Scenario For Week 7 Case: You Are A PMHNP Working In ✓ Solved
Scenario For Week 7 Case: You are a PMHNP working in
You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14-year-old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not “live without her” and decided to take his own life.
Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the client’s parents (using contact information retrieved from the 14-year-old’s cell phone). Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.”
The Assignment: Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not? Based on the laws in your state, would the client be eligible for involuntary commitment? Explain why or why not. Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain. If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment. If the client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client.
Paper For Above Instructions
In the scenario provided, a 14-year-old male has attempted suicide by overdosing on Benadryl, highlighting a critical situation that requires immediate mental health assessment and intervention. The primary concern is the client’s safety and well-being after such a tragic event. As a Psychiatric Mental Health Nurse Practitioner (PMHNP), the decision regarding voluntary or involuntary commitment must be made with careful consideration of the client’s mental state, the legal framework of the state, and the perspectives of the parents involved.
Voluntary Commitment
In this case, recommending voluntary commitment may initially seem appropriate due to the severe nature of the suicide attempt. Voluntary commitment allows individuals to seek help while granting them the autonomy to agree to treatment willingly. This form of commitment is advisable when a patient acknowledges their troubled state and expresses a desire for assistance with mental health issues.
However, in this situation, the client’s refusal to communicate with medical staff raises significant concerns regarding his willingness to engage in treatment voluntarily. The presence of a suicide note and the client’s expressed feelings of hopelessness indicate a serious risk of future self-harm and a need for structured, more intensive intervention. Therefore, while voluntary commitment could still be suggested, it is not guaranteed given the client’s current mental condition and reluctance to speak with healthcare providers.
Involuntary Commitment Considerations
Next, we must consider whether involuntary commitment is a viable option under the law in this state. Most states allow for involuntary commitment if a person is deemed to be a danger to themselves or others. The criteria for involuntary commitment typically include evidence of suicidal ideation, an attempt on one’s life, or severe distress that renders the person incapable of making informed decisions regarding their care.
In this scenario, the client’s actions of attempting to take his life indicate a clear and immediate danger to himself, which typically satisfies the criteria for involuntary commitment. Additionally, the fact that he is a minor complicates the situation further. Given that he is not legally competent to consent to treatment, mental health professionals might be justified in initiating an involuntary process based on his parent’s disagreements and concerns for his safety.
Confirmation or Challenge of Initial Recommendations
Upon further review of the state laws regarding involuntary commitment, it would likely confirm the recommendation for involuntary commitment due to the evident risk of suicide. Many states require healthcare professionals to evaluate risk factors comprehensively, including any evidence of suicidal thoughts or behaviors. The existing situation strongly supports a commitment to ensure that the client receives the necessary psychiatric care and support to address his emotional distress and suicidal tendencies.
Addressing the Parents' Disagreements
Given the conflicting viewpoints of the client’s parents, it is crucial to consider their role in the treatment process. The father’s insistence on hospitalization is appropriate in light of the situation. In contrast, the mother’s dismissive stance towards her son’s actions raises concerns about her understanding of the serious implications of suicidal behavior.
If the client does not meet the criteria for involuntary commitment, engaging both parents in discussion may be necessary to address their differences in perspective. The use of therapeutic communication techniques can help the parents understand the seriousness of the client’s condition and the need for professional intervention. As a PMHNP, providing education regarding mental health, suicide risk factors, and the necessity of seeking treatment is essential.
Initial Actions for Client Treatment
If the client is not eligible for involuntary commitment, initial treatment actions might include establishing rapport and a therapeutic relationship with the client when he feels ready to communicate. Utilizing individual counseling sessions focused on building trust could encourage him to articulate his feelings and reasons behind the overdose attempt. Incorporating cognitive-behavioral strategies may also prove beneficial in restructuring negative thoughts and developing coping skills.
Involving a multidisciplinary team will also be essential for comprehensive care, as a psychiatrist could evaluate the need for psychopharmacological treatment if necessary. Support groups or family therapy could further help educate the parents about the challenges their son is facing and improve family dynamics.
Conclusion
This scenario illustrates the complexities faced by PMHNPs when dealing with high-risk patients, especially minors experiencing mental health crises. The decision regarding voluntary or involuntary commitment involves carefully weighing legal criteria, the immediate mental health needs of the client, and the dynamics of family influence in treatment. In this case, involuntary commitment may serve as the most appropriate avenue to ensure the safety and well-being of the young patient in light of his suicidal actions.
References
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- American Psychiatric Nurses Association. (2010). Scope and standards of practice for psychiatric-mental health nursing. APNA.
- Cohen, E. S., & Comeau, J. (2014). Assessing risk for suicide in children and adolescents. National Institute of Mental Health.
- Dunbar, A. J. (2015). Involuntary commitment and the legal process. Journal of Law and Health.
- Harrison, P. J. (2019). Suicide risk assessment in children and adolescents: A practical guide. Journal of Child Psychology and Psychiatry.
- Kennedy, G. K., & Houghton, K. (2018). Mental health treatment: Understanding commitment laws. Acts of Behavioral Medicine.
- National Alliance on Mental Illness. (2020). Children and mental health: An overview. NAMI.
- Wright, K. (2017). Effective communication strategies in pediatric mental health. Pediatric Nursing.
- U.S. Department of Health and Human Services. (2022). Mental health services and law: Understanding parental rights. SAMHSA.
- Beardslee, W. R., & Gladstone, T. R. (2018). Family approaches to preventing suicide. American Journal of Psychiatry.