Sherpath suicide lesson

Children between the ages of 5 and 14 years die by suicide at a rate of

0.7 per 100,000

adolescents between 15 and 24 years die by suicide at a rate of

10.1 per 100,000.

The estimated prevalence of suicidal ideation with for adolesence that said they had a plan to committ suicide

14.6%

The estimated prevalence of suicidal ideation with for adolesence

17.7%

suicide is the fifth leading cause of death among children

5 to 14 years old in the United States

When an individual attempts to commit suicide but survives, it is called an

attempted suicide

Other life stressors include

being bullied, difficulty fitting in with others, and family financial strain.

Assess adolescents with a history of

bipolar disorder, conduct disorder, and substance (alcohol and drug) use disorders, personality disorders (including antisocial, borderline, histrionic, and narcissistic types), impulsive aggression (the tendency to react to frustration or provocation with hostility or aggression)

The nurse's voice and demeanor should be

clear, direct, and supportive.

Males are more likely to

commit suicide than females, at a ratio of 4:1

The pediatric nurse must understand suicidal ideation, attempted suicide, and death by suicide in order to

conduct assessments and provide appropriate interventions.

When assessing a child or adolescent for suicide risk, the nurse should observe behavior and note

decreased energy, persistent restlessness, or anger

Counseling, individualized or family therapy, or cognitive-behavioral therapy (CBT) (with or without medication therapy) can reduce

the risk of suicide in adolescents with a history of a mood disorder.

Suicidal ideation refers to

thinking about or planning for suicide.

The nurse may ask the patient:

"Have you known anyone (such as a family member) who has intentionally hurt himself or herself or committed suicide? -When did this occur? What was it like for you?" "Do you ever do things to deliberately place yourself at risk or in danger, such as driving when you are intoxicated?" "Have you ever thought about trying to hurt yourself? Do you have a plan?" "Do you have access to firearms or knives?" "Have you ever told anyone about wanting to kill yourself?" "Have you ever been hospitalized for suicidal behavior?" "Can you describe how you feel right now?"

Assist the patient, family, and health care team in creating a crisis plan once

a safe environment has been secured.

suicide is the third leading cause of death among

adolescents between 15 and 24 years

The nurse should provide children or adolescents who are having thoughts of suicide information about a crisis line

(the National Suicide Prevention Lifeline at 1-800-273-8255 or through its website Suicide Prevention Lifeline or the American Association of Suicidology).

When caring for patients at risk for suicide, the nurse's goals are to:

Decrease and eliminate the risk for self-directed violence. Increase the patient's self-esteem. Identify and facilitate coping strategies. Empower the patient and family and effectively mobilize appropriate support systems. Encourage the patient and family to identify and express feelings, identify strengths, and discuss appropriate actions when feelings become overwhelming.

Creating a safe environment is the first priority.

Ensure that potentially harmful objects are inaccessible (eg, prescription drugs locked in cabinets, guns locked away and secured). Monitor and assess for changes in behavior throughout the day.

Males are most likely to commit suicide by

Forearms

Other significant risk factors of suicide

History of nonlethal self-harm (e.g, cutting, hair pulling) History of suicide attempts Chronic medical illness Family violence Substance abuse Poor impulse control Poor school performance Access to unlocked firearms in the household

In counseling

Identify trigger events and strategies to avoid or manage these events. Explore coping strategies to be used when impulses arise. Plan alternative activities. Avoid isolation. Collaborate with the treatment team.

Family history of psychosocial disorders, including death of a family member by suicide

Increases suicide

Females are most likely to commit suicide by

Posions

The risk for suicide should be considered if the following are present:

Preoccupation with death Overwhelming sense of guilt or shame; obsessional self-doubt Newly self-imposed social isolation

Suicide assessment tools explore

Risk factors, stressors, lethality of method, coping mechanisms, and support systems. This information can be obtained through observing and monitoring the patient, as well as by asking some critical, key questions.

Commonly used screening tools include:

Suicidal Ideation Questionnaire (SIQ) or Suicidal Behaviors Questionnaire—Revised (SBQ-R) Columbia TeenScreen Suicide Risk Screen (SRS)

Nurses must carefully screen all patients for signs of

Suicidal ideation, identify those at high risk, and use appropriate intervention strategies.

The nurse should monitor for signs of suicidal ideation or intent by noting:

Symptoms of depression, anxiety, or restlessness Unkempt appearance Thought content and organization Awareness and expression of feelings Perceived level and types of stress Perceived availability of support resources Prior suicidal behavior Medical status

Long-standing family dysfunction is often present, with

emotional detachment and isolation among family members.

When caring for children or adolescents at risk for suicide, health care professionals should be

empathic and nonjudgmental

Interventions include

ensuring a safe environment, developing a crisis plan, and collaborating with the treatment team to coordinate care.

Anytime a child discloses thoughts of self-harm directly to the nurse or to a friend or family member, this threat needs to be

explored further immediately. The child needs to be interviewed in a safe location and stayed with until the issue is resolved.

Creating a safe environment is the

first priority.

The presence of risk factors does not mean that a suicide attempt is

inevitable, but it should alert anyone who interacts with a child or adolescent to the possibility.

Children and adolescents may have limited abilities to cope with

life stressors related to their developmental age.

Assess for suicidal ideation in a child with symptoms of

mood, psychiatric, or multiple disorders (co-morbidities).

child/adolescent who appears better after being anxious or down may actually be

most at risk for suicide. This calmness may be that they now see a way out from their problems and feelings. Nurses and others involved in their care at this time need to question the child about thoughts or plans of harming themselves.

The plan should also include a

no suicide contract." (The patient signs an agreement promising not to do anything to harm himself or herself within a specified period.) Counseling and Other Interventions

The risk for death by suicide is greatest when

no supportive adult is available to identify and intervene in the escalation of symptoms.

Overwhelming sense of guilt or shame

obsessional self-doubt

Gay, lesbian, bisexual, and transgender adolescents are linked to

social stigma, feelings of isolation, and lack of social and family support

The individual who attempts suicide is typically unable to envision a

solution

Preoccupation with death

statements about suicide or self-harm; suicidal clues, such as cryptic verbal messages, giving away personal items, and changes in expected patterns of behavior (eg, sudden calmness in a normally anxious teenager or the opposite)

Newly self-imposed social isolation

suggesting that the individual does not have adequate social support or the coping skills to find alternatives to self-harm

It is important for the nurse to use a standardized

suicide screening questionnaire to assess suicide risk

Psychologic disorders, life stressors, significant life events, and family and personal histories may contribute to an increased risk for

suicide.

Assess for underlying major depression and feelings of hopelessness, which are the most significant risk factors for

suicide. Observe for poor self-concept, which can lead to depression.

Design the plan so that the patient can

take a step-by-step approach at dealing with the situation, emotions, and behavior until he or she feels safe.

Suicide occurs when individuals harm themselves with

the intention to end their lives and succeed.

Keep the plan in a place where

the patient can easil

Gay, lesbian, bisexual, and transgender adolescents are

two to seven times more likely to have suicidal ideation and attempt suicide.

In a crisis plan pts should acknoledge and

write down actions to take, and people to contact in order to feel safe from suicide.