Editing Mental Health and Psychosocial Nursing – RN Flashcards (section)

== Suicide, Safety, and Legal ==

;Strongest single predictor of suicide, and the strongest symptom predictor
:A prior suicide attempt is the strongest historical predictor. Hopelessness predicts suicide more strongly than depression severity itself.

;Five-step suicide assessment sequence
:Ideation, plan, access to means, intent and deterrents, and preparatory behavior (giving away possessions, writing a note, settling affairs). A specific plan with available lethal means and a set time requires immediate one-to-one observation within arm's reach.

;Why are no-suicide contracts not an acceptable safety measure?
:They are not evidence-based and do not reduce suicide risk. Use a collaborative safety plan instead: warning signs, internal coping strategies, supportive contacts, professional and crisis contacts, and specific means-restriction steps such as removing firearms from the home.

;Least restrictive intervention sequence for escalating behavior
:Verbal de-escalation, then voluntary time out with reduced stimuli, then offered PRN medication, then seclusion, then restraint. Restraint is an emergency measure only, never for convenience or punishment and never a substitute for staffing.

;Restraint requirements for violent or self-destructive behavior
:A provider order is required and may never be written PRN. A face-to-face evaluation must occur within 1 hour of initiation. Orders are renewed every 4 hours for adults 18 and older, every 2 hours for ages 9 to 17, and every 1 hour for children under 9. Nursing duties include frequent observation, circulation and skin checks, range of motion, fluids and toileting, documentation of less restrictive measures tried, and discontinuation at the earliest safe moment with debriefing.

;Does involuntary commitment remove the right to refuse treatment?
:No. Involuntary admission and incompetence are separate determinations. A committed client generally retains the right to refuse treatment unless adjudicated incompetent or unless emergency treatment is needed to prevent imminent serious harm, using the least restrictive effective measure.