Ms.Wilson just returned from court, where she was sentenced to 10 years for drug trafficking. She was not expecting to serve any time. She has three small children at home, who she was sure she would get home to soon. Your facility understands that individuals receiving long or unexpected sentences are at high risk for self-harm, and have put processes in place to ensure that patients are evaluated for safety when returning from court when they receive their sentence. Per the policies and procedures at your facility, the officer who brought her to court brought her to medical after her sentencing because he knew it was a substantial sentence. You are the intake nurse charged with her evaluation post sentencing. What do you do?
Ascertain her feelings about the surprising ten-year sentence.
At first, Ms. Wilson states she is fine and just want to go back to her cell. You do not allow her to do that, but instead, ask her a series of questions that are included on your Nursing Guideline for newly sentenced patients:
What is your sentence? Is that what you expected?
10 years. Not really – everyone else got 2-3 years, and the person who did the same thing I did only got 6 months.
How does this affect you?
Using a cocky tone of voice she says, “No affect, I couldn’t care less how long they want to lock me up! I knew it was not going to be fair. Everyone is sexist.”
How will this affect your children and family?
Patient becomes tearful and loses the tough façade for a moment, then states, “They will be fine without me.”
You follow up: Why do you think that?
“My mother is a better mother than I am (and she tells me that every time I see her!), and she has them now. My children are small (2, 4, 5-years-old), and they will be better off when I am totally out of their lives.”
You remind her that there is visitation at the DOC facilities and she will be able to see them once she is transferred.
She replies, “I doubt that my mother would bring them; They are better off if they didn’t see me locked up.” She then adds, “They won’t have to worry about that because I have decided that I am not going to be there for them to visit.”
At this point, her demeanor changes. She avoids eye contact and her voice is much quieter. You then ask her:
What do you mean “you will not be there?” Do you want to hurt yourself?
To which she replies, “I don’t know,” “That might be the best thing for them;” “I am going to miss most of their lives anyway; why be a burden to them?”, “Maybe I should just fix it for them……” You then ask:
Do you have a plan?
“No, I‘ve just been thinking…..really, just forget I said anything. I am fine – I will be fine, and so will my kids. They will have a good life with their Grandmother.” You look at her and start to speak, and she says, “I am done talking, just send me back to my unit.“
Of course, you do not let Ms. Wilson go back to her unit. Instead, suicide watch is initiated until a qualified Mental Health professional can further evaluate and counsel her.
Nursing duties for the individual on Suicide Watch at this facility* include conducting a health history and evaluation upon placement on Suicide Watch, and ensuring that any notifications to administration, HSA, providers, kitchen and medication nurses are completed. Daily nursing interventions include daily visits, daily vital signs and addressing any issues she has at that time.
*As always, your company or facility policies, procedures and Nursing Protocols/Guidelines take precedence over any written recommendations on this website.