NU245 Unit 6 Suicide Risk Safety Narrative Example

Six Questions on the First Evening and a Handgun Still at Home: A Safety Assessment Narrative for a Composite Fifty-Eight-Year-Old Admitted With Depression After a Job Loss, Each Answer Recorded in His Words and Each Action Given an Owner

[Student Name]

Purdue University Global

NU245: Mental Health Nursing

Unit 6 Safety Assessment Narrative

[Instructor Name]

[Date]

The patient is composite; the screen questions are paraphrased close to their published sense rather than quoted, the student asked them with the assigned nurse present, and decisions belong to the treatment team.

Context

[Mr. G.], composite, 58, admitted voluntarily after [six] weeks of worsening depression following the loss of his job of twenty-two years. Sleeping four hours, eating little, has stopped going to church. Assessed at [1900] on the day of admission by the student with the assigned nurse present, in his room with the door partly open.

The Screen

The six screening items of the C-SSRS move in order from passive wishes to thoughts, method, intent, plan and past behavior (Posner et al., 2011); the wording below paraphrases each item.

1. Over the last month, has he wanted to be dead, or hoped not to wake up? "Yes. Most nights."

2. Has he had thoughts of killing himself? "Yes, a few times. Not every day."

3. Has he thought about how he might do it? "I have a handgun. I've thought about it."

4. Has he had any intention of acting on these thoughts? "No. I wouldn't do that to my wife."

5. Has he started to work out or worked out the details of how to kill himself, and does he intend to carry out a plan? "No."

6. Has he ever taken any step toward ending his life, even a start or a preparation? "No. Never."

The Wider Risk Picture

Risk factors: depression with insomnia and poor appetite, recent loss of work and identity, male, late middle age, and access to a firearm at home. A meta-analysis found that people with access to a firearm at home had higher odds of dying by suicide than those without (Anglemyer et al., 2014). Protective factors, given equal space: he names his wife as his reason not to act, he has two adult children who call weekly, his faith matters to him even though he has stopped attending, he sought admission himself and he answered every question openly.

He gave two answers that matter most in the same breath: a handgun at home, and a wife he would not do that to.

Actions, Each With an Owner

1. Student: reported the screen results to the assigned nurse immediately after the interview, at [1915]. Done.

2. Assigned nurse: reported to the psychiatric provider and charge nurse within the hour, as unit policy requires for a positive screen. Done at [1930].

3. Psychiatric provider: full suicide risk assessment and observation level decision. Completed at [2045]; observation level set by the provider.

4. Social worker and assigned nurse, with Mr. G.'s permission: lethal means counseling with his wife by phone the next morning, about storing the handgun outside the home with a relative or locked away with the ammunition stored separately. Planned for [1000].

5. Assigned nurse: environmental check of his room and belongings per policy. Done at [1940].

6. Nursing staff each shift: repeat screening and observation as ordered, documented each shift.

How the Conversation Was Held

Questions were asked directly, using plain words such as "killing yourself," because direct questions do not plant the idea and allow a clear answer (Halter, 2022). I sat at his eye level, waited through pauses and did not reassure him before he finished. After the screen, he said, "Nobody has asked me that straight out before." I thanked him for answering honestly.

Why Risk Is Not a Score

The screen sorts answers into levels, and his answers, thoughts with a method but without intent or plan, point toward moderate risk on many unit protocols. But a level is a starting point for the provider's assessment, not a prediction. His risk can change quickly with sleep, news about his job or a difficult call from home. The narrative therefore records the factors that could raise or lower his risk, so the next shift knows what to watch: worsening sleep, a sense of being a burden, talk about the gun, or improvement in mood that comes suddenly without a clear reason.

The Firearm Conversation

Lethal means counseling is not a judgment about gun ownership. It is a conversation about time and distance: putting barriers between a person in crisis and the most lethal method available. Storing a firearm away from home during a period of risk is temporary, and framing it that way makes agreement more likely. His wife is part of the plan because she will be at home when he returns. The same conversation covers his medications at home, since a large supply of any drug can also be dangerous, and who will hold them during the first weeks after discharge.

Documentation

Each question and answer was charted in his words, along with risk and protective factors, the time of each report and the name of each person informed.

References

Anglemyer, A., Horvath, T., & Rutherford, G. (2014). The accessibility of firearms and risk for suicide and homicide victimization among household members: A systematic review and meta-analysis. Annals of Internal Medicine, 160(2), 101-110. https://doi.org/10.7326/M13-1301

Halter, M. J. (2022). Varcarolis' foundations of psychiatric-mental health nursing: A clinical approach (9th ed.). Elsevier.

Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266-1277. https://doi.org/10.1176/appi.ajp.2011.10111704