Ch. 23 - Suicide

Question 1

Risk factors of suicide (by group - health, environment, historical)

Answer 1

+ health - comorbid mental/physical health problems, especially terminal/chronic
+ environmental - access to guns, poison, medications at lethal levels, bullying, divorce, employment loss, prolonged relationship stress
+ historical - previous attempts (highest precursor), family suicide, childhood trauma

Question 2

US profile of suicide

Answer 2

+ 2nd leading cause/death ages 15-29, growing over 65
+ ⬆️ in minorities - lgtb, refugees, indigenous, prisoners
+ PREVIOUS attempt GREATEST predictor
+ males more successful; females more more likely to attempt
+ 46% w/mental health issue

Question 3

Misconception about MODE of suicide

Answer 3

That most people try by taking pills - FALSE

Question 4

Leading mode of suicide

Answer 4

Gunshot wounds

Question 5

Risk factors: age, ethn, occupation, gender, religion, socioeconomic, marital stats, medical, psycho,etc

Answer 5

+ MARITAL: single, divorced, widowed
+ AGE: adolescents, 45-65
+ SOCIOECONOMIC: low & high
+ ETHNICITY: caucasians highest, then asians
+ OCCUPATION: healthcare, cops, artists lawyers, military
+ sever insomnia
+ chronic pain/disabling illness
+ psychiatric illness/hospitalized
+ early antidepressant treatment
+ previous try
+ severe mental disorders - schizophrenia, bipolar, anxiety, substance abuse, hallucinations
+ LGTBQ+
+ family history of suicide
+ bullying victims
+ lack of support system

Question 6

3 suicide myths

Answer 6

1. Bringing up/asking about suicide will put ideas in persons head
2. Someone will do it if they want, so don’t ask
3. Suicidal threats are attention getting, not real

Question 7

Nursing assess. for imminent risk of suicide

Answer 7

+ distinguish pt IDEAS/THOUGHTS from PLANS
+ distinguish between NON-suicidal self injury (cutting/burning) from SUICIDAL self injury (swallowing pills, stepping in front of cars)
+ assess verbal/nonverbal cues of intent
+ assess if there is a PLAN
+ assess MEANS

Question 8

Example of verbal cues

Answer 8

HOPELESSNESS statements
“I can’t take it anymore”
“Life isn’t worth living”
“Everyone is better with out me”
“I don’t want to wake up anymore”

Question 9

Examples of behavioral cues

Answer 9

+ giving away possessions
+ writing farewell notes
+ putting affairs in order
+ exhibiting sudden improvement of mood after severe depression
+ neglecting hygiene

Question 10

parameters for assessing SI

Answer 10

+ Identify current state
+ ask if they’re thinking of killing themselves
+ ask if they have a plan
+ determine logic of plan
+ gather risk factors
+ is there a history of attempts
+ Assess risk factors from previous slides
+ assess coping mechanisms
+ assess current stressors and lifestage issues

Question 11

“IS PATH WARM”

Answer 11

Ideation
substance-abuse
purposelessneas
anger
trapped
hopelessness
withdraw
anxiety
recklessness
mood

Question 12

3 immediate/current precipitating factors of suicidal crisis

Answer 12

1. new precipitating stressor - job loss, death, breakup
2. Relevant history - experienced multiple failures/rejections causing vulnerability or hopelessness
3. Life stage development struggles - adolescents, midlife

Question 13

What is C-SSRS?
What is it for?

Answer 13

+ Columbia suicide severity rating scale
+ scale that helps determine how at risk person is for suicide

Question 14

What is the SAD PERSONS scale?

Answer 14

S: sex - male - 1
A: age - < 19 or > 45 - 1
D: depression or hopelessness - 2
P: previous attempt or psych care - 1
E: excessive alcohol/drug abuse - 1
R: rational thinking loss (psychosis/illness) - 2
S: separated/widowed/divorced - 1
O: organized plan - 2
N: no social support - 1
S: stated intent - 1

Question 15

SAD PERSONS scale point ranges

Answer 15

0-5: may be safe with family/friend, followup
6-8: requires psych consult
> 8: requires inpatient

Question 16

Information that should be conveyed to a patient with suicidal ideations!

Answer 16

+ The crisis is temporary
+ unbearable pain can be survived
+ helps available
+ you are not alone

Question 17

nurses role in therapeutic communication with a patient was suicidal ideations

Answer 17

+ Remains nonjudgmental
+ listens attentively

Question 18

How are no suicide contracts different than safety plans?

Answer 18

• suicide contract is some thing the patient agrees NOT to do
• safety plan is something that the client agrees TO do, be a part of, multi-pronged

Question 19

** Steps of the Stanley brown safety plan - worksheet **

Answer 19

+ risks/warning
signs that crisis is developing
+ identify any internal coping strategies
+ assess people in social settings that provide distractions
+ list of people I can ask for help
+ professionals and agencies to contact during crisis
+ steps that make environment safe

Question 20

** How the nurse can help the patient while safety plan is being developed **

Answer 20

+ Assess suicidal ideations, plan, means every shift
+ provide safe space
+ head check every 15 minutes
+ establish rapport
+ encourage patient to talk about feelings and alternatives
+ encourage patient to identify sources of Hope and reasons to live

Question 21

Information/advice for family and friends with a suicidal person

Answer 21

+ Take threats of suicide seriously!
+ Do not keep secrets
+ be a good listener
+ emphasize ways that the suicide would devastate you
+ create connectedness
+ expressed concern about thoughts of killing themselves
+ have suicide intervention resources at hand
+ restrict all access to items that can self harm – firearms
+ communicate caring and commitment and provide support

Question 22

How to help survivors and family/friends of survivors

Answer 22

+ acknowledge and accept their feelings
+ be active listener
+ provide hope that this is temporary
+ do not leave them alone, go to where they are
+ love and encouragement, hug, touch, allow them to cry, and expressed
+ seek professional help
+ keep environment safe
+ removed children
+ do not judge or show anger or provoke guilt
+ do not discount feelings or tell them to snap out of it

Question 23

Post Evaluation for suicidal individual

Answer 23

+ Long-term goals
+ positive self-concept
+ effective ways to express feelings
+ have they achieved successful, interpersonal relationships
+ accepted by others, achieve sense of belonging