A nurse has admitted a client to the mental health unit following an attempted suicide. The client also attempted suicide four months earlier. Which is the best way to ensure client safety?

  1. give the client a task to do, such as folding towels, to distract him
  2. assign a staff member to remain with the client one-on-one at all times
  3. obtain an order for chemical and physical restraints to be used as needed
  4. keep the client in the day room around other clients who can help watch the client
  5. place the client in isolation after removing potentially unsafe articles, such as shoelaces and belts
Number 2 is correct.
Rationale: The safest option for the client is one-on-one observation by a staff member trained to work with potentially volatile clients. Distracting the client with a task may be helpful, but it is not the best choice here. Also, access to towels or sheets may allow the client to try and hang himself. Chemical and physical restraints should be used only as a last resort; physical restraints can escalate some clients to more violent behavior. Keeping the client in the day room is not an option because it is not the responsibility of other clients to watch out for one another and it shifts responsibility away from staff. Placing the client in isolation, even after removing potentially dangerous articles, is not the safest option and should not be used as a priority treatment. Clients have died in seemingly safe conditions in isolation, and this creates issues with risk management. Client safety is always the first priority.