An adolescent whose peer committed suicide attempts suicide himself and is admitted to an inpatient mental health unit and assessed as being at high risk for self-harm

Question

Which of the following nursing actions would be most appropriate to assure his safety during his first few days in the hospital? a. Place him on every-15-minute checks while awake.
b. Search the patient and his belongings for dangerous material.
c. Have him sign a no-suicide contract on arrival to the unit.
d. Place him on direct one-to-one observation 24 hours a day.

Answer 1

D
The most effective way to ensure safety for a person at high risk of self-harm is to observe that person directly at all times. Even when belongings are searched and all dangerous times are kept from the patient, it is still possible to acquire everyday items that can be used as a means for killing oneself, such as blankets, sheets, and the cords from electrical equipment. Checks made every 15 minutes still allow a window of opportunity (the 15 minutes between the checks) that is more than sufficient to permit the completion of suicide, particularly by hanging, the method most often resulting in suicide in inpatient settings. Limiting checks to when the patient is believed to be awake further reduces their effectiveness. The patient need only feign sleep or awaken in the middle of the night to have an opportunity for self-harm without being observed. Research has shown that no-suicide contracts are of limited value; while they may motivate some persons to seek help from staff before acting on suicide ideation, they cannot be counted on to reduce risk.