Description: The COE-NF provided strategies for assessing needs and providing appropriate care to this unique resident population.
Case Description: The facility urgently needed support to implement interventions for a resident who had attempted suicide. They also wanted to ensure that staff received proper training to effectively assist residents experiencing suicidal ideation.
Unique Challenges: A regional behavioral specialist met with the facility’s administrator, social worker and director of nursing to address concerns about a resident who was recently hospitalized after a suicide attempt at the facility. The team reported that the resident has a long history of mental health challenges and was diagnosed with post-traumatic stress disorder (PTSD) stemming from childhood sexual trauma. They noted that the resident is prescribed multiple antipsychotic medications to manage anxiety and PTSD symptoms. A key challenge identified by the team was the facility’s lack of resources to provide adequate support. After returning to the facility, the resident refused medication and experienced multiple anxiety attacks. In response, the facility developed a comprehensive care plan and a safety plan to ensure the resident’s well-being.
COE-NF Solution: The COE-NF provided the facility with resources to implement immediate interventions to support the resident. Recommendations included:
- Continuing to implement and revise the current safety plan as needed, adjusting interventions that prove ineffective.
- Using resources such as the COE-NF’s Comfort Menu, Tips for Managing Challenging Situations, and the Columbia Protocol for Suicide Risk Assessment.
- Requesting a new Pre-admission Screening and Resident Review (PASRR) Level 2 assessment based on recent events.
- Facilitating connections between the facility and the state’s behavioral health team for additional support.
- Educating staff on the COE-NF’s Tips to Manage Challenging Situations.
- Using the six simple questions from the Columbia Protocol to identify suicide risk. These questions help assess the severity and immediacy of the risk and determine the appropriate level of support needed for the resident.
Outcome/Benefits: The facility has implemented immediate interventions to support the resident experiencing suicidal ideation. Staff members have received training in suicide prevention, including the COE-NF’s Mental Health 101, Suicide Prevention, and De-Escalation training.
The facility’s point of contact shared the following update: “She is actually doing better (knock on wood). She started on a medication to help her sleep and has been compliant with her medications. Her sleep has improved, and if she does wake up, it tends to be for only a few minutes before she can fall back asleep. Overall, this has been beneficial for both her and the entire unit.
We were able to connect her with a counselor for weekly sessions, which seem to be going well. The counselor is communicating with the unit coordinator to ensure we are all on the same page. We received the new PASRR Level II, which outlined the measures we already have in place. It was complimentary of our team and the care plan we created. I hope things continue to go in the right direction for this resident. I really appreciate your help, guidance and ability to listen to me as I vent my frustrations and struggles.”
Interventions implemented based on the technical assistance provided by the COE-NF include:
- Nighttime Support: If the resident feels fearful at night, staff invites her to the nurse’s station to feel secure. If her behavior disrupts others, staff encourage her to walk around the facility. If she continues to be disruptive, staff provide interventions in her room.
- Comfort Item: The resident finds comfort in holding a stuffed lamb during moments of anxiety or night terrors. Staff ensure the lamb is readily available at her bedside and encourage her to use it when needed.
- Music Therapy: The resident reports that listening to music at a low volume at night helps alleviate her anxiety. Staff assists her with playing music to help her feel calm.
- Suicide Statements: When the resident makes suicidal statements but is not at immediate risk, a staff member sits with her and engages her in conversations that shift focus away from distressing thoughts. Distraction techniques are used to interrupt negative thought patterns.
- Healthy Activities: Staff promote grounding activities that help improve her mood and well-being. These activities include talking with someone, taking a walk or wheelchair ride, listening to music, watching television, performing acts of kindness, planting, participating in religious activities, engaging in wheelchair yoga or exercise, and joining group activities.
- Open Communication: Staff conduct regular check-ins and encourage the resident to be honest about her thoughts. They reassure her that sharing distressing thoughts is essential for her safety and emphasize that such thoughts do not mean she will act on them. Staff normalized mood fluctuations and stressed the importance of honesty in fostering a safe environment for the resident and her potential roommate.
- Seeking Support: Staff remind the resident that it is important and acceptable to approach them whenever she experiences distressing or harmful thoughts.
