Case Scenario: The Suicidal Patient

Peter is a young man who attempted suicide by overdose and is being assessed for further risk.

Watch the following video: How to assess and manage the risk of suicide in a mental health setting, making notes on the MSE components that you see using the resources from week one. Try to answer every section of the MSE to better inform your care plan. https://www.youtube.com/watch?v=U8Lnpwg-B1U

Answer the following critical thinking questions:

Which therapeutic communication skills are most applicable in caring for a patient who has attempted suicide?

Psychotic depression is when a person may have auditory hallucinations and behaviour is bizarre with irrational ideas. This is a subtype of major depression in which the patient is totally detached from reality (Tamparo & Lindh, 2017). In the case of Peter, it requires an immediate intervention to stabilize his condition which is pretty much identical with psychotic depression as erratic mood needs to be balanced and it may need a combination of antipsychotic and antidepressant medications and crisis intervention is needed (Tamparo & Lindh, 2017). The best course of action to take is to understand the client’s condition and have a clear grasp of the disorder. As nurses it is our responsibility to go over the details of the patient’s chart or conduct a research to obtain more information about depressive disorders and know the therapeutic techniques to effectively communicate with the clients to facilitate coping strategies and refer for a collaborative approach with other allied health professionals (Tamparo & Lindh, 2017). Correspondingly, reflective listening is valuable clients with depression need to feel secure and comfortable, providing a non-threatening environment and an open-minded approach will give the client a sense of non-judgmental approach (Tamparo & Lindh, 2017). The importance of warmth and genuineness will reflect the true intention to assist clients and recognize feelings of despair that can help them feel that they are being understood and someone knows their unmet needs (Tamparo & Lindh, 2017). Peter’s case needs a unified approach among other members of the care team in order to make him feel safe and given the previous act of suicidal attempt, advocating for client’s safety is the main priority and ensuring that he is well-supported conveying empathy includes making the client feel the “you truly care” by understanding feelings of pain and agony and recognizing the sensibility of his suffering, this can diffuse feelings of self-punishment (Tamparo & Lindh, 2017). Therefore, as future psychiatric nurses, a keen risk assessment is critical to ensure safe nursing care and frequently monitoring the client, it is also our responsibility while establishing therapeutic communication to keep his environment free from harm and maintain a calm and steady atmosphere to reduce agitation (Townsend, 2011).

Do some research on the Canadian Association for Suicide Prevention website. What support resources would be helpful for Peter? Why?

While navigating the Canadian Association for Suicide Prevention website, one thing that struck us the most is the slogan “They are suicide attempt survivors — and they have something they want you to know” (Canadian Association for Suicide Prevention [CASP], n.d.). Since Peter is a suicide attempt survivor, it is likely that he may do it again. Therefore, it is vital to support him in the healing process and keep him on track. Honoring his choice to live by acknowledging what they are talking about by employing active listening will give themselves permission to ask for help (CASP, n.d.). During our research, the following are some of the resource support that we found to be helpful for Peter in British Columbia:

The National Suicide Prevention Lifeline (lifelineforattemptsurvivors.org) – is a website that provides a hotline that connects one to a skilled counselor at a crisis center anywhere near the area. This hotline strives to engage someone who survived a suicide attempt with a goal of finding hope and keeping the client safe in the most difficult time. The website also provides stories of survivors who made it through their darkest days which are also used by friends, families, and even clinicians to support someone who is feeling suicidal. 

Life Moves On – Pacific Centre Family Centres- which offers a variety of programs and activities that encourage possibilities as well as offer family interventions. They offer clinical counseling through a registered therapist that addresses a broad range of issues from trauma to mental health including suicidal ideation. 

Vancouver Island Crisis Line: 1-888-494-3888. A 24/7 support that can offer emergency and emotional assistance for suicidal clients.

S.A.F.E.R. Counselling Service- offer individualized short-term counseling for those in a suicidal crisis, attempt, or a family member concerned about someone who is suicidal. They also provide group supports to individuals who have lost loved ones due to suicide. They offer referrals, consultations, and information throughout BC.

Heartbeat: A Suicide Survivor Support Group – CMHA- Offer acceptance, understanding, and comfort, as well as help survivors, absorb the aftereffect of a suicide attempt.

