Download SUICIDE PREVENTION

SUICIDE PREVENTION
According to 20th edition of Taber’s the definition for suicide is (sui, of oneself, + der, to
kill) The intentional and voluntarily taking of ones own life
Statistics
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Suicide is the number one ranked sentinel event reviewed by JCAHO.
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30,000+ people commit suicide annually.
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4 times more women than men attempt suicide.
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4 times more men than women succeed at suicide, usually by violent means.
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The risk rate for suicide in patients with depression is 15%.
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The risk rate for suicide in patients with bipolar disorder is 10-15%.
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It is estimated that about 60% of young people who commit suicide had a mood disorder
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Suicide attempts and completion occur more often when the patient has:
 Severe symptoms
 Psychosis
 Coexisting mental disorders
 Coexisting substance abuse
 Medical illnesses
 Stressful life events
 Family history of suicide
Risk Factors
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Male and/or adolescent or over 40 years old
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Divorced or widowed or separated
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Death of a parent or child
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Elderly with illnesses / unable to care for self
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History of previous attempt
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Lack of support systems
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Hopelessness about discharge
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Mood begins to lift following depression, they now have the energy to take action.
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Major medical / psychiatric illness
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Alcoholism
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Drug abuse
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Bipolar disorder
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Major depression
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Legal problems
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Age of 20-30 or older than 65
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Impulsive and aggressive tendencies
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History of sexually abuse
High Risk Suicidal Symptoms
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isolation and withdrawal
not eating or overeating
not sleeping or oversleeping
statements of wishing for death or making statements such as, “I’d be better of dead” or
“you’re better of without me”.
threats to hurt self
identified plan for suicide
suicidal gestures or attempts, such as hanging self, suffocating, throwing self down steps
giving away possessions
poor ADLs
hopelessness
helplessness
loss of pleasure or purpose in life
resists or refuses medication or treatments
unable to see a future for self
gives away possessions
frequently tearful, agitated, or sad
refuses to contract for safety
self-mutilation
cheeking and hording medication
The Way Patients Feel
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“There’s no way out.”
“There’s no future.”
“There’s no end to what I’m feeling.”
They feel as if they have no other choice.
Most are not sure they really want to die and accept things we do to prevent suicide.
Appearing happy after a suicide attempt can mean the person has made a decision to
attempt suicide again.
Mania along with psychotic symptoms, such as delusions of grandeur, omnipotence, or
persecution, can lead to death.
Assessment: Need to share that this what the docs and nurses do.
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Ask the patients if they have thoughts of death or killing themselves.
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If the answer is yes, ask if they have any plans how they would do it.
If yes, ask what the plan is, such as how, when, and where.
If yes, ask if they have any materials in the hospital required to do it.
Ask if they hear voices that command them to kill or hurt themselves.
If yes, ask if they plan to act on the voices.
Have they tried suicide or tried to hurt themselves in the past? If so, how and when?
Has a family member or close friend committed suicide?
Assess all depressed or bipolar patients at the following times:
 upon admission
 when transferred to a different unit
 when there are major changes in the patient’s life, such as loss of good health,
loss of relationships, loss of housing
 whenever there appears to be a change in the patient’s mood
 prior to discharge
 when patient demonstrates or verbalizes ideas of self-harm
According to JCAHO, hospitals identify failure to adequately assess as the leading cause for
suicide.
Nursing Interventions
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Monitor for high risk symptoms listed above.
Staff are to notify RN immediately if patient:
o shows a decline in mood
o states an intent to hurt self
o takes action that could be self-destructive
RN assesses for:
o suicidal ideation
o plan
o inability to contract for safety
If yes to any of the above, place patient on 1:1 immediately and notify physician.
Do contraband check immediately on patient, clothing, and environment.
If anxious, give PRN.
Patient/Family Education:
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Symptoms of major depression
Symptoms of suicidal ideation
Importance of medication compliance and maintaining therapeutic blood levels
Side effects of medications
Good nutrition, exercise, and activities to decrease stress
Social activities to increase self-esteem and decrease isolation
Access to community resources and support groups
Importance of not drinking alcohol with medication
What to observe for:
 isolation and withdrawal
 not eating or overeating
 not sleeping or oversleeping
 statements of wishing for death or making statements such as, “I’d be better of dead.”
 threats to hurt self
 identified plan for suicide
 suicidal gestures or attempts, such as hanging self, suffocating, throwing self down steps
 poor ADLs
 verbalizes hopelessness
 helplessness
 loss of pleasure or purpose in life
 resists or refuses medication or treatments
 unable to see a future for self
 gives away possessions
 frequently tearful, agitated, or sad
 refuses to contract for safety
 self-mutilation
 cheeking and hording medication
What intervention you can make.
Listen!!
Show you care
Know your own feelings and attiudes about suicide
Listening an important skill
55% of communication is visual, Body language, facial expression, posture
38% of communication is sound, cadence and tone.
7% of communication is the spoken works.
Non-verbal communication is usually true.
Becoming a better listener.
Get ready to listen
Put other things or thoughts aways.
Listen to content/data/facts as well as feelings.
Note what they are not saying
Be like a detective
Know tha t listening is an active process
Ineffective listening is the biggest barrier to communication.
Average attention span; 10-15 sec/take a millisec break and you can miss critical information.
Make sure the environment is safe.
What not to do
Don’t sidestep the issue.
Don’t keep what you know a secret.
Don’t leave them alone
Patients are admitted to the hospital for treatment and protection. All nursing staff are
responsible for recognizing and observing potential
suicidal behavior, reporting to appropriate staff, and acting
within the limits of their position descriptions to protect the
patient..
Therapeutic Communication:
Let them know that they are safe and you will be with them for then next two hours.
Non-Therapeutic Communication
“You’re going to be fine…”
“Don’t say things like that…”
“I don’t want to hear it…”
“You’re wrong…”
“You’re absolutely right…”
“Do you know where you are?”
“Why ..?”
“You’re not the only one who feels that way…”
“That’s ridiculous; no one here could have done that…”
“It’s your own fault…’”
“Prove it…”
Body language: Example of anxiety
Hand-wringing, fist-clenching, teeth-clenching, lip-biting, wincing eyes, looking up or down eyes
closed or stating, hair-twirling, fidgeting with clothing, jewelry or other object, leg-or foot-shaking,
Finger-tapping, picking at crumbs, lint, linens or part of the body, blushing/flushing, becoming
livid (“white-as-a-ghost”), falling asleep, knitting the brow, hand covering mouth, eyes, face,
ears, hand on chest or throat, arms folded, hands in pockets, head turned away up or down,
body turned away, legs crossed at knees or ankles, sitting at the edge of a chair, trembling,
eyes watering or filling, hyperventilating or other irregular breathing, rubbing, shrugging or other
turning or lifting of shoulders, gum-chewing or cracking, obscene gestures, gestures indictatin
“stop,” “go,” and son on, such as putting finger to lips, meaning “sh!”, smiling (appropriately or
inappropriately), raising the eyebrows.