patient’s feelings nonjudgmentally and to affirm personal worth and value. 5. Patient’s emotional condition may inter- fere with ability to problem solve. Assis- tance may be required to perceive the benefits and consequences of available alternatives accurately. 6. A collaboratively developed, concrete plan promotes hope in the face of a future crisis.
4.
Provide expressions of hope to patient in positive, low-key manner (e.g., “I know you feel you cannot go on, but I believe that things can get better for you. What you are feeling is temporary. It is okay if you don’t see it just now.” “You matter.”).
5. Help patient identify areas of life situation that are under own control.
6. Identify sources that the patient may use after discharge when crises occur or feel- ings of hopelessness and possible suicidal ideation prevail. This includes local suicide hotlines and other available support services. 7. Assist the patient to explore and identify future-oriented goals.
7. Identifying goals encourages the patient to focus on hopefulness for the future.
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