Mental Health-Suicide and non suicidal self-harm

Row 1Ch. 25

100

Vocab:

(1) Suicide

(2) Suicidal ideation

(3) Completed suicide

(1) Intentional act of killing oneself by any means

(2) Thinking about killing oneself

(3) Suicide successfully resulting in death

200

Learning card (no points)

--Objectives for the nurse

-- Identify evidence-based practice suicide risk assessment tools.

-- Describe three expected reactions a nurse may experience when working with patients who have suicidal ideation.

-- Discuss basic-level interventions in the hospital or community

-- Explain key elements of suicide precautions and environmental safety factors in the hospital. 

300

What are some Risk factors?

--Previous suicide attempt (primary risk factor)

-- Hx of suicide in the family 

-- Substance use

-- Psychiatric disorders

-- Access to lethal means

-- Losses and other events

-- Hx of trauma or abuse

-- Chronic physical illness

-- Exposure to the suicidal behaviors of others

400

(Assessment)

What are verbal and non-verbal cues (think overt statements and covert statements....just give an example of each) :)

--Overt: "I wish I were dead", "I can't take it anymore"

-- Covert: "it's okay, soon everything will be better." "I won't be a problem much longer."

500

What are some important interventions for your pt for the nurse to perform?

--Stay with the pt

-- Establish a therapeutic relationship

-- Create a safety plan: 

- warning sings, coping strategies, people who provide distractions, people who the pt can ask for help, professionals or agencies to contact in a crisis, steps to make their environment safe. 

-- Case manager (connecting with resources)

-- Milieu therapy (suicide precautions, interprofessional communication).

-- Documentation (15 min checks)

-- Survivors of suicide (postvention, guild is common, refer to support groups). 

Row 2Ch. 25

100

Vocab:

(1) Nonsuicidal self-injury

(2) Para suicide

(1) self-injury directed to the surface of the body to induce relief form negative feeling/cognitive state or to achieve a positive mood state

(2) a suicidal gesture or attempt whose aim is not death

200

Learning card (no points)

Treatment

--Pharmacotherapy

- Tx underlying comorbid disorder--antidepressants, mood stabilizers, antipsychotics

-- Brain stimulation therapy

- Electroconvulsive therapy (ECT): involve a brief electrical stimulation of the brain while the pt is under anesthesia. 

--Psychological therapy

- CBTs for cognitive distortions, interpersonal therapy, group therapy. 

300

What are protective factors for suicide?

--Effective mental health resources

-- Strong social connections

-- Marriage, having children

-- Problem-solving and conflict resolution skills

-- Contact with providers 

400

What are some interventions for NSSI?

--STAY WITH THE PT

-- Establish a therapeutic relationship

-- Assess for SI

-- Care for wounds/injuries

-- Teaching coping skills

-- Encourage therapy and pharmacotherapy for underlying disorders. 

500

What are some suicide precautions to follow? 

"Think Safety of the pt!" 

-- Plastic utensils, count upon collection

-- Ensure the pts room door remains open, no private room

-- Jump-proof and hang proof bathrooms/rooms

-- Short cords and strings, no shoestrings or belts

-- Sitter within one-arms length distance

-- Lock all utility and med rooms

-- Take all harmful objects away and lock up belongings

-- Search pt for harmful objects, search belongings brought in by visitors

-- Mouth checks with medications 

Row 3Ch. 25

100

Learning card (no points)

Clinical picture

--Largely preventable

-- Half of people who die by suicide had a healthcare visit within the last month before death

-- Comorbidities: MDD, substance use, psychosis, anxiety, personality disorders, eating disorders, and trauma-related disorders

-- Loss of relationships, financial difficulty, and impulsivity and usual precursors 

200

Learning card (no points)

Non-suicidal self injury (NSSI)

-- Intentional damage to one's own body without suicidal intent

-- Behaviors: cutting, biting, hitting, skin picking, interfering with wound healing

-- Self-loathing, beliefs of being bad, defective, or deserving of punishments are common beliefs

-- Comorbidities: anxiety, MDD, eating disorders, substance use disorders. 

300

What are some warning signs for suicide?

-- Talking or writing about death

-- Making comments of being hopeless, helpless, or worthless

-- Expressions of having no reason to live, no sense of purpose in life. 

-- Increased alcohol or drug misuse

-- Withdrawal from family, friends, and community

-- Reckless behavior

-- Dramatic mood changes

-- Talking about feeling trapped or being a burden to others

Row 4Ch. 25

100

(Assessment--learning card, no points)

Suicide risk assessment questions

-- have you felt that life is not worth living?

-- Do you think about suicide?

-- have you ever attempted suicide?

-- Do you have a plan for ending your life? If so, what is your plan for suicide?

-- Assess lethality/means to carry out plan

Row 5Ch. 25

100

(Learning card, no points)

Assessment:

Lethality and Self-assessment

--Lethality:

-Is there a specific plan? - How lethal is the proposed plan.

Remember hard methods: gun, hanging, jumping off bridge, carbon monoxide poisoning, staging a crash

Remember soft methods: cutting wrist, natural gas, ingesting pills

--Is there access to the planned method?

--Self-assessment:

- Countertransference, limited belief that asking will cause the pt to act on intentions.