Q1. Suicide Prevention
***Determining Degree of Suicide Risk
***Intensity of Risk: (i don't have exact criteria but these are explanations i found online) -Very High Risk: very low WTL (will to live), very high WTD (will to die), high prediction of future suicide attempts, talks about suicide frequently -High Risk: low WTL, high WTD, frequent suicidal thoughts -Low Risk: low prediction of future suicide attempts, moderate suicidal thoughts -First Nursing intervention is to assess suicide risk (***Why should the nurse assess suicide risk first?Even if they don't have a plan: its part of your assessment and it keeps them safe. If you don't do a suicide assessment on the patient and they do hurt themselves, it's going to come down on you legally)
suicide: what is it, what to do when they say "life is over, its not worth living", why interventions/education sometimes isn't enough
-***Suicide is not a diagnosis or a disorder; it is a behavior. "Life is not worth living. Its over" -Clarify what is going on during crisis and suicide: what do they mean? -You won't trigger them to commit suicide by asking them if they are going to if the plan is already there. If the plan is there, its clearly delineated (and this person shouldn't be left alone) -"The loss of we": they now feel like they are by themselves in all of this -Even with all of the education, future plans, interventions, etc. that they have going for them, doesn't mean the patient is buying into it: they could have a lot of fear since they are leaving familiar people and going onto something new -They lack that rational thinking in that crisis -They will eventually be successful in this if this is the plan they have in their heart: they WILL commit suicide
what % of suicides are by people with mental disorders? how many veterans commit suicides each day?
-95% of suicides are by individuals who have a diagnosed mental disorder. -18 U.S. Veterans Commit Suicide Each Day
Guidelines for treatment of the suicidal client on an outpatient basis:
-Do not leave the person alone -Establish a no-suicide contract with the client -Enlist the help of family or friends -Schedule frequent appointments -Establish rapport and promote a trusting relationship -Be direct and talk matter-of-factly about suicide -Discuss the current crisis situation in the client's life -Identify areas of self-control -Give antidepressant medications
***medications: Fluoxetine (Prozac) & Amitriptyline (Elavil)
-Fluoxetine (Prozac): 1 month of treatment patient shows bright affect, increase mood and talking a lot. (increase frequency of client observation) -Amitriptyline (Elavil): Why is it important to provide a week supply and follow up appointment on discharge? For safety reason: overdosing is very common with this, only give them enough
Crisis counseling with the suicidal client
-Focus on the current crisis and how it can be alleviated -Note client's reactivity to the crisis and how it can be changed -Work toward restoration of the client's self-worth, status, morale, and control -Introduce alternatives to suicide -Rehearse more positive ways of thinking -Identify experiences and actions that affirm self-worth and self-efficacy -Encourage movement toward the new reality -Be available for ongoing therapeutic support and growth
Biological Factors: role of serotonin
-Genetic and decreased levels of Serotonin (chemical NT) are often implicated associated with predisposition for suicide. -It is commonly regarded as a chemical that is responsible for maintaining mood balance.
***self harm/cutting: patient safety & nursing interventions
-Patient safety: Nursing intervention would be to place 1:1 suicide precautions. [Why? prevents harm & lawsuits from happening] -Take all statements seriously: there is no joking when patients say they want to harm themselves -Other nursing interventions: remove all sharps, belts, and other potentially dangerous articles -Accompany patient off unit activities -Obtain a promise not to harm self
other risk factors: psychiatric illness & severe insomnia
-Psychiatric illness: mood disorders are the most common psychiatric illnesses that precede suicide (they act as the catalyst) -Severe insomnia is associated with increased risk of suicide (When you lose sleep, the whole mindset shifts: clarity isn't there, you're hearing and seeing things) -When doing your patient assessment, figure out how many hours of sleep your patient has had: this will impact how they are presenting
***risk factors: age
-Risk of suicide increases with age, particularly among men. -*****While the elderly make up less than 13% of the population, they account for 16% of all suicides. (A lot of this comes from Fl: Why? The man loses their wife, and after being married a long time, have nothing to live for. They will commit suicide) -White men older than 80 years are at the greatest risk of all age/gender/race groups -Next is teengagers/adolescents
***Nursing Process: Assessment, outcome, planning/implementation
Assessment: Successful long-term psychotherapy could be measured by patient showing an increased sense of self-worth Outcome: The patient has experienced no physical harm to self. Planning/ Implement: Information for family and friends of the suicidal client: the more specific the plan is, the more likely the client will attempt suicide. ...Ask the patient "What exactly do you have plan to do?"
what is a common misconception about suicide?
Most individuals commit suicide by taking an overdose of drugs: (Gunshot wounds are the leading cause of death among suicide victims)