When reviewing the video, what are the key points of information (Hint* subjective and objective data) you require to assist you in building a care plan for this patient?

Subjective data:

Patient verbalized the following:

He feels fed up and horrible

Suicide attempt (he took 60 tablets of paracetamol)

Suicidal thoughts (He knows that he won’t take tablets anymore as it won’t kill him and also, he thought of jumping from a block of flats close to where he lives)

Feeling of despair, hopelessness, and worthlessness (He thinks that his brother, dad, teachers think that he is useless)

Feeling of abandonment (He feels that his sister left him alone)

Sleep disturbance (he is unable to sleep)

Feeling scared (he doesn’t like to be in mental hospital as he feels frightened)

Social isolation (he stays in his room most of the time)

Exhaustion or fatigue (He feels tired)

He drinks special brewed (he drinks three or four cans)

He felt anxious at times

Auditory hallucinations

Objective data:

Young man

He lives with his mom and dad

He has a brother and a sister

He is well-groomed and alert

Cooperative as he is answering all the questions being asked

Soft tone of voice, slow speech noted

Face muscle tension observed

The client kept on looking somewhere else unable to maintain eye contact

Tearful/weeping

Disturbed thoughts observed

Kept repeating words

He looks confused

Profound sadness/ loneliness noted

He panics and looks worried when the helper mentioned about hospital

Which members of the health care team will you involve in Peter’s care at home?

The BC Psychosis Program is a specialized treatment that provides services to clients with psychotic disorders including schizophrenia or schizoaffective disorder and mood disorders (BC Mental Health & Substance Use Services, n.d). It is composed of the multidisciplinary team that looks into medications, psychosocial aspects of the individual and it provides consultation and collaborative effort with the following care team:

Psychiatrists

Neuropsychiatrists

Nurses

Peter’s Family

Occupational therapists

Social workers

Peer support workers

Recreation and music therapists

Psychologists

Dieticians

Pharmacists 

The treatment program also ranges within 4-6 months and looking into the group of care team, it will definitely assist Peter to gain significant improvement of his condition and reduce psychotic features that may likely to provoke his suicidal ideation (BC Mental Health & Substance Use Services, n.d). In BC, a referral is usually being done by the case manager in the community to reinforce the stability of Peter’s overall mental health and to provide a safe care as nurses, that is our main priority and also advocate to achieve long-term health and wellness (BC Mental Health & Substance Use Services, n.d). Moreover, the health care team should attend to a “risk for suicide” patient who needs a prompt response in four levels: emotional, educational, institutional, and administrative (Kelleher, Kelleher, & Grad, 2014). It is imperative to be able to provide time and space for understanding reactions and feelings, especially for family members who are one of the key members of the health care team (Kelleher, Kelleher, & Grad, 2014).

Create a care plan, using the care plan template, for Peter. Remember to base your

diagnosis on a NANDA approved nursing diagnosis.

Top of Form

Bottom of Form

NANDA Nursing Diagnosis and Support Data

Goal/Outcome Criteria

(at least 1/diagnosis)

Nursing Interventions

(at least 3/goal)

Scientific Rationale/Principle

(with reference)

Evaluation of Intervention

Risk for suicide related to hopelessness, alcohol use, history of suicide attempt, poor support system, loneliness as evidenced by feeling useless and that no one will miss him when he died.

1. Client will remain safe at all times and abstain from attempting suicide.

2. Client will verbalize thoughts and feelings of suicide.

3. Client will agree with the treatment strategy to reduce the suicide risk.

 

1. Maintain a secure and safe environment for the client (Gulanick & Myers, 2014, p. 187).

2. Provide ways for clients in a non-judgmental setting to voice concerns, worries, emotions and aspirations (Gulanick & Myers, 2014, p. 187).

3. Guide the client to use medications properly to improve their capacity to cope. Also, inform the client’s reactions to suicidal thoughts in cognitive-behavioral self-management (Gulanick & Myers, 2014, p. 188).

1.  To discourage the patient from acting on unexpected self-destructive impulses, suicide precautions are being used. Also, such steps involve eliminating items like medications, sharp objects and electrical appliances that may be harmful (Gulanick & Myers, 2014, p. 187).

