SUICIDE: PREVENTION AND INTERVENTION

Key Points: SUICIDE

*Any suicidal thoughts or behaviors, whether ideation, threat*, gesture, or attempt, indicate an *emergency situation* and require *prompt assessment and intervention* *Suicidal intent accompanied by imminence* represents a *high level of lethality.* Accessibility to dangerous weapons *raises* the suicide risk. *Close observation and continued reassessment* of suicide risk minimize the chances of completed suicides.

Planning and Implementation

*Focus on strengths*: Help the client to identify effective *coping techniques* that they have used successfully in the past. *Prioritize their concerns*: Encourage the client to prioritize problems from most significant to least significant; Encourage client to delegate their problem-solving-POSITIVE SELF TALK *LET'S TALK ABOUT THE PROBLEM THAT YOU FEEL IS THE* *MOST URGENT...*

*Warning Signs of Suicide* *IS PATH WARM*

*I deation* *S ubstance Abuse* *P urposelessness* *A nxiety* *T rapped* *H opelessness* *W ithdrawal* *A nger* *R ecklessness* *M ood Change*

*Clinical Description*- SUICIDE

*Lethality Assessment* *Imminence* *Intent* *Conscious or unconscious* *Level of hopelessness* *PAL:* *Plan* *Accessibility* *Lethality*

*Assessment*- SUICIDE

*Observation* *Client HX& data from family/friends* *ASK!!!* Are *weapons* available in the home? *MSE* *Physical Exam* *Intuitive Reasoning* It is best to *err on the side of caution* when diagnosing suicidality than to allow serious injury or death to occur.

Planning and Implementation:Additional modalities

*Pharmacological interventions* -Pharm: Antidepressants, anxiolytics, antipsychotic meds, mood stabilizers *Psychotherapy* COUNSELING ,THERAPIST -PsYchotherapy: insight-oriented techniques, cognitive reframing, and brief solution-focused crisis intervention *Electroconvulsive therapy (ECT)* -ECT: sometimes used for patients with *refractory/intractable depression*, that is *NOT responsive* to medication (medication resistant)

Clinical Alerts

*Social media networks* are possible factors in depression and suicide in teens *Anxiety disorders can cause depression*, which can result in suicide Asking suicidal patients and their family members about *access to dangerous weapons* in home, work, or car must be a *part of our nursing assessment* *Increased energy and the ability to concentrate facilitate* *suicidal actions*

A person with an acute *risk of suicidal behavior* will most *demonstrate* one or more of the following:

*Threatening to hurt or kill himself/talking about it* *Looking for ways to harm himself/herself* *Talking about or writing about death*, dying when this discussion seems out of the ordinary

Clinical Description- SUICIDE: *Lethality:*

*potential for causing death* r/t *level of danger* associated with the suicide plan

Electroconvulsive therapy (ECT): SUICIDE

-*ECT: sometimes used for patients with* *refractory/intractable depression*, that is *not responsive* *to medication (medication resistant)*

*Pharmacological* interventions: SUICIDE

-Pharm: Antidepressants, anxiolytics, antipsychotic meds, mood stabilizers

SUICIDE HOTLINE

: 1-800-SUICIDE, 1-800-273-TALK

Key Points: SUICIDE

A *sudden brightening of affect or lifting of depression* frequently *signals that the client has resolved* his or her *indecision about living or dying* and has made the decision to commit suicide. After a suicide attempt, an individual sometimes *continues* to be at high risk for attempting suicide again. *It is best to err on the side of caution* when diagnosing suicidality than to allow serious injury or death to occur.

Clinical Alerts

Clients may find they *have more energy after starting* *antidepressants.* This is a time when they *may have the energy to carry out* *suicide. * They should *continue to be watched carefully* at this time. *Patients can recover and lead productive lives.*

Evaluation

Must be ongoing and all-encompassing Helps nurse target areas of outcomes that are critical to the client's survival Revision might be necessary to implement other treatment modalities to help ensure client's continued safety and readiness for discharge

Assessment- SUICIDE (explained)

