Suicide

Treatment

treatment of the actual suicidal crisis

suicide bombing

•DSM-5 excludes religious and political suicides from its criteria

24 hours after an emergency hospitalization for depression with SI, the nurse should reassess the client's risk of suicide when:

1.The client requests discharge because he is feeling so much better.

After being treated in the ICU for multiple fractures after a suicide attempt by jumping, the client is transferred to the medical unit. Which of the following factors should be reported immediately to the MD/NP?

1.The patient shares a specific plan for suicide.

Suicide

Intentional act of killing oneself by any means

suicide attempt

a non-fatal self-directed potentially injurious behavior with any intent to die.

Suicide/Death by suicide / Fatal self-directed violence

the voluntary and intentional act of taking one's life

Suicide survivor

family and friends grieving a loved one's suicide

Suicide intent

at the time of injury or death, the person had thoughts of killing him/herself or wished to die.

What are the biological factors that cause suicide?

1. Familial tendency 2. Lowered SKA2 gene expression 3. Low serotonin levels

A male client states " I have nothing to live for"; How should the nurse respond?

1."Are you thinking of killing yourself"

A crisis caller spends 5 minutes telling the nurse that "he can't make it" and his "life is over" . The nurse's best response would be::

1."Are you thinking of killing yourself?"

.Recently, a patient took an intentional overdose of 6 extra strength tylenol tablets. Which nursing intervention would be most therapeutic?

1.Encourage verbalization of feelings.

A person with which psychiatric problem is most likely to complete suicide?

A.Major depression Between 32% and 47% of patients who have major depression or bipolar disorder (during the depressed phase) will complete suicide. For the others, percentages of suicides are as follows: Personality disorders: 8-11%; Substance abuse: 3-17%; and schizophrenia: 15-20%.

Which method of suicide has the highest lethality?

A.Self-inflicted gunshot wound Define lethality. A self-inflicted gunshot wound is considered a high-risk method, or "hard" method. The other examples listed here are lower-risk, or "soft" methods.

Considering Gina's behavior on the fourth day of hospitalization, which factor should the nurse consider?

A.The patient may have decided to commit suicide; the nurse should reassess suicidality. rationale: It is always wise to consider the possibility that a patient who was recently suicidal may be exhibiting positive traits because he or she is at peace with a final suicide decision and is feeling relief, or even exhilaration about this. Do not just assume that they are immediately better until you have had more time for observation.

Completed suicide

Suicide successfully resulting in death

what is the number 1 priority?

Safety

Suicide ideation

Thinking about, considering, or planning to kill oneself

prevention

activities that provide support, information, and education to prevent suicide

suicide behavior

acts associated with suicide intent

Non-suicidal self-directed violence

behavior that is self-directed and deliberately results in injury or the potential for injury to oneself but there is no evidence of suicidal intent

postvention

interventions with a circle of survivors left by individuals who completed suicide to reduce the traumatic aftereffects

Identify Protective Factors Against Suicide: External

•Children or pets to care for in the home •Family responsibilities •Pregnancy •Social support system •Financial incentives or deterrents •Effective access and clinical care for mental, physical and substance use disorders •Restricted access to highly lethal means of suicide i.e. guns

What are unacceptable terms?

•Completed suicide •Failed attempt •Nonfatal suicide •Parasuicide/Suicide gesture •Suicidality

Observation as an intervention

•Determine the Level of observation: •Constant (1:1); every 15 minutes; every 30 minutes; hourly •Locations •Locked Inpatient Psychiatric Unit: observation level is assigned based on acuity. Usually higher at beginning of admission or if patient verbalizes strong SI. •Acute care unit: usually 1:1 constant observation by trained staff; no family members allowed to provide 1:1. •Changes in Level of observation •decreased only per MD/NP order. •increased by RN-then MD notified/ discussed with.

Health professionals may experience:

•Fear •Grief •Anger •Puzzlement •Condemnation of suicidal feelings/ intent Acknowledge feelings to team members to avoid countertransference.

Psychological factors of suicide?

•Freud—aggression turned inward •Menninger's three parts to suicide hostility •Wish to kill •Wish to be killed •Wish to die •Aaron Beck—central emotional factor is hopelessness •Diathesis-stress model—combination of suicidal fantasies and significant loss •Copycat suicides

What are other nursing interventions?

