suicidal intent
Table of contents
wait what’s going on
well i got a conditional offer to work as a full-time hca in a&e at St Peter’s Hospital. this one’s a mini-reflection of what happened on a shift on 23-07-2020.
suicidal intent
When starting off in healthcare, we all quickly realise that your main priority is your patient. Nothing is important than it.
But what happens when you have a patient that has come in after attempting to slit their own wrists and overdosed on their medication. What happens when this patient is not talking you or any of the nurses or doctors. What happens when this patient leaves hospital premises.
Security is informed and police support are on their way. If support is not available yet and the real level of suicidal intent is unknown, am I the best placed person to protect this young lady should this young lady want to go off and try to end her life again.
Hospital policy is clear that you should not chase after patients i.e. you should not leave hospital premises. But this was a situation were I felt that my duty is with the patient. If we don’t stray too far away from hospital grounds, can I encourage her to come back? If I were to turn and head back and she were to take her life, could I live with the decision I made? She was vulnerable but also I was vulnerable. There was no real way of knowing whether or not she had intent to harm others.
She came back to the hospital. Reflecting back, I felt that taking this decision to leave hospital premises would be a good exercise in figuring out the response of management - the nurse in charge and how would they react - what kind of ’telling’ off would I receive. I did my job in providing safety for the patient as the patient did come back to the department but was I overly courageous / naive / energetic / youthful / inexperienced in doing so - however you’d like to frame it - yes - but I was happy to take that risk. Hospital management would rather me mitigate that risk because that risk to me was unknown.
protect yo-self
- Physically - preparing yourself for patient handling e.g. moving patients. sorta did 40 press-ups and 100 push-ups every day before a shower before my ed st peter’s hca shifts.
- Mentally - taking breaks. take every minute of your allocated breaks. not debateable. simply critical.
effective talking
And with these patients who have suicidal ideation, long-term mental health conditions - effective talking is only really a short-term remedy. Suicidal intent can be considered ‘attention-seeking behaviour’ but really it is ‘care-seeking behaviour.’ These patients want help + action now by doctors - who can give the final word on medication and where they go next. Possibly A+E doctors and psychiatric teams should also probably seem them sooner when they come in. But for every patient that comes into the department with A+E, how can you predict the one which will abscond AND return to the department. Its a multifactorial question.
Situational Awareness - being aware of the situation and your role. In any given situation, be capable + prepared to defend your actions. Our boundaries are not just set by prioritising the patient, they are set by prioritising you.