Therapeutic conversation

1. Therapeutic Communication Project
September 19, 2014
Suzette Lynn Eliopoulos and Jessica Frost
The medical term for thoughts of killing oneself or the attempts to take one's own life is known as Suicidal
ideations. Suicidal ideations can be detailed plans or various degrees of reoccurring fantasies of harming one's self
ultimately resulting in death (Crosby, Ortega, & Melanson, 2011).
While it is difficult to estimate an accurate number of attempted suicides due to many attempted suicides
go unreported the number of successful suicides are alarming. "According to the FDA (Food and Drug
Administration), there are about 30,000 completed suicides in America each year, an annual incidence of 0.01%.
80% of suicides are among males. Suicide is the third leading cause of death among 15 to 24 year olds. Twenty per
cent of all suicides are among this age group" (Nordqvist, 2013).
Suicide is most often a result of a diagnosis of Depression (Nock, et al., 2008). Although it is not hard to
understand suicidal ideations in those suffering the aftermath of grief from the death of a loved one, death of a child,
chronic illness, terminal illness, abusive relationships either physical or psychological, or even job lo ss or lost
opportunities such as school or promotion. Acute stress or pressure from job or family could be a reason for one's
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Ivy Tech Communi ty Col lege, Northeast Campus
School of Nursing: NRSG 126-21C
Professor Linda Romines
suicidal ideations.
Depression is not the only cause of suicide and suicidal ideations. Other known causes for those suffering
from suicidal ideations are those with bipolar disorder, post -traumatic stress disorder or PTSD, psychosis,
schizophrenia and drug abuse. (Nock, et al., 2008)
There is also the link of suicidal ideations to those diagnosed with Borderline Personality Disorders. Often
these are attention seeking behaviors. For example the individual with Borderline Personality Disorder may plan and
make suicide attempts only when they know the attempt will be interrupted. They might make written plans meant
to be discovered or openly discuss plans with others as a means to gain attention be it negative or positive. (Crosby,
Ortega, & Melanson, 2011)
The signs and symptoms of suicidal ideations are hopelessness, anhedonia, insomnia, oversleeping, loss of
appetite, overeating, depression or depressed state, anxiety, loss of concentration, and remorse (Nordqvist, 2013).

2. Therapeutic Communication Project
September 19, 2014
Suzette Lynn Eliopoulos and Jessica Frost
Therapeutic Conversation
pg. 2
Ivy Tech Communi ty Col lege, Northeast Campus
School of Nursing: NRSG 126-21C
Professor Linda Romines
Scenario:
RN is reviewing discharge instructions to a patient who was seen in the ER for injuries sustained in a MVA. Patient
has abrasions from seatbelt as well as minor skin tears and bruising to left per orbital region from patients personal
cell phone upon impact. Testing at ER has ruled out any fractures. CT of the head and chest have come back within
normal limits. Despite injuries the patient has not complained of any pain this admission but states she feels
lethargic and "out of it". After reviewing all discharge instructions and per hospital policy the nurse asks the patient
NON- Therapeutic Conversation:
NURSE:
Have you ever wanted to "off"
yourself or any other tom-foolery
stereotyped comments,
clichés, and trite
expressions
PATIENT:
yes
NURSE:
OH, now, stop fooling around! Well
now I have to ask, do you have a gun
or lots of pills at home?
Belittling feelings
expressed
PATIENT:
yes
NURSE:
Do you like the show "Walking
Dead"? Cause I just love that
show!
PATIENT:
Excuse me?
Introducing an unrelated
topic

3. Therapeutic Communication Project
September 19, 2014
Suzette Lynn Eliopoulos and Jessica Frost
Therapeutic Communication:
pg. 3
Mrs. Jane, have you ever had or
do you currently have thoughts
of harming yourself or other?
Ivy Tech Communi ty Col lege, Northeast Campus
School of Nursing: NRSG 126-21C
Professor Linda Romines
Terms:
NURSE:
 OFFERING GENERAL LEADS
o giving encouragement to continue
 ENCOURAGING DESCRIPTION OF PERCEPTIONS
o asking the patient to verbalize what he perceives
 REFLECTING
o directing back to the patient questions, feelings, and ideas
 MAKING STEREOTYPED COMMENTS
o offering meaningless cliches, trite expressions
 BELITTLING FEELINGS EXPRESSED
o misjudging the degree of the patient's discomfort
 INTRODUCING AN UNRELATED TOPIC
o changing the subject.
Offering general leads PATIENT:
yes
NURSE:
Can you tell me about these
feelings? Encouraging description
of perceptions
PATIENT:
I have no one and nothing left.
There is just no reason left to
live anymore! Do you think I
need help?
NURSE:
Mrs. Jane do you think you need
help?
Reflecting
PATIENT:
I don't know. But I know I don't
want to do this anymore! Can
you help?

4. Therapeutic Communication Project
September 19, 2014
Suzette Lynn Eliopoulos and Jessica Frost
References
Crosby, A. E., Ortega, L. M., & Melanson, C. M. (2011). Self-directed Violence Surveillance: Uniform
Definitions and Recommended Data Elements. Atlanta: Centers for Disease Control and Prevention.
Nock, M. K., Borges, G. P., Bromet, E. J., Alonso, J. M., Angermeyer, M. M., Beautrais, A. P., . . . de
Girolamo, G. M. (2008). Cross-national Prevalence and Risk Factors for Suicidal Ideation, Plans and
Attempts. The British Journal of Psychiatry, 98-105.
Nordqvist, C. (2013, November 20). 1. Retrieved from 1:
http://www.medicalnewstoday.com/articles/193026.php
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Ivy Tech Communi ty Col lege, Northeast Campus
School of Nursing: NRSG 126-21C
Professor Linda Romines