The nurse is developing a plan of care for a client admitted to the psychiatric unit at high risk for suicide. The focus of the plan is to promote a safe and therapeutic environment
Which of the following interventions would the nurse include in the plan of care? 1. Place the client in a private room.
2. Establish a therapeutic relationship.
3. Assign a leadership task to the client.
4. Maintain a distance of 10 inches at all times.
2
Rationale: A therapeutic relationship will increase feelings of acceptance in the suicidal client. Placing the client in a private room would intensify the client's feeling of worthlessness. Placing the client in a leadership role can overwhelm the client, lead to failure, and reinforce the feelings of worthlessness. Distances of 18 inches or less constitute intimate space, and invasion of this space may increase the client's tension and feelings of helplessness.
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