Author Question: A man was brought to the emergency room for treatment of minor injuries after an accident in which ... (Read 61 times)

mpobi80 · **on:** Jul 19, 2018

A man was brought to the emergency room for treatment of minor injuries after an accident in which his life partner, a transvestite, was killed.

He refuses care, paces, screams, Why, why, why repeatedly, and scratches at his arms as if trying to tear the flesh. A nurse says, Geez, he's going to hurt himself. We'd better admit him to psych.. Which explanation for the nurse's response is most likely? a. The nurse's experience tells her that the patient is developing a psychotic reaction to the stress of the accident and death.
b. She is stigmatizing the patient due to his sexuality, dramatic grief response, and connection to a transvestite person.
c. The nurse is unsure how to handle a person presenting in this manner, is anxious as a result, and copes by wanting to shift the patient to another unit.
d. Medical nurses usually have less skill in managing emotional problems, and psychiatric staff are more appropriate to deal with persons who are grieving.

Question 2

A student has committed suicide. Which statement(s) about those left behind after suicide is accurate?

a. A suicide makes survivors more conscious of risk factors and more motivated to reduce risk in themselves and others, leading to a reduced risk of suicide in survivor groups.
b. The first few weeks after a suicide are the most difficult and are when survivors are at highest risk; the risk then returns quickly to its pre-suicide level as time passes.
c. All survivors are at increased risk, should be assessed for risk at intervals after their loss, and would benefit from ongoing support primary intervention to reduce their risk.
d. Speaking of the dead increases the discomfort of surviving loved ones and should generally be avoided in their presence.

sarajane1989 · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

B
The patient's sexuality and romantic involvement with a transvestite person subject him to stigma, even from health care providers who, as professionals, should be self-aware enough to recognize and intercept such inappropriate and nontherapeutic responses. The patient's grief response, unusual from the cultural perspective of many persons, perhaps, also is stigmatizing and as a result is incorrectly attributed to a mental illness. There are no data to suggest that the patient is not in touch with reality; he is simply expressing his acute grief in a dramatic fashion (which may be a culturally-mediated response). The nurse may be anxious, unsure how to help the patient, or believe that medical nurses have less skill in managing emotional problems, but all nurses should be capable of helping patients with both emotional and physical health needs and should consult with other staff if they are not. This nurse's exclamation of Geez suggests that the primary issue underlying the response is countertransference related to stigma.

Answer to Question 2

C
All survivors, both family and peers, are at higher risk of suicide after their loss. Grief, guilt, despair, and modeling all contribute to this risk, as does the isolation that can sometimes follow because of the shame, discomfort, and stigma often associated with suicide. Although consciousness and preventive efforts (e.g., screenings) may increase following a suicide, the overall risk among surviving family members and peers is significantly increased nonetheless. The grief and other factors underlying this increased risk usually lasts for many months or even years, so the risk does not resolve in the weeks after the death. Regular contact to provide support and observe for indicators of risk should be continued for at least a year following the death and for even longer periods around the loved one's birthday, family events, holidays and the anniversary of the loss, or if the risk has continued or independent risk factors exist. Most survivors feel isolated when their loved one is not mentioned. They usually want their loved one to be remembered, and talking about the loss helps reduce the hurt, stigma, and isolation.