Nurses and suicide patients

SarasotaRN2b · Jul 2, 2005

I am curious, on several occasions I have seen nurses delay or withold care for pts. hospitalized for suicide attempts -- medically hospitalized not psych. I am wondering about that. I know nurses for the most part deal with people that are struggling to live through some pretty horrendous problems and I kind of wonder how you as nurses feel about working with suicide pts.

What do you mean by delaying or withholding care? I think that if a suicidal patient is in the hospital for a medical reason, you take care of that, but also make sure that adequate psychiatric counseling is also available. Withholding care seems to be the antithesis of nursing.

Kris

madwife2002, BSN, RN · Jul 2, 2005

I have no problem i didn't come into nursing as a judge.

ps maybe we should the expert opinion of Tom Cruise, he seems to be the new professional on mental health problems.

ZASHAGALKA, RN · Jul 2, 2005

I've never seen care withheld - that would be counter-productive, even if you don't like taking care of suicide patients - the longer the time until they are 'medically cleared' the longer the time they stay in the hospital before they can be 'psychological assessed'.

I do see a prevailing attitude of 'taking my time away from patients that really need my time'. But this I can understand, even if it's not right. Somebody that 'creates' their health problems are taking up space and time from those that had no choice in being sick.

This is especially true if the unit is full, there are 2 suicide watches, and the AMI has to sit in the ED as a result.

Some suicide patients can consume tons of time being hostile and agressive, etc. I normally explain on admission that 1. Although I have some psych training, I'm not a psych nurse - my primary job is to treat their medical problem first so that then they can get psych help later. 2. I explain the concept of 'escalation' - I will meet them at the level they meet me. If they are calm and polite, so am I. If they are aggressive and rude, while I will not be aggresive and rude, the tactics that I will use to address that behavior will likely be perceived as such (restraints if they strike at me or try to leave if under emergency detention, I don't repond well to demands - ask me for water, I will comply, demand it, and I will decline., etc.) But that's not withholding care, that is, in fact, in my opinion, a care strategy. 3. I point out that, as I have time, I am happy to provide an ear if needed. Fortunately, I work in critical care (at least in my area, we tend to do more suicide patients because the ratios allow for suicide watch.) Those same ratios do allow for, whats the term, psychosocial communication. Oh and I love the concept of 'therapeutic silence' - you'd be amazed what you can find out when an uncomfortable silence compels your patient to say anything to end it.

~faith,

Timothy.

MandyInMS · Jul 2, 2005

I have had to assume care for suicidal pts on a few occasions..It's not fair for me nor the pt in a medical setting imo..they have been admitted to our med/surg floor until a psych bed becomes available..usually the doc orders a family member/friend to stay with pt at all times..how often does someone stay with the pt 24/7 ? rarely..q 1 hr room checks per nursing,call md of any changes/increased anxiety/threats of harm, ect....I would NEVER neglect nor delay care to any pt..reguardless of diagnosis..it's not my job to judge anyone..I do have objection /concern about taking care of these pts because of safety issues..I don't have eyes in the back of my head and cannot watch them at all times and NEVER do we have enough staff to cover one on one ..not safe , most of the suicidal pts are ambulatory and could leave at any time they felt like it and are quite smart in figuring out when staff make rounds and are busy doing meds ect, and could easily sneak out...just puts everyone involved in a sticky situation. Of course I notify MD/supervisor if no one is staying with pt..response is watch them the best you can...I just hope for my sake and the pts that's good enough and no harm comes to him/her..but there's always that possibility, and I don't like being put in that situation.

Works2xs · Jul 2, 2005

For a prospective student's curiosity... is that idea at all common? I remember from my fire dept days that if we let those sorts of judgements get into the picture, we'd rarely roll out of the station. I mean, if we had a nickle for every self-inflicted malady that resulted from personal neglect, short-sightedness, taking unnecessary risks, i.e., ending up sick/hurt due to poor choices, we could give everyone in the profession a raise!

...sir, gasoline is not the same as lighter fluid... rock climbing can be dangerous to your health... drinking in combo w/ is a good way to get hurt... no, your palm is not a good alternative to the cutting board when using that bagel knife...shoulda been wearin' a helmet when skating/biking/driving your harley...you shoulda come in before that foot turned completely black...

I'd bet a paycheck you've all seen the same stuff. I know a certain amount of that cynicism is pretty much required to maintain your own sanity, but acting on it would seem totally over the top. Perhaps I'm just naive. All the same, someone slap the bejeebus outta me if I ever exhibit that attitude.

Besides, unlike the choices some folks made to get them into the local hospital, there's a rather convincing argument that the truely suicidal make the attempt because they believe there IS no other choice.

ZASHAGALKA, RN · Jul 2, 2005

I do see a prevailing attitude of 'taking my time away from patients that really need my time'. But this I can understand, even if it's not right. Somebody that 'creates' their health problems are taking up space and time from those that had no choice in being sick.

For the record, I want to point out that I did mention that such judgements aren't 'right', even if I can understand them and maybe exhibit them from time to time.