2. The client benefits from speaking with a trustworthy helper concerning suicidal thoughts. Furthermore, clients want a chance to address suicidal ideation and negative thoughts. Moreover, verbalizing these feelings can diminish their strength. Also, clients’ do have to know that health care providers are receptive to suicidal thoughts being addressed (Gulanick & Myers, 2014, p. 187).

3. Drug treatment might help the client deal with underlying psychological issues like depression and clients can understand as well as react to suicidal thoughts. Also, it is possible to teach the person to recognize negative self-talk and unconscious thinking leading to suicidal thoughts. Thus, the client knows how to establish constructive responses and useful self-talk to these negative concepts (Gulanick & Myers, 2014, p. 188)

1. The client remained safe and he was able to refrain from hurting himself.

2. The client was able to freely express his emotions, thoughts, and feelings to the care provider.

3. The client was able to adhere to the treatment plan by taking his prescribed medications and able to demonstrate self- control.

Support Data (subjective, objective, assessment)

Subjective data:

Patient verbalized the following:

He feels fed up and horrible

Suicide attempt

Suicidal thoughts

Feeling of despair, hopelessness, and worthlessness

Feeling of abandonment

Sleep disturbance

Feeling scared

Social isolation

Exhaustion or fatigue

He drinks special brewed

He felt anxious at times

Auditory hallucinations

Objective data:

Young man

He lives with his mom and dad

He has a brother and a sister

He is well-groomed and alert

Cooperative as he is answering all the questions being asked

Soft tone of voice, slow speech noted

Face muscle tension observed

The client kept on looking somewhere else unable to maintain eye contact

Tearful/weeping

Disturbed thoughts observed

Kept repeating words

He looks confused

Profound sadness/ loneliness noted

He panics and looks worried when the helper mentioned about hospital

Bottom of Form

NANDA Nursing Diagnosis and Support Data

Goal/Outcome Criteria

(at least 1/diagnosis)

Nursing Interventions

(at least 3/goal)

Scientific Rationale/Principle

(with reference)

Evaluation of Intervention

 

Ineffective coping related to coping capabilities were insufficient, situational crises, and minimal social support resulting from a relationship with the family as evidenced by expression of fear and anxiety

 

1.Client will determine the effective coping behavior and state consequences.

2. Client will acknowledge own coping abilities

3. Client will fulfill psychological needs as evidenced by a proper emotional expression, choice identification, and resource utilization.

1. Offer opportunities for addressing issues, uncertainties, emotions, and desires. Emphasize feelings of understanding and acceptance (Gulanick & Myers, 2014, p. 54)

2. Motivate the client to recognize the strengths and weaknesses of their own (Gulanick & Myers, 2014, p. 54).

3. Help clients with a detailed assessment of the situation as well as their achievements. Support in creating an alternative approach of aid. Promote involvement in self-help groups (Gulanick & Myers, 2014, p. 55).

1. Verbalizing actual or potential risks may help lessen stress and open up opportunities to regular interaction. A truthful relationship makes problem-solving and effective coping (Gulanick & Myers, 2014, p. 54).

2. Clients may not know their abilities during a crisis. Sensitivity can accelerate the use of certain attributes (Gulanick & Myers, 2014, p. 54).

3. Recognizing if he or she has the abilities and strength to manage the situation efficiently could be beneficial for the client. The client may need assistance in having a positive view of the situation. Also, it could be helpful to have connections with people with shared interests and goals. Involvement in a group can provide different techniques for successful coping for the client (Gulanick & Myers, 2014, p. 55)

1. The client was able to identify his coping skills and was able to address his concerns.

2. The client was able to recognize the effective coping mechanism that works for him.

3. The client was able to attain his psychological needs by utilizing resources that will support him in coping for any stressful situation.

Support Data (subjective, objective, assessment)

Subjective data:

Patient verbalized the following:

He feels fed up and horrible

Suicide attempt

Suicidal thoughts

Feeling of despair, hopelessness, and worthlessness

Feeling of abandonment

Sleep disturbance

Feeling scared

Social isolation

Exhaustion or fatigue

He drinks special brewed

He felt anxious at times

Auditory hallucinations

Objective data:

Young man

He lives with his mom and dad

He has a brother and a sister

He is well-groomed and alert

Cooperative as he is answering all the questions being asked

Soft tone of voice, slow speech noted

Face muscle tension observed

The client kept on looking somewhere else unable to maintain eye contact

Tearful/weeping

Disturbed thoughts observed

Kept repeating words

He looks confused

Profound sadness/ loneliness noted

He panics and looks worried when the helper mentioned about hospital

NANDA Nursing Diagnosis and Support Data

Goal/Outcome Criteria

(at least 1/diagnosis)

Nursing Interventions

(at least 3/goal)

Scientific Rationale/Principle

(with reference)

Evaluation of Intervention

Hopelessness related to the feeling of abandonment, sense of hopelessness and helplessness as evidenced by lack of support from the family, the feeling of being useless and though that he was left behind.

