Pediatric Patients Suicidal Case Study

This article is about caring for pediatric patients who are suicidal. I believe in coincided with what we have recently been learning about during our clinical experience. I was also interested in this article because I had worked in pediatrics for six years prior to working in a rehab/nursing home setting. After reading this article, I learned ways to carefully screen the pediatric patient, how to do an assessment and how some families act and what measures of support they need during their families time of crisis. This article gave a case study of a boy that was brought into the emergency department with his mother and grandfather. When the nurse met him in the reception area he was sitting in a chair with his legs pulled up to his chest and his shoe laces were untied. He avoided eye contact during their meeting. The mother in the case study was visibly upset. This boy was brought to the emergency department because this young boy was found in the kitchen holding a butcher knife to his neck, when his mother walked in and got the young boy to give her the knife. Prior to this day there were many changes in the young boy’s life, he recently started a new school and he was diagnosed with Asperger’s syndrome. This boy also had trouble making friends in his school and he was being bullied. Other children at school
were threatening this boy. This story made me think of all the children that are in PEHMS and how he seemed to have a lot of things in common with them. They were all in similar situations. The nurse after obtaining this history from his mother and asking about any medications, vaccinations, allergies, possible exposures to communicable diseases also needed to obtain his vital signs and head to toe assessment. The young boy let the nurse do his height and weight but as soon as the nurse put the stethoscope to the boys chest he felt his heart pounding and he thought it meant he was going to die. The boy had anxiety during the assessment so the nurse stopped the assessment and showed what she needed to do on his mother and after the boy relaxed a little bit, he allowed the nurse to finish the assessment on him. The nurse got a one on one to stay with this patient because he was at risk for doing harm to himself. The nurse also had to obtain an ECG and urine drug screen. In our clinical setting, I have seen the urine drug screen used on every patient but not the ECG. According to this article, it is important to obtain a baseline ECG because many psychopharmacologic agents can affect the conduction system of the heart. After the boy was medically cleared, he was eligible to meet with the psychiatrist and social worker. He had to wait for the psychiatrist and he became agitated and started kicking the wall. Security had to be called into the room and the safety door was lowered. The nurse removed their name badge and their bandage scissors as they were both safety hazards. The nurse re-entered the room keeping their pathway to the door unobstructed. All dangerous items were removed from the room. The nurse used many different techniques to deescalate the situation and used the mother to get information of things that have worked in the past. When the boy was ready to discharge, the nurse gave them education on a safety plan the called for keeping knives out of the boys reach and follow up for outpatient care. No medications were given to calm him down. The suicide rate in the entire world has increased over the past few decades with a greater number of boys attempting suicide then girls. In 2010, there was a study that found 14% of children ages 11-20 reported having suicidal thoughts within the previous month. According to this article, Native American males have the highest suicide rate in the United States for children over 10, and non-Hispanic black females have the lowest rate. Some psychosocial risk factors include, the presence of an underlying psychiatric condition, a history of prior suicide attempts, a history of physical or sexual abuse, and a lack of mental health treatment. Poor coping skills have been identified as a predictive of a suicide attempt in both sexes. Environmental and social risk factors include owning a gun in the household, being homeless or living in a corrections facility or group home, poor parent-child communication, social isolation, bullying and difficulties at school. Many emergency rooms are using the five level triage classification systems called Emergency Severity Index Triage Algorithm. This takes into account not only the acuity of the patient but also the number of resources that will be required during the evaluation. A level 1 patient would require immediate life-saving intervention. A level 2 patient would be considered in the “danger zone,” and needs emergent treatment. Level 3 patients need more the 1 resource, level 4 patients require 1 resource and level 5 patients require none. At the Children’s Hospital Boston, the use a screening tool that consists of 4 questions, “Are you here because you tried to hurt yourself?” “In the past week, have you been having thoughts about killing yourself?” “Have you ever tried to hurt yourself in the past other than this time?” “Has something very stressful happened to you in the past few weeks?” If the patient answers yes to one or more of these questions they become characterized as ESI level 2, and the nurse would explain the policy on physical and chemical restraints which are only used as a last resort. Some strategies that nurse’s use to promote successful interactions with the patient and their family members include active listening, close observation of behavior, attending to non-verbal body language, asking open-ended questions, conveying a non-judgmental attitude, clarifying information, and providing support. The patient’s safety is always the greatest concern as well as the staff’s safety. Family education is very important when working with suicidal patients, because their care is often managed at home. It is important for them to follow up with outpatient care, outpatient psychiatric support, and a home safety plan. Also, the nurse needs to let the family know if when they will need to seek emergency care again. This article has helped me gain a better understanding of the psychiatric patient, no matter the age, even though it focused on pediatrics.
All these techniques can be used when dealing with suicidal patients. Our role as nurse’s plays an important role in managing our patient’s care while they are in our care and promoting their health by educating our patients and their families. Education has been the biggest thing with all aspects of care no matter the illness our patients have. I have learned so much during this clinical experience and hope to continue learning as I continue my education, so I can continue to educate my
patients.

References
Schmid, MS, RN, CPNP-PC/AC, CPEN, A. (2011). Care of the suicidal pediatric patient in the ed: A case study. American Journal of Nursing, 111(9), 34-43. Retrieved from 5http://journals.lww.com/ajnonline/Fulltext/2011/09000/Care_of_the_Suicidal_Pediatric_Patient_in_the_ED_.24.aspx