Case study - Depression and suicidal ideation: Nursing

Nurse. Iris works on an inpatient psychiatric unit and is caring for da 30 year old patient with a history of depression and previous suicide attempts who was admitted for suicidal ideation.

In collaboration with the registered nurse, RN Amrita. Nurse Iris goes through the steps of the clinical judgment measurement model to make clinical decisions about des care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, nurse Iris recognizes important cues including D's vital signs which are temperature 98.9 °F or 37.1 °C heart rate, 65 BPM, R 16 breaths per minute and BP.

100 and 16/70 millimeters of mercury. She also notices D does not make any eye contact and has a flat effect.

Hi, Dee, I'll be your nurse today. How are you feeling?

I am upset. My friend brought me to the hospital because I told him I wish I was dead.

I don't wanna be here anymore. I'm sorry to hear that.

I want you to know that I and the rest of your medical team care about you. We're here to support you and keep you safe.

Next nurse Iris analyzes these cues. She reviews the electronic health record or EHR and notes that D is prescribed FLUoxetine for depression and has been hospitalized in the past year for suicidal ideation.

She also notes that D scored in 19 out of 27 on his PHQ nine assessment, which is a nine question self reporting depression survey indicating a moderately severe level of depression.

Nurse. Iris recognizes that dee needs a safe environment while he receives treatment for his depression and suicidal ideation.

Now, using the information she's gathered along with des medical history nurse, Iris reports her findings to RN Amrita. And together they choose a priority hypothesis of risk for suicide.

Then they generate solutions to address D's suicidal ideation that will include pharmacologic and nonpharmacologic interventions.

And they establish the expected outcome that after intervening D will take part in a safety contract and will remain safe from self harm.

Nurse Iris then takes action to implement these solutions. First, she confirms that items D could use to harm himself like belts, shoelaces and drawstring pants have been removed from his room.

An unlicensed assistive personnel or UAP is assigned to sit with D to prevent self harming behaviors. Next, she checks the EHR and notes D is prescribed an antidepressant.

She gathers the supplies and enters D's room D I have your antidepressant medication for you called sertraline. I noticed in the progress notes that you stopped taking your FLUoxetine at home.

I hate FLUoxetine. It gives me headaches.

I'm sorry, that, that medicine made you feel sick. How have you been feeling since your last dose of sertraline?

It didn't give me a headache yesterday. It doesn't matter though.

I won't be here much longer anyways. Nurse Iris then administers the sertraline.

According to the principles of safe medication administration, it must be overwhelming and tiring to feel depressed all the time.

Your friend who took you to the hospital must care a lot about you. If you want, I can ask them to visit when you're feeling ready.

Sure, I know that RN Amrita talked with you about something called a safety contract. It's a document we'll work together on so you can identify feelings that make you want to harm yourself.

Ok? Nurse Iris answers des questions about the safety contract and together with RN M.

Rita de signs the safety contract. Soon after the psychiatrist comes to visit with D and conducts a thorough suicide assessment.

At the end of her shift, nurse, Iris Re enter Dee's room to evaluate the outcome of her actions. She takes these vital signs which are temperature 98.4 °F or 36.9 °C, heart rate, 62 BPM, respirations, 16 breaths per minute and BP.

100 and 20/78 millimeters of me de has continued to work on the safety contract and remained free from harm and tells nurse Iris that his friend will be visiting tomorrow.

All right. As a quick recap, nurse, Iris recognized and analyzed cues related to des risk for suicide and in collaboration with RN M Rita prioritized hypotheses and generated solutions to address this problem.

Nurse, Iris and RN M Rita then implemented pharmacologic and non pharmacologic measures and evaluated DES outcomes and compared them to the expected outcome since de took part in a safety contract and remained free from self harm.

They determined the plan of care was successful.