Dear writer, I need to answer following 8 objectives after watching the simulation (I described simulation after objectives). Simulation is on Suicide. Each answer has to be related to the simulation and chapters from the books I scanned and uploaded. You can use additional material, but the main focus has to be the chapters I uploaded. The books used are : Varcarolis, Fondation of psychiatric health nursing 8th and also Manual of psychiatric nursing care planning 6th. Thank you.
- Define essential terms associated with suicide including suicidal ideation, suicide attempt, and completed suicide.
- Discuss risk factors for the development of suicidal ideation and for suicide.
- Identify evidence-based practice suicide risk assessment tools.
- Discuss basic-level interventions to address suicidality in the hospital or in community settings.
- Explain key elements of suicide precautions and environmental safety factors in the hospital.
- Describe three expected reactions a nurse may experience when working with patients who have suicidal ideation.
- Examine nursing interventions for nonsuicidal self-injury.
- self-assessment of the paper.
John age 53 (age is a risk criteria) married for 12 years, lives with wife Joyce. She is a travel nurse so she has to be away a lot. John was admitted to psychiatric unit following a suicide attempt by hanging at home last evening, when his wife was away on an assignment. John stated that he felt more alone than ever and tried to kill himself. John brother in law, Evan was with him when the attempt occurred, and he called 911. After assessment and stabilization, he was admitted to the inpatient unit. (john doesn’t have medical illness or substance use disorder, but he has depressive disorder and family history of suicide. His father shot himself with the gun when John was 11 years old, and john found him dead. Mother has no mental illness, just feeling sad after john father committed suicide. John was depressed all the time when he was a teenager but never got treatment. He became depressed again when he was in his 30s, and he got prescription for ELAVIL, and he got better, but then hi stop the medicine, got depressed again, went to psychiatrist and got prescription for PAXIL, but stop them as well because of sexual side effects. All together he had 3 prior episodes of depression and didn’t stay on any antidepressants. John has previous attempt of suicide when his last girlfriend broke up with him at 28, so he shot himself in a chest and almost dye. John was hospitalizing back then for 8 months on medical surgical unit, but never had any psychiatric follow up after lethal attempt of suicide. John Irrational thinking: is that when his wife going away for an assignment he believes that she is distancing herself from him so she can make a decision about divorcing him. John has a great social support, his family, Mother and brother in law, they care about him a lot. The get together often and all get along great, nevertheless he often perceives that he is alone. This time John didn’t have an organize plan, he acted impulsively. He drank some alcohol and wanted to stop the feeling of being alone. He thinks that suicide is always an option for him). Suicide is a frequent companion to mood disorders and depressive people. The SAD PERSON scale is a risk factor scale for suicide. In 2000 suicide by firearms was the most common method for both man and women.
Thomas is a psychiatric nurse who is providing care to john, continues with initial assessment:
Nurse: “You are admitted after pretty serious attempt; can you tell me how you feeling right now? Have you had any thoughts about killing yourself in the last few hours?”
John: “Yes I’ve been thinking about it quite bit.”
Nurse: “Can you say exactly what is on your mind?
John: “Well I can’t believe I wasn’t successful this time. I am telling you right now, I will take myself out by Christmas!!! (Angry voice) (First few days after admission the risk is the highest for suicide reattempt).
Nurse: “It sound like you very intent on doing this, have your thought about suicide are constant or they come and go?”
John: “They pretty much constant, it can last for hours or even days.”
Nurse: “Right now do you think about ways of killing yourself on the unit?”
John: “I rather not say, it is a matter of time!”
Nurse: “John in order to help you, I need to understand what you thinking?”
John: “I had looked at the shower rods, but I think they will break away, so I know that the gun will always work.”
Nurse: “Its sound that you are very sad about things, is there anything you can identify so it will keep you from killing yourself?”
John; “Well if anything it will be my wife Joyce, she has been such a good wife for me, I would do anything for her …(crying).
Nurse: “It is important that you can identify your support like your wife. How it would affect Joyce of you were gone?”
John: “she would be better off if I am not here, I am no good for her. Then again she would be devastated, she loves me so much.
Nurse: “It sounds like there’s some ambivalence there for you. You mention your Dad earlier, I can’t imagine how it was for you, when you found him.”
John: “Well at the time, I tried to go on the best I could, but lately that bothers me more and more.’
Nurse: “It is not unusual those thoughts will be coming back to you especially at this time. I think it is very important to Address it during your stay.”
After assessment for first 24 hours the priority is: Suicide precaution, John will not harm himself, he will be able to talk to the nurse if he is feeling suicidal, He will be able to talk about his feelings openly, any shaving… need to be done with supervision, stay out of the bathroom and the kitchen unit supervised, be in public area as much as possible. Start on medications, learn how to manage side effects, and learn the importance of adherence.
Interview with the family showed that the wife and the mother show quilt, and anger, and confusion. (It is important to address survivors of the suicide attempts family coping) They were crying and very upset. The nurse told the family that its normal to feel that. When John stop his medications abruptly, it increased the risk significantly. Depression can affect the way John was thinking and acting, and the wife absence was a trigger, but no one is to blame.
John started on medications (Paxil control release, 25 mg daily until reaches 75 daily, during treatment with SSRI’s medications, it is important to monitor the patient first few days extra careful, because they feel more energy to complete the suicide plan. The mood is the last to improve, up to 4 weeks.)
And on day 2 he was feeling better, and he started coming to dining room to eat.
Nursing interventions for this time: Reassess frequently. John doesn’t feel that he wants to die anymore, He says that those thoughts doesn’t stay, just go through his mind sometimes, and by killing himself it wouldn’t accomplish anything. He realizes that he has things to look forward to. He doesn’t think about his dad as much.
Before his discharge: John needs help to establish comprehensive care plan. And his family need additional coping help.
This simulation focuses on caring for a client who is acutely suicidal. The clinical scenarios takes place in the inpatient unit of can an acute psychiatric hospital. The case targets nursing care that focuses on accurate and comprehensive assessment of suicidal ideation, medication management, personal in environmental safety within the inpatient milieu. family intervention and crisis intervention to rally outside support networks, working with clients who are acutely suicidal requires continuous, vigilant assessment and supervision. Family work is an important component ow working with the suicidal client and this simulation includes family assessment and intervention strategies for living with a client who has made a recent lethal attempt. This scenario portrays the student with exposure to comprehensive assessment of suicidality, the most common suicidal client behaviors and problems and information on how to manage the most acutely ill clients within the inpatient setting.