Substance Abuse and Abuse Q 32
In conferring with the treatment team, the nurse should make which of the following recommendations for a client who tells the nurse that everyday thoughts of suicide are present?
A. A no-suicide contract
B. Weekly outpatient therapy
C. A second psychiatric opinion
D. Intensive inpatient treatment
Correct Answer: D. Intensive inpatient treatment
For a client thinking about suicide on a daily basis, inpatient care would be the best intervention. Although a no-suicide contract is an important strategy, this client needs additional care. The client needs a more intensive level of care than weekly outpatient therapy. Put on either suicide precaution (one-on-one monitoring at one arm’s length away) or suicide observation (15-minute visual check of mood, behavior, and verbatim statements), depending on the level of suicide potential. Protection and preservation of the client’s life at all costs during a crisis is part of medical and nursing staff’s responsibility. Follow unit protocol.
Option A: Construct a no-suicide contract between the suicidal client and nurse. Use clear, simple language. When the contract is up, it is renegotiated (If this is accepted procedure at your institution). The no-suicide contract helps clients know what to do when they begin to feel overwhelmed by pain (e.g., “I will speak to my nurse/counselor/support group/family member when I first begin to feel the need to end my life”).
Option B: During the crisis period, health care workers will continue to emphasize the following four points: the crisis is temporary; unbearable pain can be survived; help is available, and you are not alone. Because of “tunnel vision“, clients do not have a perspective on their lives. These statements give perspective to the client and help offer hope for the future. Keep accurate and thorough records of the client’s behaviors (verbal and physical) and all nursing/physician actions.
Option C: Immediate intervention is paramount, not a second psychiatric opinion. Follow unit protocol for suicide regarding creating a safe environment (taking away potential weapons– belts, sharp objects, items, and so on). Providing a safe environment during times the client is actively suicidal and impulsive; self-destructive acts are perceived as ties, the only way out of an intolerable situation.