# A nurse is caring for a 32-year-old client admitted to the psychiatric unit after attempting suicide by overdose. The client appears calm and cooperative during the initial assessment but states, 'I don't want to live anymore. I have a plan to end my life when I get discharged.' What is the nurse's priority action?

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> subject: Mental Health

## 문제

A nurse is caring for a 32-year-old client admitted to the psychiatric unit after attempting suicide by overdose. The client appears calm and cooperative during the initial assessment but states, 'I don't want to live anymore. I have a plan to end my life when I get discharged.' What is the nurse's priority action?

## 보기

1. Document the client's statements in the medical record and notify the physician during rounds
2. Immediately implement one-to-one suicide precautions and notify the physician **✔ 정답**
3. Encourage the client to discuss their feelings and explore alternative coping strategies
4. Assess the client's support system and discharge planning needs

**정답: 2**

## 해설

Immediate one-to-one suicide precautions are the priority for a client expressing active suicidal ideation with a specific plan. Other actions like documentation, therapeutic communication, or discharge planning are important but do not address the immediate safety risk.

## 심화 해설

Priority Action for Imminent Suicide Risk

The client's statement, "I don't want to live anymore. I have a plan to end my life when I get discharged," represents a clear and immediate psychiatric emergency. In the NCLEX-RN framework, this scenario falls under the Safe and Effective Care Environment category, specifically addressing the management of care and safety priorities. The client's calm demeanor, often described as a period of resolution after deciding to act on a suicide plan, does not reduce the lethality of the risk; rather, it can signal an even greater danger.

The clinical priority is to ensure the client's physical safety above all else. The research underscores that the period following a suicide attempt is one of the highest risk for a subsequent, potentially fatal, attempt. A study on developing risk management protocols for emergency department patients highlights the crucial role of immediate identification and management of repeat suicide risk [1]. The client's explicit disclosure of a future plan directly activates this high-risk protocol. The most effective, evidence-based initial step is to restrict the means for self-harm, which is achieved by implementing one-to-one suicide precautions. This intervention provides constant observation, removes access to potentially lethal items, and creates a safe environment, directly addressing the imminent threat.

While other options represent important aspects of care, they are not the immediate priority. A Safety Plan is a highly effective, evidence-based brief intervention for reducing suicide risk, as confirmed by systematic reviews on training healthcare professionals in its implementation [2] and pilot trials on enhancing its use [3]. However, a safety plan is a collaborative coping strategy for managing future suicidal crises; it is not a substitute for immediate environmental safety measures when a client is actively expressing suicidal intent with a plan. Interventions such as exploring feelings, assessing support systems, or documenting for later physician notification are secondary to the fundamental nursing action of protecting the client from immediate harm. The nurse must first stabilize the physical safety of the environment before moving on to therapeutic communication and discharge planning.

References (research sources)

- [1]Development of a Repeat Suicide Risk Management Protocol for Emergency Department Patients With Suicide Attempts: An Exploratory Sequential Mixed-Methods Study.Research articleTan R, Teng F, Wang JQ, Wang YD, Li LC, Hu DY. (2026) · DOI: 10.1111/inm.70252

- [2]Training health care professionals in safety plan implementation to prevent suicide reattempts: A systematic review.Meta-analysis/systematic reviewChalancon B, Vacher A, Leaune E, Vieux M, Poulet E, Leblanc J. (2026) · DOI: 10.1016/j.ijnsa.2026.100539

- [3]Increasing Safety Plan Use and Reducing Suicidal Ideation Among Emerging Adults: A Pilot Randomized Trial of the STARS Intervention.RCT/clinical trialBrown LA, Tran JT, Gallop R, Webster JL, Wolfe JR, Kautz MM, Zhu Y, Arcomano A, Nathan JB, Mayinja L, O'Connor AA, Mowery D, Mandell DS, Brown GK, Oquendo MA, Bauermeister JA. (2026) · DOI: 10.1111/sltb.70101

## 임상 시나리오

Managing Imminent Suicide RiskImmediate Safety Interventions
A patient stating a specific plan to end their life requires immediate activation of one-to-one suicide precautions. This is a psychiatric emergency, and ensuring physical safety is the sole priority over all other interventions.

Implement constant, arm's-length observation. Remove all potentially hazardous items from the environment, including sharps, cords, and personal belongings. A period of resolution or calm demeanor does not indicate decreased risk; it often signals the patient has finalized their suicide plan.

CautionDo not delay safety measures for documentation, therapeutic communication, or discharge planning. The immediate post-attempt period is a high-lethality window for a subsequent, potentially fatal attempt.

## 핵심 개념

- **One-to-One Suicide Precautions** — A continuous observation protocol where a staff member is assigned to monitor a patient at arm's length at all times to ensure safety.
- **Imminent Suicide Risk** — A clinical state where there is a clear, immediate threat of self-harm, often indicated by a specific plan, intent, and access to means.
- **Period of Resolution** — A deceptive calmness that can occur after a person has decided to act on a suicide plan, indicating increased rather than decreased risk.

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