Introduction
Tom, a dairy farmer in his mid-forties, experienced the loss of his wife and infant son, which became a severe challenge for him. His older daughter moved because of the grief, and he feels pressure from a large company that wants to buy his land. Tom’s brother Oliver wants him to sell the land and split the money. The multiple stressors contributed to suicidal thoughts; however, he managed to contact the local GP to ask for assistance. Another critical factor is that Tom drinks beer daily, and the amount of alcohol increases if he feels stressed.
Priority Needs
Tom’s mental health is the priority area as it suffers from numerous factors. Mental well-being, especially the prevalence of mood disorders, is a large-scale issue nowadays (Van Rheenen et al., 2020). Without specialized assistance, traumatic separation from the family, with Tom’s wife and son dying in a car crash and his older daughter leaving his house, can contribute to hopelessness, posttraumatic stress, and mood dysregulation (Sköld, 2021; Van Rheenen et al., 2020).
The loss of a wife and a child became a crucial stressor that led to the development of the feeling of grief and the inability to cope with it. As a result, Tom cannot adapt to the new life and the challenges it offers. Additionally, his suicidal attempt shows the critical deterioration of his mental health, developing depression and fear to continue living. It means that the priority need is to teach Tom how to cope with grief and continue living.
The second priority is addressing his drinking behaviors and providing the necessary assistance. Tom’s suicidal attempt after the episodes of heavy drinking shows the inability to select effective coping strategies and manage the stress and grief (Sánchez-Almagro et al., 2022). As a result, Tom’s depression and feelings of helplessness worsen, which is often associated with guilt after using substances to avoid reality (Sánchez-Almagro et al., 2022).
In such a way, another priority need in Tom’s scenario is addressing drinking behaviors and suicidal ideation due to previous stresses and the tragedy that happened to his wife and child. Addressing these priority areas is essential for guaranteeing that Tom will recover and his quality of life will return to the desired level (Sánchez-Almagro et al., 2022). It is essential to support holistic care by designing a step-by-step and individualized approach (Vera, 2023). At the moment, Tom’s mental health requires much attention and assistance.
Nursing Care Plan
Plan for the First Priority Need
Patient assessment reveals worrisome subjective data, such as fear and helplessness, and objective findings, including hopelessness, grief, and suicidal attempt history. Based on these findings, the risk of suicide is the first nursing diagnosis to inform the plan (Ackley et al., 2021). Five expected outcomes of Tom’s diagnosis can be formulated. These include making no further suicidal attempts, having an eagerness to live, knowing how to cope with feelings, understanding one’s strengths and instrumentalizing them to cope with the situation, and visiting support groups regularly.
Four evidence-based interventions with rationales and evaluation measures can be proposed to assist Tom. Intervention one involves assessing the risk for self-injury by talking to the patient. The rationale is that determining the patient’s suicide ideation supports the identification of possible interventions, and the evaluation focuses on documenting that the patient realizes the impossibility of committing suicide (Kõlves et al., 2020).
The second intervention is to assess the presence of mood disorders. Concerning the rationale, such assessments are crucial since mood changes might impact decisions about suicide (Conner et al., 2022). The evaluation measure is that the patient will understand the impact of mood changes.
The third and the fourth interventions focus on action rather than assessment. As intervention three, the provider should offer support therapies to improve the patient’s state (Saatchi & Taghavi Larijani, 2019). The rationale is that supportive psychotherapy promotes coping with daily struggles and unwanted thoughts (Saatchi & Taghavi Larijani, 2019). The client’s acceptance of the need for therapies will underpin the evaluation.
The fourth nursing intervention is to encourage the patient to join the therapeutic group for those who lost loved ones (Goldberg et al., 2023). Regarding the rationale, therapeutic groups offer grief-coping advice and can expose Tom to opportunities to build connections, thus alleviating hopelessness (Goldberg et al., 2023). Intervention evaluation will focus on revealing that a support group significantly improves the client’s state and observing the absence of suicide ideation after Tom begins to attend group meetings.
Plan for the Second Priority Need
Based on another assessment, subjective data peculiar to Tom reveals the feeling of loss and having no idea how to live in the future. Objective data features the desire to stop emotional pain, evidence of drinking, and a suicidal attempt, so ineffective coping is identified as the second nursing diagnosis (Ackley et al., 2021). The plan for this diagnosis includes three anticipated outcomes for Tom. They include acquiring effective coping during stressful situations, verbalizing confidence in facing new challenges, and refraining from using alcohol as a relaxant.
The nursing response to the diagnosis above can consist of four interventions based on relevant evidence. The nurse should establish trustful therapeutic relations with the patient as the first intervention. The rationale for this proposed action is that therapeutic communication can reduce the grieving patient’s sense of isolation, thus supporting coping (Özel & Özkan, 2020). In terms of evaluation, the fact that Tom communicates with the nurse eagerly can reveal the intervention’s success.
The second intervention involves cooperating with the client to set realistic and achievable goals to eliminate his fear of the future. As for the rationale, setting realistic goals can help improve distressed and grieving clients’ coping strategies (Hechinger & Fringer, 2021). The evaluation measure to demonstrate success is that the patient can formulate three realistic goals for the future.
The following two proposed interventions target Tom’s fears and awareness of opportunities for relaxation other than alcohol consumption. As intervention three, the nurse should help the client to express his fears, concerns, and intense emotions. The rationale for this action is that verbalization of threats and fears helps reduce anxiety, thus promoting coping (Goldberg et al., 2023). The evaluation will document that the patient can clearly outline his key fears. Intervention four involves talking to the client to assist him in finding new ways to relax without using alcohol. As for the rationale, helping the patient find a non-harmful way to relax and spend free time is central to replacing alcohol as the main relaxant (Gomathy & Gracy, 2021). The success should be evaluated by revealing that the patient has developed a new hobby that he enjoys.
Conclusion
Conclusively, Tom’s drinking and suicidal attempts stem from ineffective coping and inability to recover after the loss, so the outcomes focus on achieving progress in these areas. The interventions and care plan should be focused on setting new goals for him and assisting the client in finding the best coping strategies. The proposed plan might help to reduce the risk of suicide and help Tom to overcome the challenges he faces. The expected outcomes include the client’s rejection of the idea of suicide and a better understanding of mood alterations, support groups’ benefits, need for psychotherapy, goals to pursue, fears, and alcohol-free relaxation.
References
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