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For the third time within a month, a client with borderline personality disorder took a handful of pills, called 911, and was admitted to the emergency department. The nurse overhears an unlicensed staff member say, "Here she comes again. If she was serious about committing suicide, she’d have done it by now." The nurse determines there is a need to teach the staff member which of the following?

1. Clients with personality disorders rarely kill themselves.
2. Each suicidal attempt should be taken seriously.
3. Exploration of suicidal ideas and intent should be avoided.
4. The nurse should prepare the client for direct inpatient admission.


Option 2 is correct. The risk of suicide is not reduced because a person makes frequent attempts or threats of suicide. Instead, the risk for successful suicide is greater once a single attempt has been carried out. Persons who make verbal threats or attempts are conveying their desperateness and need for assistance in controlling their own impulses for self-harm. Clients with certain personality disorders, including borderline personality disorder, are actually at higher risk for suicide (option 1). These individuals are easily overwhelmed and tend to react dramatically to events that others would find more tolerable. The nurse is obligated to provide protection to the client in a suicidal crisis (option 3). In every suicidal situation, the nurse must objectively explore the nature, frequency, and specificity of the suicidal thoughts. Talking about this, and determining whether a plan and a means for suicide are present, is a standard part of nursing intervention with the suicidal client. Talking about suicide does not increase the risk for suicide, which is a commonly held myth among nonprofessionals. There is not enough information to know whether the client will be admitted to an inpatient unit (option 4). If a sufficient action plan is developed that will provide for the client’s safety outside the hospital, it is possible that the client can be discharged from the emergency department. Notice that the client has made three suicidal attempts within one month's time. Even if you didn't know that the client had borderline personality disorder, focus on the probability that that the client must have a certain sense of desperation to aid in making a selection.


Member since: April 2011
(Boynton Beach,FL) Original question source

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