•Inform all unit staff of patient's risk. •Advise Patient Safety Companion/ NCT of risk. •Schedule break times for the PSC /NCT •Maintain RN hourly rounding with the patient •Place patient close to nursing station •Implement suicide precautions and elopement precautions. •Monitor medication ingestion for cheeking. •Get help for underlying psychiatric or substance use disorder. •Identify access to firearms or other means of self-harm at home. •Involve social support person. •Provide community resources and help hotline number •Help with problem solving. •Therapeutic use of self; give unconditional positive regard •Open, accepting, trust-building frequent brief interactions •Ask the question •Be available; spend time; nonjudgmental; allow expression •Be direct and talk matter-of-factly about suicide. •Discuss the current crisis situation in the client's life. •Identify protective factors. Identify areas of self-control. •Help person identify successful past coping strategies. •At discharge give suicide hotline number: 1-800-273 -TALK

Suicide is often in Disguise

•Motor Vehicle "Accidents" •Adolescent Panic Attacks and History of Physical Abuse •Suicide risk underlying non-mental health concerns •Somatic complaints in older patients. •Missed suicide risk factors •Multiple chronic illnesses •Self-injurious behavior •"Accidental" poisonings

the correlation of LGBT youth and bullying with suicide?

•Online bullying •Name calling •Verbal harassment •Physical harassment •White LGB and Hispanic bisexual females more likely to be bullied than white heterosexuals •Black LGB's vulnerability to bullying was about the same as white heterosexual youths •Sexual minority youths were more likely to report suicide ideation

Cultural factors of suicide?

•Protective factors 1.African Americans - Religion, role of the extended family 2.Hispanic Americans - Roman Catholic religion and importance of extended family 3.Asian Americans -Adherence to religions that tend to emphasize interdependence between the individual and society

What are the risk factors for suicide?

•Psychiatric disorders •Alcohol or substance use disorders •Male gender(woman attempt suicide, but men are more successful) •Race (85%-90% Caucasians) •Religion •Marriage •Profession •Physical health •Chronic pain

Advanced practice interventions

•Psychotherapy •Psychobiological interventions •Clinical supervision •Consultation

Environmental safety?

•Remove any potential lethal objects (materials for hanging like clothing; place in hospital gown, remove sharps like razors, perfume bottles, make up mirrors; meds from home, lock windows, lock bed in low position, no shoelaces) •Use Disposable food tray and dispose of tray and implements outside patient room •Check all packages brought in by visitors for harmful contraband. •Instruct sitter that patient is suicidal. MONITOR SITTER FOR VIGILANCE; teach to observe patient even in bathroom!!! •Use (and count) plastic utensils. •No private room; always keep door open. •Jump-proof and hang-proof bathrooms. •Lock doors to non-patient areas. •Monitor for and remove potentially harmful gifts. •In patient's presence, assess belongings and search patient for harmful objects. •Ensure that patients do not bring or leave harmful objects.

Research indicates an increase in suicides by when:

•Stories about suicides increase •A story is reported at length •Story placed on front page or beginning of broadcast •Person broadly known—and story/news of suicide spreads •Headline is particularly dramatic

Internal Protective Factors

•Successful past stress reduction strategies •Meaning in life / reason to live (job, loved ones, helping others) •Access to care •Cultural / Religious prohibition or belief/Spirituality •Capacity for reality testing •HOPE!!!! •Skills in problem solving, conflict resolution •Connectedness •Social support •Effectiveness of mental healthcare •Successful past positive coping strategies •Frustration tolerance •Optimism •Life satisfaction

warning signs of suicide (Implications for teaching significant others)

•Threatening or talking about hurting or killing oneself •Looking for means to kill self-guns, pills •Talking or writing about death, dying or suicide •Giving away prized possessions •Putting one's affairs in order: will; gravesite; 'setting things right •Feeling rage or uncontrolled anger/ seeking revenge •Acting reckless or engaging in risky activities-seemingly without thinking •Increasing drug or alcohol use •Withdrawing from friends / family •Feeling anxious or agitated, being unable to sleep or sleeping most of the time •Seeing no reason for living or having no sense of purpose in life. •Dramatic mood swings •Feeling trapped •Feeling hopeless

Assisted suicide

•United States: Individual states can allow, regulate, or prohibit assisted suicide •Netherlands, Belgium, Switzerland: assisted suicide legal

Interrupted self-directed violence by self

•a person takes steps to injure self but stops prior to fatal injury.

Suicidal self-directed violence

•behavior that is self-directed and deliberately results in injury or the potential for injury to oneself with evidence of suicidal intent.

Interrupted self-directed violence by other

•person takes steps to injure self but stopped by another prior to fatal injury occurringat any point during the behavior or thought of suicide.

Suicide plan

•the organized plan and time frame for killing oneself.