Observe for changes in behavior...*calm, non-reactive*, *isolation, irritation, impulsivity, restlessness, sudden* *brightening of affect*; *LETHALITY LEVELS INCREASE *DURING HOSPITALIZATION, in first 24 hours* or AS *DEPRESSION LIFTS* AND DISCHARGE IS APPROACHING...*HANGING* IS MOST COMMON METHOD IN HOSPITAL.*BELTS, SHOE STRINGS, GARBAGE* *BAGS, SHEETS, TOWELS, MED CHEEKING* See handout History: events that might lead to self-destructive behavior; anniversary dates of losses, etc. It can be helpful to interview pt and family together and apart. MAKE SURE TO ASSESS HISTORY OF SUICIDAL GESTURES OR ATTEMPTS! ASK!!! Have you had or are or you having any thoughts about harming yourself? (or others?) Nursing assessment questions on p. 515, in text *MSE: Look for disturbances in concentration, orientation* *and Memory...disturbances in thought processes* ...like *hallucinations* *Physical Exam:* Look for *S/S of substance abuse*, *previous suicide attempts, chronic or debilitating medical* conditions *Intuitive Reasoning*: Be attentive to the nurse feeling *uneasy, anxious, sad*; research suggest that "intuitive feelings" are based on previous experiences in similar client care situations, so *DO NOT IGNORE IT IF YOU DON'T FEEL* *RIGHT ABOUT A SITUATION OR CLIENT!*

*Myths & Facts* regarding suicide

People who talk about suicide never commit suicide. Suicidal people only want to hurt themselves, not others. There is no way to help someone who want to kill himself or herself. Do not mention the word suicide to a person you suspect to be suicidal, because this could give him or her the idea to commit suicide. Ignoring verbal threats of suicide or challenging a person to carry out his or her suicide plans will reduce the individual's use of these behaviors. Once a suicide risk, always a suicide risk.

Outcome Identification The Patient will:

Remain *safe and free from self-harm.* ULTIMATE GOAL! *VERBALIZE an absence or decrease in SI/plan/intent.* *Verbalize a desire to live and list several reasons* for wanting to live. *Agree to inform staff immediately if suicidal thoughts* recur. *Display brightened affect* *Initiate social interactions.* List *support persons* Use effective *coping methods*. Express *positive self-worth.* Meet *own needs through direct communication.* Verbalize *realistic role expectations and goals.* Make *plans for the future, including follow-up therapy* and med compliance.*

*Suicide*

Suicide is the intentional act of killing oneself,.

*PAL*

The *method and its accessibility* determines the outcome of the suicidal behavior...the *more specific the plan* the *greater the risk*

Planning and Implementation

To assist in the development of improved coping skills: Use effective therapeutic communication skills that include nonjudgmental empathetic listening, tolerance, flexible responses to client's needs *Assist the client to focus on strengths* *Assist client to prioritize their concerns* *Help the individual acknowledge problems* that are beyond his/her control Affirm rational decisions and sound judgment

Planning and Implementation

To enhance family and support systems: Enlist the client's significant others in the treatment plan Determine the degree of support Teach significant others about critical signs Provide empathy when significant others express feelings Refer to social services, aftercare groups, support groups, pet support, etc. Refer to a suicide hotline Remove weapons from the home

Planning and Implementation

To provide safety: Maintain a *safe environment* Implement a *"No-suicide contract"* *1:1 observation* *Remove weapons* from home environment Create a *supportive* environment Provide a *roommate*

Clinical Description- SUICIDE: *Level of hopelessness*...

how hopeless is the patient feeling?

*Psychotherapy*: SUICIDE

insight-oriented techniques, cognitive reframing, and brief solution-focused crisis intervention

*Attempted suicide*

is a suicidal act that either failed or was incomplete.

*Passive suicidal ideation*

is when a person things about wanting to die or wishes he or she were dead, but has no plans to cause his or her death.

*Active suicidal ideation*

is when a person thinks about and seeks ways to commit suicide.

*Suicidal ideation*

means thinking about killing oneself.

Clinical Description- SUICIDE: *Unconscious intent*

much more complex to assess...sometimes characteristics of self-destruction...*risk taking behaviors*

Clinical Description- SUICIDE: *Intent:*

the *method chosen* and *its accessibility* *Conscious intent* includes an awareness of the outcomes and others' responses, an awareness of rescue possibilities

Clinical Description- SUICIDE: *Imminence*:

the likelihood that an even will occur within a specific time period *(24 hours)*; the determination of imminence is *critical*...you *need to act quickly* If a person has a *high lethality and refuses tX*, there is a legal consideration for safety called *involuntary hold-and*-*treat status*

Safe Environment:

use *plasticware*, count ; remove sharps, monitor client at all times, *provide a roomate* for suicidal client; Remove cords, shoelaces, ropes, curtains; Clear all gifts/bags from visitors WHATS THE BEST PLACEMENT FOR AN ACTIVELY SUICIDAL PATIENT? THERE ARE MIXED FEELINGS ABOUT THE EFFECTIVENESS OF A NO-SUICIDE CONTRACT...*MUST STILL MONITOR* *CLOSELY EVEN IF A CLIENT HAS SIGNED ONE* MOST SUICIDES OCCUR *within 24 hours of admission* or *WITHIN 90 DAYS AFTER HOSPITALIZATION*, SO A *SAFE* *HOME ENVIRONMENT IS EXTREMELY IMPORTANT*