Psychiatric nursing concepts and practice

¶ … nurse working as a psychiatric-Mental health facility and have been asked to complete a suicide assessment on a client.

What are the different areas you would need to assess? List at least two questions you would ask to assess each area.

Suicide assessment begins with understanding the behavior of the patient. A patient may be acting in a way that causes the nurse to question the possibility of risk. Questions to ask might be: Is the behavior unusual for this person? Has their behavior changed drastically after a tragic event? (Mohr,, 743). Next the nurse needs to establish a therapeutic relationship that is built on trust. This relationship should have begun prior to the behavior change. Nurses should ask about family, talk honestly about issues that the patient wants to hear about, and try to seek a common ground that will help build rapport. If the patient is in crisis they will trust someone with whom they have built a trust relationship. Specific areas to cover in the assessment include: feelings of helplessness and hopelessness, feeling of isolation or guilt, asking if the patient has made prior suicide threats, whether they are finalizing their will all of a sudden (Mohr,, 744). Engage the patient about specific plans to determine how serious their suicidal intentions are.

b. What affects can suicide have on those left behind?

People who have a loved one who has committed suicide are much more likely to commit suicide themselves than those in the general population (Gaering, Saini, & McNeill, 2007). But, that is not the only danger they face. People often blame themselves for the suicide because they believe that they could have done more. They will also not receive as much empathy as people who normally experience the death of a loved one. There is a negative stigma attached to a suicide (Mohr,, 748).

2. Many individuals experience a maturational crisis at some point in their life.

a. Provide an example of a maturational crisis. Identify a behavior that may be manifested in each crisis phase.

This type of crisis is most commonly referred to as a developmental crisis and was demonstrated in the writings of psychologist Erik Erikson (Mohr,, 754). One of the best examples of such a crisis that most people face is leaving home, for the first time, to go to college, start a job, or start a family. Leaving the safe and comfortable confines of known shelter and sustenance can be a frightening event. According to the text a person will experience "increased anxiety," a "further increased anxiety" if coping mechanisms fail, reach out for help, and then goes through an active state of crisis (Mohr,, 753). In the case of a student far away from home, these phases could manifest as anxiety following a failed test or relationship, increased anxiety as grades continue to fall, seeking out a trusted friend or teacher, when all else fails they could experience suicidal ideation or drop out of the school.

b. Develop a list of resources available to an individual experiencing the maturational crisis that you specified.

A student in this crisis could seek out a college mental health counselor or one from the town, seek help in the class from a teacher's assistant or the professor, talk to admissions about dropping the class, seek help from trusted clergy, seek the advice of a friend, look for professional sources at the university or in the community that deals specifically with the issues of someone who is far from home for the first time (Knitzle & Bride, 2010).

3. After helping a client through a crisis, you become interested in the role of crisis intervener.

a. What are the most important skills for a crisis intervener and how these skills are implemented in a crisis?

The first goal of intervention is to build an instant rapport with the person by caring about the situation and validating the feelings of the person involved. After there is some trust built up, the intervention should focus on the problem and how to solve that and not the person who has the stress. To alleviate a crisis, the individual involved has to get the focus off of themselves and work on the immediate cause of the stress.

b. Compare and contrast the variations in crisis intervention, including the team approach, crisis groups, and families in crisis

The team approach to crisis intervention involves a group of professionals who interact at some predetermined time span to discuss the crisis that a person may be experiencing and how they are dealing with it. Crisis groups allow someone to understand that there is universality in their issue (Freedberg, 2007). This means that they are able to meet with people who have like issues and have a shared healing experience. Families in crisis can have conjoint therapy so that all members of the family who are affected by the crisis can offer input.

An individual who is experiencing a crisis may benefit from having a team of professionals work to help them resolve some of their issues, but the individual may also attend a crisis intervention group to meet with other who have the same issue. This same individual may also benefit from some family counseling to see how their family is affected and help the family group realize how the crisis affected the individual.

4. You are conducting an interview with a client and he reveals to you that he abuses his wife. He asks you not to tell anyone.

a. Would you be required to keep this client's confidentiality or to share the information with someone?

A helping professional is required by law to keep the confidence of a patient in most cases. However, in this case the client has revealed that he is causing physical harm to someone else (Mohr,, 81). The nurse is legally obligated to report the abuse.

b. How would you respond to the client?

The patient should have already been advised of the extent of confidentiality and where that right does not apply. In general, if the patient is, or the professional has a belief that they will, causing harm to themselves or someone else, the nurse must report that to the proper authority. I would remind the client of their confidentiality rights and tell them that talking to a therapist about their issues may be in their best interest. If they have already told me about the issue, I would assess my own safety, but I would tell them that I could not maintain a confidence such as that (Voyce, 2009).