Case 1: Jerome, Age 23, Lives In An Impoverished Inner City ✓ Solved

Case 1: Jerome, age 23, lives in an impoverished inner-city

Case 1: Jerome, age 23, lives in an impoverished inner-city neighborhood. He finished high school but struggles with literacy. He advanced grades because of basketball skill but lacks stable employment, is bored, drinks with friends, feels pressure from family, and is considering suicide by driving off a bridge.

Case 2: Susie, age 17, is a college freshman who is depressed. She feels isolated at a large university, struggles academically, is grieving a close uncle's sudden death, and is distressed about her relationship. She has had recurrent thoughts of jumping from her dorm or finding poison.

Assignment: For each case, assess suicide risk by identifying acute and chronic risk factors and protective factors; outline a brief suicide risk assessment (including intent, plan, means, past attempts, and lethality); propose immediate nursing and psychiatric interventions, safety planning, documentation elements, appropriate referrals and follow-up; and discuss implications for nursing practice, prevention strategies, and ethical/legal considerations.

Paper For Above Instructions

Introduction

Suicide risk assessment and intervention require a structured, empathetic, evidence-based approach. The two vignettes—Jerome, a young adult with social and economic stressors, and Susie, an adolescent college student experiencing acute grief and isolation—illustrate different constellations of risk and protective factors that guide assessment, safety planning, and nursing interventions (NIMH, 2023; WHO, 2021).

Case 1: Jerome — Risk and Protective Factors

Acute and chronic risk factors for Jerome include male sex (higher lethality of attempts), recent unemployment and hopelessness, social isolation, substance use (alcohol), boredom and lack of purpose, family conflict, and a stated plan (driving off a bridge) indicating access to lethal means (vehicle) and intent (WHO, 2021; CDC, 2022). Protective factors are family connections (albeit strained), prior successful social bonds through sports, and no explicit history of prior attempts reported in the vignette (SPRC, 2019).

Brief Suicide Risk Assessment (Jerome)

  • Ideation: Reports thinking about “ending it all.”
  • Intent: Expresses willingness/intent by describing a specific method (driving off a bridge).
  • Plan: Described method is specific and plausible; timing unspecified but contemplated.
  • Means: Access to a car and a known bridge increases lethality potential.
  • Past attempts: Not described — must be directly assessed.
  • Protective factors: Family ties, athletic involvement, community connections.

This profile suggests elevated to high acute risk due to plan, intent, and access to lethal means (NIMH, 2023).

Immediate Interventions (Jerome)

Safety is paramount: if immediate danger is suspected, implement constant observation or supervised environment, remove/secure means (restrict car access), and consider emergency psychiatric evaluation or hospitalization if risk remains high (APA, 2019). Provide empathic, nonjudgmental engagement, validate feelings, assess substance intoxication, and involve family with Jerome’s consent when safe. Use collaborative safety planning rather than no-suicide contracts (Stanley & Brown, 2012).

Case 2: Susie — Risk and Protective Factors

Susie’s risk profile includes adolescent age (with rising suicide rates in youth), recent bereavement (uncle’s sudden death), social isolation in a large impersonal university, academic stress, relationship turmoil, and passive-to-active ideation (thinking about jumping or poisoning) (Goldston et al., 2016; Gunn & Lester, 2013). Protective factors include strong ties to family and prior extracurricular engagement; however, geographic distance from family reduces immediate protective buffering.

Brief Suicide Risk Assessment (Susie)

  • Ideation: Recurrent thoughts of jumping or poisoning.
  • Intent: Ambivalent; no explicit immediate intent but ideation is active and specific.
  • Plan: Has contemplated locations (top of dorm) and methods (poison), increasing concern.
  • Means: Dorm access to heights; potential access to substances—needs assessment.
  • Past attempts: Not reported—must be assessed.
  • Protective factors: Close family relationships and previous social engagement.

Susie appears at moderate to high risk given specificity of methods and recent acute stressors; further direct assessment needed.

Immediate Interventions (Susie)

Provide immediate, compassionate assessment and ensure safety (remove access to lethal means, increase monitoring). Facilitate access to campus counseling and crisis services; given potential lethality (height), consider higher-level care if intent escalates (Rudd, 2006). Engage family (with consent/consideration of minors and institutional policies) and create a safety plan, including emergency contacts, coping strategies, and scheduled follow-up (Stanley & Brown, 2012).

Safety Planning, Documentation, and Referrals

Safety planning should be brief, specific, and collaborative: identify warning signs, internal coping strategies, social contacts for distraction, supportive contacts, professionals/agencies to contact, and steps to make the environment safer (remove firearms, secure keys/car access, limit access to poisons) (Stanley & Brown, 2012). Documentation must record subjective statements, assessment findings (ideation, intent, plan, means), interventions performed, informed consent or refusals, notification of family/others, and disposition (discharge, hospitalization) to meet legal and clinical standards (APA, 2019).

Appropriate referrals include emergency psychiatric services for high risk, outpatient psychotherapy (CBT for suicide prevention or DBT for recurrent self-harm), substance use treatment for Jerome if indicated, grief counseling for Susie, and community resources (hotlines, campus resources, social services) (Linehan, 1993; NIMH, 2023).

Implications for Nursing Practice and Prevention Strategies

Nurses are often first-line responders for suicidal patients and must use trauma-informed, culturally sensitive assessments with validated screening tools (e.g., Columbia-Suicide Severity Rating Scale) and apply brief interventions such as safety planning and means restriction counseling (Posner et al., 2011; SPRC, 2019). Prevention strategies at the population level include improving access to employment and educational support for youths like Jerome, campus mental health outreach and bereavement support for students like Susie, and means restriction campaigns (WHO, 2021; CDC, 2022).

Ethical and legal considerations include duty to protect, confidentiality limits when risk is imminent, informed consent for treatment, mandatory reporting where applicable, and documentation to support clinical decisions and legal requirements (APA, 2019).

Conclusion

Both vignettes require prompt, individualized assessment and tailored interventions. Jerome’s combination of intent and access to a lethal means suggests high acute risk and need for immediate safety measures and linkage to social and vocational supports. Susie’s grief, isolation, and ideation call for rapid evaluation, grief-informed counseling, campus supports, and structured follow-up. In all cases, empathetic engagement, safety planning, means restriction, and timely referral to mental health services are evidence-based priorities for nursing practice (NIMH, 2023; Stanley & Brown, 2012).

References

  • American Psychiatric Association. (2019). Practice guideline for the assessment and treatment of patients with suicidal behaviors. American Psychiatric Publishing.
  • CDC. (2022). Suicide prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/suicide
  • Goldston, D. B., et al. (2016). Suicide prevention in youth: A developmental approach. Journal of Clinical Child & Adolescent Psychology, 45(2), 123–134.
  • Gunn, J. F., & Lester, D. (2013). Suicide, life stress, and bereavement among college students. Journal of American College Health, 61(6), 342–349.
  • Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
  • NIMH. (2023). Suicide prevention. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/suicide-prevention
  • Posner, K., et al. (2011). The Columbia–Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies. American Journal of Psychiatry, 168(12), 1266–1277.
  • Rudd, M. D. (2006). The assessment and management of suicidal behavior. Journal of Clinical Psychology, 62(2), 137–143.
  • Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264.
  • World Health Organization. (2021). Suicide worldwide in 2019: Global health estimates. WHO. https://www.who.int/publications

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