A client diagnosed with major depressive disorder with psychotic features hears voices commanding self-harm. The client refuses to commit to developing a plan for safety. Which would be the nurse's priority intervention at this time?

Question

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Placing the client on one-to-one observation while monitoring suicidal ideations would be the nurse's priority intervention at this time as the client is actively experiencing auditory hallucinations that are commanding self-harm and refusing to commit to developing a plan for safety. This intervention would ensure that the client is constantly monitored and kept safe until further interventions can be implemented. Conducting 15-minute checks may not be sufficient in ensuring the client's safety, especially as the client is actively experiencing psychotic symptoms. Obtaining an order for locked seclusion may be indicated if the client becomes actively suicidal and exhibits unsafe behavior, but it may not be necessary at this time. Encouraging the client to express feelings related to suicide may be important for therapeutic communication but would not necessarily address the immediate safety concern.

A Client Diagnosed with Major Depressive Disorder with Psychotic Features