A female client who’s at high risk for suicide needs close supervision. To best ensure the client’s safety, Nurse Mary should:
A. Check the client frequently at irregular intervals throughout the night.
B. Assure the client that the nurse will hold in confidence anything the client says.
C. Repeatedly discuss previous suicide attempts with the client.
D. Disregard decreased communication by the client because this is common with suicidal clients.
Correct Answer: A. Check the client frequently at irregular intervals throughout the night
Checking the client frequently but at irregular intervals prevents the client from predicting when observation will take place and altering behavior in a misleading way at these times. Once the patient is deemed to be at risk for suicide, then intervention steps must be initiated right away. The individual must not be left alone. Enlist the help of a support person while at home. The suicidal individual must be treated in a safe and secure place. In addition, the place has to be monitored.
Option B: This may encourage the client to try to manipulate the nurse or seek attention for having a secret suicide plan. Assessing the individual’s judgment is critical. One should try and determine how the individual can handle stress. Does he or she have an impairment in decision making? Does the individual know that jumping in front of a train is dangerous? Reflect empathy and concern. Offer a hand to help. Provide the patient with confidence that he or she can overcome the issues.
Option C: This may reinforce suicidal ideas. Help develop internal coping strategies (e.g., exercise, journaling, reading, developing a hobby). Utilize the help of healthcare professionals to follow up on therapy. Once the individual is safe as an inpatient or outpatient, a formal treatment plan should be established. The next step is to refer all patients deemed to be at higher risk for suicide to a mental health counselor as soon as possible. Every state has laws and procedures regarding this process which must be incorporated into the clinical practice when addressing individuals at high suicide risk.
Option D: Decreased communication is a sign of withdrawal that may indicate the client has decided to commit suicide; the nurse shouldn’t disregard it. In some cases, assessment of the mental status may provide a clue to the individual’s potential for self-harm. Depressed patients will often tend to appear unclean and unkempt. The clothing may not be ironed or dirty. The risk of suicide is often high in people who appear very anxious or depressed. The patient may exhibit a flat affect or no emotions at all. Some depressed patients may develop hallucinations that may be telling him or her to kill themselves. The majority of these hallucinations are auditory.