Holding Hope

[verene, MSN]

I work with a lot of suicidal patients, and have a fairly high degree of comfort working with actively suicidal individuals. The vast majority of my patients I can hold hope for - even if they are in crisis now -- I strongly believe that we can help them move into a non-crisis place and that they will live, some with chronic baseline passive SI, but many with out SI at all.

Recently, however, I worked with a patient that I genuinely felt fear for, and who I do not expect to survive long-term. I think this was the highest level of emotional pain I have ever been exposed to, and despite their hospitalization and supports, I really don't know that it will be enough to help them move into less extreme emotional space, or to move them beyond their suicidal thinking.

I feel like so much of being a Psych RN is working to instill hope, and even if the patient can't feel hope yet, holding hope for them until they can feel it for themselves - it is rare that I feel that I am incapable of holding hope for a patient, in 7 years of mental health / health care work, this is only the second time I've felt this way. I'm rather at a loss emotionally for myself as well as to what can be done for this individual.

I debriefed some with my team, but we are all overwhelmed by the intensity of the pain this individual has. To those of you with more experience - how do you process these really intense cases? Any strategies for finding hope in a case that feels completely overwhelming and hopeless?