Suicide screening for all is not needed - page 2

At my hospital every patient who comes in to the ER is supposed to be asked suicide screening questions. If they are admitted as an inpatient they are asked again. I don't think this is useful and... Read More

  1. by   djh123
    Quote from Emergent
    I suspect that these sorts of policies originate from the personal grief or guilt of someone in a regulatory role in healthcare. 'If only my brother had been screened for suicide in the ER when he broke his arm last year, he'd still be alive today!'.
    Funny, because before I got to the last paragraph, I thought 'Geez, someone could just be in the ER for something like a broken arm! What the heck does that have to do with suicidal thoughts?!?'. I think this is totally absurd. It goes back - again - to some decision made by some moron 4 levels (of managment) up in some office that has never been on the floor doing the actual work.
  2. by   MunoRN
    Quote from djh123
    Funny, because before I got to the last paragraph, I thought 'Geez, someone could just be in the ER for something like a broken arm! What the heck does that have to do with suicidal thoughts?!?'. I think this is totally absurd. It goes back - again - to some decision made by some moron 4 levels (of managment) up in some office that has never been on the floor doing the actual work.
    A broken arm can certainly be a result of intentional self harm, are you actually arguing that a broken arm never results from intentional self harm? If so, this is why we aren't allowed to just decide for ourselves which patients warrant a basic assessment of self-harm.
  3. by   ThePsychWhisperer
    Quote from djh123
    Funny, because before I got to the last paragraph, I thought 'Geez, someone could just be in the ER for something like a broken arm! What the heck does that have to do with suicidal thoughts?!?'. I think this is totally absurd. It goes back - again - to some decision made by some moron 4 levels (of managment) up in some office that has never been on the floor doing the actual work.
    I couldn't disagree with you more. You would be surprised the stigma mental health still carries, and as others have pointed out, how many people will not admit to having feelings of depression or suicidal thoughts unless directly asked. Even if that isn't their main complaint on that particular visit, it's still worth addressing, especially considering about 45,000 people commit suicide annually. It's not difficult to grab someone literature from the in-house emotional health unit or from the local mobile crisis prior to discharge; you know, just in case.
  4. by   djh123
    Quote from MunoRN
    A broken arm can certainly be a result of intentional self harm, are you actually arguing that a broken arm never results from intentional self harm? If so, this is why we aren't allowed to just decide for ourselves which patients warrant a basic assessment of self-harm.
    Of course I didn't mean a broken arm couldn't be intentional. But I don't want to comment further.
  5. by   hppygr8ful
    Ok now - let's consider that suicide rates among adults have increased by 125% in the past two decades and the rates among teenagers especially girl's ages 13 to 21 have increased by 30% in the past two years. I touched on this in my opinion piece "13 Reason's Why" which was posted on the Break Room page. Most suicides attempts these days are impulsive acts that have not been well thought out or planned. Often a person can feel that no one cares about them or can identify with what they are going through. Oftentimes people who are extremely accident prone may actually be passively suicidal. In my own case when I overdosed in 2002 I was suffering from severe post partum depression that had been going on for two years without intervention. I had once told my doctor that when I held my son I felt nothing. I received no intervention. Suicide within 3 days of an ER visit or hospital stay are considered sentinel events and nurse and doctors are being sued for malpractice for failing to perform screening on the patient. If a nurse or doctor simply chooses not to do a screening because they don't think it "necessary' and the patient attempts or completes suicide that practitioner can be arrested for and tried for malfeasance. Not worth risking my license for. These questions do need to asked with kindness and compassion though. Often times when I encounter a patient with suspicious injuries I do ask further questions. A simple compassionate "What happened" with a respectful silence for the answer can reveal a level of pain no one would have ever guessed was there. I know these screenings are annoying but if we can stop one person from ending their life we should be willing to try.