But if you deal with suicidal patients routinely, can you honestly deny that you've never said / thought some variant of 'they ought to teach a course on how to do it right'. It's macabre and wrong, but as I said in another thread: some preverse humor/cynicism is required to keep your sanity. Nursing requires too high an emotional expenditure not to have a 'healthy' balance. And as long as it doesn't affect care, I do believe it's healthy.

It's how we keep our empathy sharp.

~faith,

Timothy.

Tweety, BSN, RN · Jul 2, 2005

I frequently care for suicide attempts, especially if they've caused some trauama like a gunshot, stabbing, even cared for a guy who jumped from a bridge and broke his neck, people who've tried to kill themselves driving at high speeds in their cars.

The pysch facilities here don't take them until they are medically clear and have no equipment (like crutches or halos) or dressings they can't change themselves.

I'm not understanding what you are saying about delaying treatment and withholding care. That's against the nurse practice act and unethical. So perhaps you can clarify a bit.

I agree with the above poster that while they are recieving med-surg care sometimes their pysch needs are not met, as we are med-surg nurses, not pysch. Most of the time the patient's however are under the care of a phsychologist who sees them once a day. We also keep them under 24 hour supervision with a sitter for suicide watch. Most of the time they are under involuntary commitment, so they can't leave.

Mandy, I agree, it's dangerous not to have the patients watched.

But for those with serious injuries sometimes they are in the hopsital a long time without proper pysch treatment.

Works2xs · Jul 2, 2005

ZASHAGALKA - ack.. I did see your statement regarding "right" and understood your meaning. If I came across as accusatory, my deepest appologies.

I also noted the need for a certain amount of thick-skinned attitude. Lord knows we often used "gallows humor" in the department as a sort of self-defense mechanism. The distinction between that (what you mentioned) and what the OP was apparently witness to is subtle, but the difference huge. In the former situation, you use the mind-set to ENABLE you to provide care (gets you past the often horrid reality of the situation) - whereas the latter attitude is one that seems an excuse to NOT provide care (or delay, or adversely affect).

ZASHAGALKA, RN · Jul 2, 2005

ZASHAGALKA - ack.. I did see your statement regarding "right" and understood your meaning. If I came across as accusatory, my deepest appologies.
I also noted the need for a certain amount of thick-skinned attitude. Lord knows we often used "gallows humor" in the department as a sort of self-defense mechanism. The distinction between that (what you mentioned) and what the OP was apparently witness to is subtle, but the difference huge. In the former situation, you use the mind-set to ENABLE you to provide care (gets you past the often horrid reality of the situation) - whereas the latter attitude is one that seems an excuse to NOT provide care (or delay, or adversely affect).

No apologies needed and I didn't feel accused. I just didn't want to point out the "gallows humor" part of that post without re-acknowledging that I wasn't actually defending that kind of humor, just noting its inevitability - we are human.

I do think our macabre humor makes us better nurses because empathy is a commodity and you cannot give and give without having outlets to recharge.

But I agree that an outlet is one thing, using it as an excuse to deny or abrogate care is completely another.

I live in a college town with lots of students making suicidal attempts and/or gestures. I'm actually quite sympathetic. I feel blessed that my life has taken on more or less the wonderful template that it is. I can't imagine looking at living as anything but an awesomely wonderful experience and it saddens me that someone can get to the point where they can't feel my exuberance.

~faith,

Timothy.

Katnip, RN · Jul 2, 2005

In our ED we take care of a lot of suicide attempts. Young kids, too. Our youngest was 7years old.

We take care of them medically, then if they are well enough, we send them to our psych ed to be evaluated and placed into a psychiatric treatment center. If they need continued medical care, they go to the floor, yes, with a sitter.

As far as gallows humor, yep, we all use it, but I've never seen it directed specifically at a patient.

And never, ever have I seen treatment delayed for anyone who needed it. Of course tell that to the people in the waiting room.

People who attempt suicide have deep emotional and probably chemical imbalance problems. They need help just like anyone with a medical problem.

I'm rambling, so I'll stop now.

drriley · Jul 3, 2005

I do see a prevailing attitude of 'taking my time away from patients that really need my time'. But this I can understand, even if it's not right. Somebody that 'creates' their health problems are taking up space and time from those that had no choice in being sick.
This is especially true if the unit is full, there are 2 suicide watches, and the AMI has to sit in the ED as a result.

I have absolutely no understanding of a health care professional who would have the attitude that a psych/suicide patient is taking time away from people who "really need it" or "really ARE sick." And the idea that an attempt suicide pt. has any more "created" his/her situation than the AMI pt. who is overweight and drinks and smokes is ridiculous. Patients do not suffer depression, suicidal ideation or attempt suicide because it is "fun". These are sick people who deserve every bit as much professional care, attention and concern as any other patient who crosses your path.

It is a tragedy of our society and health care system that psychiatric patients are VERY often treated as second-class and/or as a nuisance. Imagine the outrage if a cancer patient were treated as a nuisance/interruption in the ER, a waste of bed space in the ICU, and disposable when it comes to funding of adequate inpatient and outpatient resources.

Isn't there a saying about a society being best judged by how well it treats its most vulnerable?