I recently had a man sincerely, state to a staff nurse that if he had a gun he would shoot himself, and that he had friends that have done this. No psych history, other than good ole fashion depression, put on Zoloft. Recent Cabg x2. During care plan I point blank discussed this with him. He did state he said this. Went through the why etc.........Long story short. I take any of these statements for what they are worth. And asked for a verbal agreement . He agreed. I then put in writting and putting in this contract that if he had any ideas of doing harm to himeself that he would asap notify staff, he agreed. Had the ADON, SW his wife as witness. Then I proceeded to type up a 30 min check for 24 hrs, and an hourly check for another 24. His wife and other staff said well he is ok, he doesn't have a gun. I informed the staff, that you don't have to have a gun to do yourself in. His room is across from the nursing station, that is a plus. He is fine. But we don't have a policy. Does your facility have one? P.S. on his H&P, MD wrote "tab abuse", I am assuming this is medication abuse. Tex:rolleyes:

Good job, tex. I had a similar experience a few years ago. This woman followed through, she did not have a gun, but I happened to walk in her room and she had the garbage can liner over her head attempting to suffocate herself. You just never know. We do have a policy in place. We have a home health agency on campus, we staff a private duty with the resident 24/7. Also have a good psychiatrist on staff. I don't know if other facilities have this luxury, but it really helps.

dawn

You know, I've been in this situation before. It can get ugly. I had to fight tooth and nail to get this lady sent out to get some psychiatric care. Sweet old thing was completely psychotic, violent, depressed and suicidal and nobody wanted to deal with her. Incidentally, this all came about when attending MD decided to monkey around with her LIthium Carbonate (which had been prescribed by a psychiatrist, and she had been on that dose for a long time). I had to fight to get her 1:1 care with an HCA. MD just put her on VALIUM! Finally got a physcian to allow me to transfer her to emerge because nobody would take her as a direct transfer to a psych unit. They sent her right back saying that they couldn't take her. She had come to our unlocked interim care personal care unit from a hospital geriatric psychiatry unit. After 2 weeks of my protesting her being on our unit, she was transferred back to where she came.

It was just a really bad scene. Pt.s family issued a complaint against me b/c I had called them to accompany her to emerge (facility would not spare staff to accompany her). Unit was still healing from a patient suicide the year before. Nurse had found body of a patient who had hung himself in employee washroom (that was before I transferred there) so all the PTSD symptoms were resurfacing for everybody -- they were so afraid that there was going to be another suicide. Nobody wanted to touch the present patient. Absolutely no support from manager (actually told me that pt "was ours and it was up to us to deal with her"). I was able to get one of the shift co-ordinators to side with me.

I quit shortly after.

We found a demented pt trying to do herself in after having a dream about a dead child. So I talked to her about her child, and she told me all about him for a couple of hours while we took turns holding her hand. She finally cried and I said, "You know, you have children living here who need you now....do you think you could stay here for their sakes?"

And she agreed; they needed her more. That was the last time she tried to harm herself.

Sometimes it just takes a little patience and understanding, too....