1. The client will show the desire to live and have a positive expression about life.

2. The client will describe thoughts and verbalize them to the care provider.

3. The client will alleviate feelings of hopelessness, using coping mechanisms.

1. Evaluate the client’s self-confidence and their skills. Define the ideals and happiness of the person with their role or goal in life. Motivate a positive hope mindset (Gulanick & Myers, 2014, p. 98-99)

2. Continue to offer the client the opportunity to express pessimistic feelings. Also, it motivates the individual to understand their weaknesses and attributes (Gulanick & Myers, 2014, p. 98-99).

3. Support the client to establish a rational analysis of the condition and extend the range of coping skills of the clients (Gulanick & Myers, 2014, p. 99).

1. Highlighting the intrinsic value of the client and considering the underlying problem as controllable. It would not be beneficial to promote unachievable hope and can considerably aggravate the client’s trust in their care provider. Perception in the partnership between nurse and client as a collaboration on the road to recovery is crucial to cultivating optimism (Gulanick & Myers, 2014, p. 98-99).

2. Through listening to the client in a non-judgmental way, the nurse provides a safe environment. Clients may not be able to identify their abilities over a time of hopelessness. Awareness could accelerate the need for these qualities (Gulanick & Myers, 2014, p. 98-99).

3. Clients may not be mindful of all possible support resources to assist them to get through this difficult situation. Trying new strategies to cope with stressful situations can assist the patient. Such abilities can promote a restored sense of self and bring hope back to life (Gulanick & Myers, 2014, p. 99).

1.  The client was able to display his willingness to live and was able to share his positive outlook about his life.

2. The client was able to open and express his emotions and feelings to the nurse.

3. The client happily shared his plans in life and was able to use coping strategies and support services that gave him hope to continue living his life.

Support Data (subjective, objective, assessment)

Subjective data:

Patient verbalized the following:

He feels fed up and horrible

Suicide attempt

Suicidal thoughts

Feeling of despair, hopelessness, and worthlessness

Feeling of abandonment

Sleep disturbance

Feeling scared

Social isolation

Exhaustion or fatigue

He drinks special brewed

He felt anxious at times

Auditory hallucinations

Objective data:

Young man

He lives with his mom and dad

He has a brother and a sister

He is well-groomed and alert

Cooperative as he is answering all the questions being asked

Soft tone of voice, slow speech noted

Face muscle tension observed

The client kept on looking somewhere else unable to maintain eye contact

Tearful/weeping

Disturbed thoughts observed

Kept repeating words

He looks confused

Profound sadness/ loneliness noted

He panics and looks worried when the helper mentioned about hospital

References

BC Mental Health & Substance Use Services (n.d). BC Psychosis Program. Retrieved from http://www.bcmhsus.ca/our-services/provincial-mental-health-programs/bc-psychosis-program

Canadian Association for Suicide Prevention. (n.d.). British Columbia Survivor Support Centres. Retrieved from https://suicideprevention.ca/Survivor-Support-Centres.

Gulanick, M., & Myers, J. L. (2014). Nursing Care Plans: Diagnoses, Interventions, and Outcomes (8th ed.). Philadelphia, PA: Elsevier

Kelleher, E., Kelleher, M. F., & Grad, O. (2014). Effects of patient suicide on the multidisciplinary care team. The Lancet Psychiatry, 1(3), 174–175. doi: 10.1016/s2215-0366(14)70299-8

Tamparo, C. D., & Lindh, W. Q. (2017). Therapeutic communication for health care professionals. Boston, MA, USA: Cengage Learning.

Townsend, M. C. (2011). Nursing diagnoses in psychiatric nursing: Care plans and psychotropic medications. Pennsylvania: F.A. Davis Company.