Ch. 25
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
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
Learning card (no points)
Clinical picture
-- 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
(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
(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.
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.
Learning card (no points)
Treatment
- 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.
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.
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
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
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
(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."
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.
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).
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