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Ms. Queen is a 23-year-old single waitress who is brought to the emergency department (ED) by ambulance after a suicide attempt. Her live-in boyfriend had narrowly prevented her from shooting herself with a gun kept in their apartment. She has a minor scalp wound and remains under observation for a few hours after treatment. She is then interviewed by the psychiatric nurse and psychiatrist on call.
She states that she has been under increasing stress for the past two months as a result of entering a management training program at work. She ultimately failed at this venture and lost her job. She expresses a great deal of desperation because of the accumulation of several bills and the upcoming Christmas holidays. She admits to keeping these feelings to herself and self-medicating her growing fear and anxiety with drugs and alcohol. She states that she feels “like a total loser.”
Because Ms. Queen continues to state that she wants to kill herself, because of her reluctance to open up and share her feeling with anyone, and because her score on the SAD PERSONS Scale is 4, the decision is made to hospitalize her. After careful assessment, Ms. Queen is placed on antidepressant therapy and carefully monitored. In addition, problems relating to her depressive state are assessed and monitored (poor appetite, insomnia, self-care deficit, and anxiety). After 3 days on suicide precautions, she is no longer acutely suicidal and agrees to continue treatment in the outpatient division of the hospital. In this system, outpatient nurses rotate through the ED. Ms. Queen requests assignment to the nurse who has seen her initially.
Assessment
Objective Data
Reported first suicide attempt in a 23-year-old woman
Self-medicating with alcohol and substances (denies chronic use)
Isolated without social support systems
Recent failure at work and subsequent loss of job
Mounting debt at holiday season
No history of bipolar disorder or related behaviors
Subjective Data
“I love my boyfriend, but I don’t like to talk about my problems.”
“I have a lot of friends, but they don’t really know me; I keep secrets from everyone.”
“I just feel so down and depressed.”
“I’m constantly getting in over my head and screwing up.”
“I don’t want my family to find out what a mess I’ve made of things . . . again.”
Self-Assessment
Mrs. Ruiz is a registered nurse with a bachelor’s degree and 5 years of experience. She remembers Ms. Queen from the emergency evaluation and expressed reluctance to take the assignment. She seeks out the clinical supervisor to discuss the case. In talking about her feelings, she realizes that she wants to avoid this patient for two reasons. The first is that Ms. Queen makes her feel anxious and inadequate by being impatient, agitated, and angry.
In addition, Mrs. Ruiz disapproves of Ms. Queen’s attempt to end her life. “She is so young and has her whole life in front of her. How bad can her problems be? My Catholic faith makes suicide difficult to accept.” Mrs. Ruiz also notes the countertransference involved in that Ms. Queen reminds her of her own daughter. Mrs. Ruiz recognizes her own feelings and can now better focus on Ms. Queen’s issues: she feels angry and helpless after losing her job and facing financial concerns; her isolation seems self-imposed because she pushes people away and keeps her feelings to herself, probably because of low self-esteem. After consultation, Mrs. Ruiz agrees with her supervisor that she can work with Ms. Queen.
Questions:
Identify at least two appropriate diagnoses for this patient. Provide evidence to support each.
It is clear that humiliation, shame and despair have been real precipitants to Ms. Queen’s attempt to end her life. What other precipitants or stressors are commonly connected to suicidal behavior, particularly identified as part of the SAFE-T assessment tool?
Mrs. Ruiz wants to help this patient identify for herself protective factors she may be able to look to as she gets stronger. What is the difference between an internal and external protective factor.
Students must include 1-2 APA-style references within the last 5 years for their initial post and respond to at least 2 participating classmates, with a substantial descriptive answer, in order to receive full credit for this discussion.
To enhance your submission, include more specific, measurable, and time-bound elements in the outcomes.
