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.