Documenting Care

Psychiatric Nurse Practitioner as Educator for Psychiatric RN Documentation on Suicidality on the Inpatient Psychiatric Unit. 

Documentation of care given to suicidal patients on inpatient units is critical to treatment and ongoing care of anyone who is suicidal. It is also critical in deciding on when a patient is ready for discharge to a less restrictive environment in the community. I believe RN’s are capable of doing a suicide assessment and documenting the result. It should be done on every shift for anyone who has admitted to having suicidal thoughts, plans, or intent to take their own life. 

The psychiatric nurse practitioner may be available for any questions the RN may have. The psychiatric nurse practitioner should be available to teach RN’s as required, or as you may volunteer, to add to the RN’s psychiatric understanding of suicide assessment, psychotropic medications, and other complex psychiatric treatments and diagnoses. This should be a labor of love as nursing is our profession after all. 

As a Clinical Nurse Specialist (CNS) in Psychiatry, I did a lot of teaching for psychiatric nurses, other psychiatric staff and even the complete staff of a large medical center. Teaching suicide prevention was one theme that easily fell to me, but there were others. Through the years I found out that there was much more to teach on suicide than we all thought possible. Somehow it didn’t seem readily available. This blog will continue to provide content and available information on suicide prevention for your practice and discussion. 

The slides I have prepared help the RN to make the a more detailed evaluation of suicide prevention than just asking “Are you suicidal today?” or “Are you still having suicidal thoughts?” These type of questions may be necessary, but they are not especially building trust or helping the patient to open up about their suicidal thoughts, plans or intent. Open ended questions related to when the suicidality started, why particularly now was the patient considering ending their life. This is the main ingredient of the suicide assessment so that down the road treatment may be provided to help problem solve the patient’s dilemna. The psychosocial context that the patient is in related to the suicidal thoughts is also helpful. 

The patient’s spirituality or lack thereof may also be of concern to the person assessing a patient’s motivation for wanting to take their own life. While some clinicians may still find questions about spirituality to be inappropriate, many studies have shown that a spiritual life is part of a healthy life. 

Physical issues or disorders may also be a cause of suicidality. By asking questions in all of these dimensions of health and how they may relate to suicidality demonstrates concern on the part of the staff member asking the questions. This builds trust that is critical to being able to help a person who has suicidal thoughts plans or intent. The slides on “Documentation by RN’s on an Inpatient Mental Health Unit” gives structure to these areas of concern for the suicidal patient.

As far as documentation of suicide prevention by RN’s on each shift, I am making these slides available to anyone who wants to use them. Please request the “Documentation of Suicide Prevention by RN’s” to mjv.office@gmail.com. Any Psych NP, RN or other NP from another discipline is welcome to request the slides. The slides I send by email will be all in color or you may use those posted on the site. Please reference me and my blog if you use them. 

A Psychiatric Nurse Practitioners (PNP) may also find these psychiatric nurse documentation slides helpful for their own practice. In addition the PNP needs to evaluate the patient for medication for his/her depression and suicidality. More about treatment of suicidality with medication will follow in a subsequent blog. 

Please feel free to comment on any aspect of the slides. I appreciate your feedback.