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DSSSB - 28 August 2019 (Shift-1)
Mental Health Nursing
Medium

Which of the following would be a priority nursing intervention for a patient who has suicidal behaviour?

Appeared in: DSSSB - 28 August 2019 (Shift-1)

Explanation

  • The nursing process prioritizes Assessment first. Directly asking about suicidal thoughts is the primary method of assessing immediate risk.
  • This action allows the nurse to determine the level of risk (ideation, plan, means, intent) and implement appropriate safety precautions.
  • Contrary to a common myth, direct questioning does not introduce the idea of suicide. Instead, it opens a line of communication and can relieve the patient by allowing them to share their distress.
  • A thorough risk assessment is the foundation for creating a collaborative safety plan, which is a key evidence-based practice for suicide prevention.

Why Other Options Were Wrong

  • Option A: Avoiding the topic of suicide is dangerous because it prevents the nurse from assessing the level of risk and implementing necessary safety measures. It can increase the patient's feelings of isolation and hopelessness.
  • Option C: While involving patients in activities is a valid therapeutic intervention (milieu therapy), it is not the priority. Immediate safety assessment must come first. An actively suicidal patient may require one-to-one observation, not placement in a group activity.
  • Option D: Explaining the consequences of suicide is not the initial priority. During an acute crisis, the focus is on safety and empathy. This approach can be perceived as confrontational or judgmental and may shut down communication.

Related Visual

Visual explanation — Related Visual
Clinical Relevance
  • Nursing practice connection: Safe nursing care depends on performing Suicide Risk Assessment and Priority Nursing Interventions in the correct sequence, documenting the action clearly, and monitoring for the expected response.
  • A nurse's primary ethical and legal responsibility is to ensure patient safety (non-maleficence). A failure to adequately assess for suicide risk is a serious breach of the standard of care.
  • In India, suicide is a significant public health issue. Nurses are on the front lines and must be competent and confident in performing suicide risk assessments in any clinical setting.
  • What if? If a patient answers 'yes' to having a specific, lethal plan and the means to carry it out, the priority immediately shifts from assessment to direct, urgent intervention. This includes initiating one-to-one constant observation, removing all potentially harmful objects (e.g., belts, shoelaces, sharp objects), ensuring the patient is in a safe room (often near the nursing station), and immediately notifying the psychiatrist and treatment team.
How to Approach the Question
  • First, identify the keywords in the question stem. The keyword 'priority' is critical, indicating you must choose the most important and immediate action.
  • Next, recall the steps of the nursing process: Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE). The first and most fundamental step is always Assessment.
  • Evaluate each option against the nursing process. Option B ('Ask the patient...') is a direct assessment action.
  • Options C ('Involve patient in activities') and D ('Explain consequences') are interventions that would occur after an assessment is completed and a plan is made.
  • Option A ('Avoid bringing up the subject') is a failure to perform the assessment step and is therefore incorrect and dangerous.
  • Conclude that the assessment action (Option B) must be the priority to ensure patient safety before any other intervention is considered.
Concept Tested & Keywords
  • Concept Tested: Suicide Risk Assessment and Priority Nursing Interventions
  • Stem keywords: priority nursing intervention, suicidal behaviour
  • Lead-in keywords: priority
  • Negative lead-in flag: false

Question ID

QACdXnuJ35LnJ6hGrE2Y7J

Reference Book

E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 1 (pp 26-289 of 579) p. 217-219

E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 2 (pp 290-564 of 579) p. 108-110

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 8790-8792

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