Nurse Mary is assigned to care for a suicidal client. Initially, which is nurse’s highest care priority?

Correct Answer: B. Exploring the nurse’s own feelings about suicide.

The nurse’s values, beliefs, and attitudes toward self-destructive behavior influence responses to a suicidal client; such responses set the overall mood for the nurse-client relationship. Therefore, the nurse initially must explore personal feelings about suicide to avoid conveying negative feelings to the client.

• Option A: Assessment of the client’s home environment and relationships may reveal the need for family therapy; however, conducting such an assessment isn’t a nursing priority. A clear and complete evaluation and clinical interview provide the information upon which to base a suicide intervention. Although risk factors offer major indications of the suicide danger, nothing can substitute for a focused patient inquiry. However, although all the answers a patient gives may be inclusive, a therapist often develops a visceral sense that his or her patient is going to commit suicide. The clinician’s reaction counts and should be considered in the intervention.
• Option C: Discussing the future and providing anticipatory guidance can help the client prepare for future stress, but this isn’t a priority. If suicidal ideation is present, the next question must be about any plans for suicidal acts. The general formula is that more specific plans indicate greater danger. Although vague threats, such as a threat to commit suicide sometime in the future, are the reason for concern, responses indicating that the person has purchased a gun, has ammunition, has made out a will, and plans to use the gun are more dangerous. The plan demands further questions. If the person envisions a gun-related death, determine whether he or she has the weapon or access to it.
• Option D: Referring the client to a clergyperson may increase the client’s trust or alleviate guilt; however, it isn’t the highest priority. The only way to prevent suicides is to work in an interprofessional team that includes a mental health nurse, psychiatrist, the primary care provider, social worker, and nurse practitioner. Practitioners must work with the patient’s family and friends, as well as with the other patients who knew the client.