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Difficulty: HardGrief and Loss

An occupational health nurse is conducting a follow-up assessment on an employee who returned to work 6 weeks ago after the sudden death of their spouse in a traumatic accident. Over the past month, the employee has reported severe insomnia, frequent crying spells, and difficulty concentrating on work tasks. During today's visit, the employee appears remarkably relaxed, hands the nurse a prized vintage watch stating, "I want you to have this; I really won't be needing it anymore," and says, "I've finally figured out how to make all this pain stop." Which of the following is the priority nursing action?

  1. A
    Document the significant improvement in the employee's mood and coping abilities.
  2. B
    Validate that the employee has successfully reached the acceptance stage of grieving.
  3. Ask the employee directly if they are having thoughts of suicide and if they have a plan.Answer
  4. D
    Escort the employee to the human resources department to arrange immediate medical leave.

Answer

Ask the employee directly if they are having thoughts of suicide and if they have a plan.
The employee is exhibiting classic, high-risk warning signs of impending suicide: sudden and unexplained mood improvement after a period of severe depression, giving away prized possessions, and making ambiguous statements about ending their pain. The priority nursing action is to ensure client safety by conducting a direct, unambiguous assessment for suicidal ideation and intent. Nurses must ask direct questions when self-harm is suspected.

Step-by-Step Solution

1
Analyze the client's clinical presentation and recent history.
The client has a recent history of severe grief and depression following a traumatic loss, which has suddenly shifted to a relaxed state.
Identifying changes in baseline behavior is crucial for accurate assessment in grieving individuals.
2
Identify key behavioral cues and verbal statements.
The client is giving away a prized possession, reports feeling relaxed, and states they have figured out how to make the pain stop.
These are classic warning signs that a severely depressed individual may have finalized a suicide plan, bringing them a false sense of peace.
3
Determine the highest priority nursing intervention using safety principles.
The immediate priority is to directly assess the client's risk for self-harm.
Client safety always takes precedence over documentation, administrative tasks, or exploring psychosocial stages.

Key Concept

Suicide Risk Assessment in Grieving Clients
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Topics

Grief and Loss

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