The client tells the nurse, "I want to die.". Which is the best response by the nurse to facilitate therapeutic communication?

Question

1. "Now why would you say a thing like that?"
2. "Tell me more about how you are feeling.".
3. "We need to tell the provider how you feel.".
4. "You have too much to live for to say that.".

Answer 1

2
2. The client's statement warrants further investigation to determine how serious the client is about dying and whether the client has a plan. Research on suicide supports the claim that clients with well-established suicide plans are more likely to carry out the plan; thus, details about the client's feelings on dying and suicide plans are important for preventing self-injury and for planning medical therapy, nursing care, and client safety. To elicit more information from the client, the nurse allows the client to expand on the statement, "I want to die" by stating, "tell me more….". The statement displays concern for and value of the client by acknowledging the client's message and encouraging the client to continue. The nurse also avoids giving the client the option of not responding by using a statement instead of a question with a yes or no answer, "Can you tell me more…?" Safety is a major concern when a client wants to die, and the remaining options are unlikely to further the discussion to keep the client safe or to facilitate therapeutic communication.
1. "Why" questions are confrontational; in addition, this question displays lack of respect for the client's feelings, and possibly the nurse's discomfort with the topic, because the nurse forces the client to justify feelings.
3. Safety is a major concern and the provider needs to know about the client's feelings; however, the nurse has limited information to share with the provider and needs more information before reporting the client's statement.
4. Stating that the client has "... too much to live for…" is a stereotypical response forcing the client to justify feelings and displays a lack of respect and concern for the client. Pointing out the "bright side" or the many positive things in the client's life is a poor method of changing the client's perceptions because the client is unlikely to forget those aspects of the client's life and potentially increase feelings of guilt, worthlessness, or shame for being unable to enjoy those things other view as positive.