Forensic Nursing Chronicles

I recently was invited to help create a suicide risk screening form for our busy ER. With the help of our Psyche Nurse Clinician and Nurse Manager, we came up with a form that consists of several "observations" as well as questions to ask the patient. Their responses dictate a score and the score dictates the severity. Since the creation of the form, nurses are having difficulty assessing for this risk because they are uncomfortable and feel the questions are intrusive. A good interviewer will find a way to incorporate the questions into the interview. We have counseled several nurses regarding the interview process, having to work closely with them to find that level of comfort and professionalism that "allows" other nurses to comfortably ask questions. Some other barriers are nurses perceptions to mental illness. Some nurse believe that ALL psyche patients will lie or try to cover the truth, when in fact if you treat the psyche patient like they have an acute illness or a chronic illness, they are more likely to open up. Nurses should not be afraid to ask about diagnoses or medications. I have actually had one patient respond to this question: "Sir, what do you take this medicine for?" His response: "I take it so I don’t do what the voices tell me to do." Of course I was taken aback at first, but allowed my professionalism to rise up and move right on to the next question in my interview. He was very matter-of-fact about his mental illness and actually seemed at ease in speaking with someone without feeling judged. Embracing mental illness like heart disease and lung disease will only help the nurse in the care of this patient population.

Original Post:
July 13, 2009
Suicide Risk Assessment in Nursing Practice, comment
Nurses should not find themselves in uncomfortable positions when they reach the psychiatric section of an intake assessment. We must remember that medicine is holistic. The mental health of our patients is just as important as their physical health. If the patient is on psychiatric medications, we need to know that. We must know what the medications are, their doses, and their actions. If a person states that they have “chronic back pain”, this should not be any worse for an RN to hear than “I am chronically depressed”. Since depression can lead to suicidal thoughts, it should only be natural that the RN asks the patient if they have ever thought about suicide. It is of utmost importance to treat the entire person.

Original Post:
May 26, 2009
Title: Suicide Risk Assessment in Nursing Practice
I wanted to briefly address the need to emphasize suicide risk assessment in the acute care setting. I see in this inpatient setting a hesitancy by many nurses to assess patients for suicide risk. As acute care nurses, we often overlook the psychiatric components to our patients health and as a result, do not give the care often needed by our patient population. As psychiatric illness can play the role of contributing factor in some physical illness, I do see it as necessary to not forget this aspect of our nursing assessment, especially on patient admission. We are often afraid of offending or creating an awkward introduction to our patient/ nurse relationship, however I do see this as an obstacle that we, as nurses need to overcome to provide adequate care to our patients. The more open we are in addressing psychiatric needs, such as suicide risk or other chronic psych illnesses, the better trust we will build with our patients.

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