A female patient is admitted to an acute psychiatric ward after a suicidal attempt. She says to you "Why am I still alive? There is no valid reason for me to live in this world. Whatever happened in my life was a failure only. I am good for nothing". What would be your response that promotes therapeutic communication with this patient?

1. A

   "You have many reasons to live for"

2. B

   "Why are you thinking in a negative way?"

3. C

   "You are depressed now. That's why you are talking so"

4. D

   "You have been feeling like a failure for a while?"

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Explanation

• This response uses the therapeutic technique of reflection, which shows the nurse is actively listening.
• It validates the patient's feelings of failure without agreeing or disagreeing with them.
• By phrasing it as a gentle, open-ended question, it encourages the patient to share more about their experience.
• This approach is non-judgmental and helps to build the trust needed for a therapeutic relationship.
• It focuses on the patient's expressed feelings, which is the central issue at the moment.

Why Other Options Were Wrong

• Option A: This is a classic example of false reassurance. It minimizes the patient's intense pain and feelings of hopelessness, making them feel unheard and misunderstood.
• Option B: Asking a "why" question is a non-therapeutic technique that can sound accusatory or judgmental. It puts the patient on the defensive and can shut down communication.
• Option C: This response involves labeling the patient ('You are depressed') and interpreting their feelings for them. This blocks the patient from exploring and expressing their own unique experience.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Therapeutic communication with a suicidal patient in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Building a therapeutic rapport is the foundation of psychiatric nursing. Using techniques like reflection shows the patient they are being heard and respected, which is the first step toward establishing trust.
• In any situation involving suicidal ideation, the nurse's priority is patient safety. After establishing initial rapport, the next step is always a direct suicide risk assessment (e.g., 'Are you having thoughts of harming yourself right now?').
• What if the patient responds 'Yes' to 'You have been feeling like a failure for a while?' The nurse's next action would be to validate the feeling ('That sounds very difficult') and then gently explore further ('Can you tell me more about that?'), while maintaining constant observation and ensuring a safe environment.

How to Approach the Question

• First, identify the core of the question: it asks for the most therapeutic response to a patient expressing suicidal ideation and feelings of worthlessness.
• Analyze the patient's statement: The patient feels like a 'failure' and sees 'no reason to live.' This indicates hopelessness and despair.
• Evaluate each option based on the principles of therapeutic communication.
• Option A ('many reasons to live') is false reassurance; eliminate it.
• Option B ('Why are you thinking...') is a 'why' question, which is judgmental; eliminate it.
• Option C ('You are depressed...') is labeling and interpreting; eliminate it.

Concept Tested & Keywords

• Concept Tested: Therapeutic communication with a suicidal patient.
• Stem keywords: suicidal attempt, psychiatric ward, failure, good for nothing, no valid reason for me to live
• Lead-in keywords: What would be your response, promotes therapeutic communication
• Clinical cues: Patient's verbatim statement expressing hopelessness and worthlessness after a suicide attempt is a high-risk indicator requiring immediate therapeutic engagement.

Question ID

QpsBqSOxa9DI4UAtfuxo2z

Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 2 p. 124-126

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 3260-3262