    HPPY
  6. by   thoughtful21
    Quote from beekee
    If you read the screening questions off the computer in a monotone voice, then the questions are probably not that useful. However, I look at my patients, sit next to them, and ask gently. You'd be amazed at the responses you'll get. The charge nurses have frequently commented on how often my patients admit to feeling depressed/suicidal when I happen to be the nurse. (And no, I don't work in psych).
    Beekee, sometimes I get flack from my coworkers for being "too involved" with patients about mental health issues. Patients often open up to me about things that they're struggling with. When I notice warning signs, I sit down and take extra time to talk with them. My coworkers sometimes seem a little irked about this... or maybe dismissive is a better word. One time when we were going into the room of a patient who had hinted at needing mental health help, I was told "don't ask." It seems like they would rather not know what's going on, so that they don't have to deal with it. They would rather just read the admission questions in a monotone voice and move on.
    Have you ever had this happen to you? How should I deal with it? I don't want to get over-involved or do more than I should. I do realize that psych issues are hard to work with, because they take extra time and don't have clear-cut answers. Also, I admit, like other people in this thread have said, that it can be hard to find enough time to form a good therapeutic relationship. And sometimes it's hard to even make a good referral for a patient, because of the lack of mental health care in rural parts of the country. And definitely in the ER it is hard to find time to address the issue properly. But I believe that it's very important, and I know that just taking a little time to talk with a patient, and showing that I care, can make a world of difference for them. Someone did this for me once, and made a world of difference for me.
    I guess to sum it up, I feel pressured about "wasting time" and "getting too involved" when trying to help patients with mental health issues, but I really want to help. Since I'm new (haven't even graduated yet, but I'm close), so I don't have much confidence yet, and I'm worried that my nursing judgment isn't very well developed. I was wondering if you'd ever had an experience like this, and if you could give me any advice?
    P.S. A related question...when does 'taking time to talk' and 'therapeutic nursing communication' cross the line to become 'counseling' and become out of my scope of practice?
    P.P.S. I welcome everyone's opinions/feedback, even if you disagree - they are all valuable!
  7. by   Euro_Sepsis
    I'm in paradoxical agreement with everyone in this thread. On one hand, I can completely see nurses as a whole probably missing some substantial chunk of SI, so 100% screening becomes the gold standard. For instance, we in the ED under-triage ~50% of MIs, as the literature from last year demonstrates. That's not apples-to-apples, but I'm not as good as I thought.

    On the other hand, it being a national patient safety goal to ask such an important question during ED triage is monumentally stupid for all of the reasons JKL pointed out. The line of check-ins just keeps getting longer, and so does the list of click-boxes that detract from focusing on the chief complaint.

    Asking at admission makes sense because some of the hustle has settled down and the patient can focus a little more meaningfully on these types of questions, but then that defeats the purpose of early screening, getting psych involved in the ED, etc.

    Alas, I'm not at a level of influence to change it, nor am I inclined to ascend to that echelon of nursing policy-making, so I'll just continue to grumble through it in triage. And I'll echo that I've never been caught off-guard by a positive SI screen. These patients stick out like a sore thumb to the trained eye when they look anxious, high, or when they just happen to bring all their worldly possessions just to be seen for some hinky complaint.
  8. by   /username
    God forbid you have to ask a question if it saves someone's life.
  9. by   elkpark
    Quote from Euro_Sepsis
    And I'll echo that I've never been caught off-guard by a positive SI screen. These patients stick out like a sore thumb to the trained eye when they look anxious, high, or when they just happen to bring all their worldly possessions just to be seen for some hinky complaint.
    Really? Because I work on the psych C&L service of a community hospital, we're the service that gets called for the consults when someone screens positive in the ED, and the experience here is that the ED nurses and physicians get caught by surprise all the time by the people who answer positively to the safety screening questions, and end up being mildly or seriously dangerous. I don't mind admitting that even I, as a psych CNS with >20 yrs experience, sometimes get caught by surprise by the people I am interviewing for some other psychiatric reason who endorse recent SI and are actually at risk. It's really not that simple or straightforward.
  10. by   RobbiRN
    Quote from /username
    God forbid you have to ask a question if it saves someone's life.
    This isn't about laziness; it's about being pertinent and efficient. The vast majority of the time, those who want help with an abusive relationship tell us on the doorstep. "I'm here because my boyfriend beat me up." Suicidal people are usually brought in after they tell someone or they are found following an attempt. There are plenty of red flags to raise suspicion. I can't say the screening questions have never uncovered a potential suicidal patient, but I didn't need the mandated questions to be suspicious. The plethora of irrelevant mandatory screening questions add hours to wait times, and God forbid someone dies in the lobby while I'm listening to a patient tell me about his trip to Morocco.
  11. by   OldDude
    Quote from djh123
    Funny, because before I got to the last paragraph, I thought 'Geez, someone could just be in the ER for something like a broken arm! What the heck does that have to do with suicidal thoughts?!?'. I think this is totally absurd. It goes back - again - to some decision made by some moron 4 levels (of managment) up in some office that has never been on the floor doing the actual work.
    I hear ya...You never know when a 4 month old is contemplating suicide...our intake questions for this subject at the pedi Urgent Care I work at are the same, regardless of age.
  12. by   elkpark
    Quote from OldDude
    I hear ya...You never know when a 4 month old is contemplating suicide...our intake questions for this subject at the pedi Urgent Care I work at are the same, regardless of age.
    Maybe not a 4 mo old, but plenty of older children are suicidal.
  13. by   OldDude
    Quote from elkpark
    Maybe not a 4 mo old, but plenty of older children are suicidal.
    OF COURSE!!! I'm referencing detached, irrelevant, decisions from administrators who have lost touch with reality as referenced by djh123...Geez!!! I was thinking the subject was that every patient is due an individual evaluation so why waste the time to fill in the data for a baby!!!!!!! Cmon!!

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