The number one priority of a nurse is to meet the physical and emotional needs of their patients. The impact that nurse’s actions can have on the health outcome of the patient is substantial, therefore it is important to understand the complex nature of what it means to be in a position of providing care. In this reflection, the connection between physical and mental health will be examined through an experience I had while working on a medical surgical unit as a certified nursing assistant. I had cared for this patient before as they were frequently in and out of the hospital for varying illnesses related to substance abuse. The reason for this particular admission was because the patient had been found unconscious on the side of the road, under the influence of alcohol, and brought to the hospital for evaluation. While the primary admitting diagnosis was for ETOH withdrawal, the patient was placed on suicide precautions after their evaluation in the emergency department.

Since I had worked with this patient before, and they were usually very upbeat, agreeable, and pleasant, I was surprised to see them being placed on suicide precautions. During their previous admissions, I remember helping the patient move from the bed to the commode because they had lost most function of their lower extremities and were becoming incontinent. The physical condition of the client was heavily impacted by their substance use disorder, which the patient was aware and had insight as to how their condition was being made worse by the consumption of alcohol. That day, I was assigned as a “one-to-one” for the patient, meaning I was to sit with the patient and do safety checks every 15 minutes. I truly got to understand the internal psyche of this patient and what had caused them to end up in that situation while sitting in on a psychological evaluation with the patient and the hospital psychiatrist that morning. The condition in which this patient was found was alarming to hospital staff and warranted the need for a psychological evaluation during their admission. The patient expressed a feeling of hopelessness and wanting to end their life with no specific plan in place. The patient had been using alcohol as a coping mechanism for their depression but the feelings they were feeling were becoming too much to handle, even with the use of alcohol.

The patient had history of physical and sexual abuse from a young age and was currently dealing with an abusive relationship. Their depression was exacerbated six years prior when their son was shot and killed in the town in which they both lived. From that point on, the patient was unable to maintain a job, had no source of income, and was being housed in unstable living conditions. At the time of this admission, the patient was homeless and had been drinking alcohol for days when they were found by the police on the side of the road and covered in bugs; they had no recollection of this encounter. It would be important to understand if the patient had access to mental health care following the death of their son and whether they would be open to pursuing counseling, either in an outpatient or in-patient setting, for their substance use disorder. The past history of abuse and trauma is a huge driving factor behind the patient’s depression; however, it would be important for the nurses to focus on the current abusive relationship; the safety of the patient is always a priority, and the nurses can provide information and resources to clients experiencing physical and mental abuse from their partners or family members.

The nursing diagnosis that I identify for this patient are imbalanced nutrition: less than body requirements, ineffective coping, and risk for self-directed violence. The nursing diagnosis of imbalance nutrition: less than body requirement falls in the biological domain because the patient was only consuming alcohol and not getting the proper nutrition from food sources that were required to maintain a healthy, functioning body. The social domain nursing diagnosis is the patient’s ineffective coping mechanisms due to their long-standing history of physical and mental abuse; the preferred choice of coping with feelings and emotions only involved the consumption of alcohol. Lastly, the patient was at a heightened risk for self-directed violence because they stated they were having suicidal ideation and an overwhelming sense of hopelessness. The patient was deemed a high suicide risk, and it was the nurses responsibility to ensure the proper precautions were put into place to ensure the patient’s safety while they were in the hospital. This included removing all wires from the room, only having paper trash bags, removing the sharps contained, not having any needles or syringes near the patient, and removing any excess/unnecessary equipment from the patient’s room. My job with this patient was also to ensure they remained safe by documenting their condition every 15 minutes.

Unfortunately, I have no idea what became of this patient once I left my shift that evening, but that happens quite frequently when caring for patients. Based on the knowledge I have gained through this semester of mental health nursing, I can say what I would expect the post-discharge plans should have been and what patient education could have been completed by the nurses. This patient would benefit from counseling to help with their past traumatic experiences and would also benefit from a social worker to help get them into a more stable living situation. The patient might also benefit from being in-patient in a substance use disorder treatment center. Sobriety and management of their major depressive disorder are long-term goals for this patient. I believe that this patient truly did not want to be in this situation, and it was causing them a lot of internal anguish; with the right help and being provided with resources to get better, I believe that this patient’s mental health status would improve tremendously and in turn their mental health would improve as well.