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crisis and suicide > crisis and suicide > Flashcards

crisis and suicide Flashcards

1
Q

suicide stats (5)

A
  • 1 mill people/yr die by suicide
  • 10-20 mill people engage in some form of suicidal behavior
  • U.S more than 32000 people each yr die by suicide, many more receive emergency tx following suicidal behavior
  • suicide is the 11th leading cause of death, 3rd among 15-24 yo
  • more than 90% of people who die by suicide have some form of psych illness, substance abuse, or both
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2
Q

theory of suicide(3)

A
  • bio factors: twin and adoption studies suggest presence of genetic factors. low levels of serotonin are thought to play a role. physical illness is considered an important factor
  • psychosocial factors: freud: aggression turned inward. Beck: underlying emotion is hopelessness
  • cultural factors, religious beliefs, fam values and attitude toward death. “I won’t do it b/c my family needs me, matters to somebody”. European and native americans have twice the suicide rate of other groups.
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3
Q

definitions (3)

A
  • suicidal behaviors: range of actions associated with suicide
  • death by suicide: act of killing oneself
  • avoid terms such as completed suicide, failed suicide, or successful suicide
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4
Q

risks for suicide (7)

A
  • fam hx
  • sexual and physical abuse in childhood
  • recent life events
  • impulsive and aggressive personality traits
  • suffered loss of love-can be violent
  • suffered a narcissistic injury (humiliation)
  • experienced overwhelming moods like rage of guilt
  • identify with a suicide victim
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5
Q

SAD Persons scale

A

s: sex (male gets 1)
a: age (1 under 45 or over 65)
d: depression (1 if present)
p: previous attempt (1 if present)
e: ethanol abuse (1 if present)
r: rational thinking loss (1 if present)
s: social supports lacking
o: organized plan (1 if plan is made and lethal)
n: no spouse (1 if divorced, widowed, separated, or single)
s: sickness (1 if chronic, debilitating, and severe)

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6
Q

scoring for SADPERSONS (5)

A
  • 0-2: send home with follow-up
  • 3-4: close follow-up, consider hospitalization
  • 5-6: strongly consider hospitalization, depending on confidence in the follow-up arrangement
  • 7-10: hospitalize or commit
  • follow-up would include a sitter to watch person at all times
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7
Q

verbal and nonverbal cues (6)

A
  • clues are usually sent out to supportive people. “Life isn’t worth living anymore” “You won’t have to bother with me much longer”
  • usually it is a relief for people contemplating suicide to talk to someone about their despair.
  • not all clients with suicidal ideation really want to die
  • behavioral clues-farewell notes, giving away, possessions
  • somatic clues-sleep disturbance (distress and not sleeping is worrisome, need to get them to sleep), weight loss
  • emotional clues-social withdrawal, hopelessness, exhaustion
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8
Q

lethality of plan (6)

A
  • specificity of details-the more details included in the plan, the higher the risk (longer the planning process the more risk)
  • lethality: how quickly the person would die using the method
  • high risk: gun, jumping, hanging, carbon monoxide, car crash
  • low risk: wrist slashing (bc physically uncomfortable and often call for help), ingesting pills
  • availability of means, if the means are available, the risk is greater than if one still has to secure the means
  • often feel better right before suicide b/c feel better/relief with the plan
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9
Q

protective factors preventing suicide (8)

A
  • effective clinical care for mental, physical, and substance abuse disorders
  • easy access to various clinical interventions and support for help-seeking
  • close familial/friend relationships, which foster better coping with stress
  • restricted access to highly lethal means of suicide
  • strong connections to family and community support
  • support through ongoing medical and mental healthcare relationships
  • skills in problem solving, conflict resolution, and nonviolent handling of disputes
  • cultural and religious beliefs that discourage suicide and support self-preservation
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10
Q

nursing assessment for suicide risk (5)

A
  • begins with a consideration of the therapeutic relationship
  • focuses on establishing a therapeutic alliance with clients at risk
  • is carried out with a caring and compassionate approach
  • attempts to understand the experience that the suicidal person is having
  • involves understanding the person within his or her social and family context
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11
Q

assessment questions for suicide (6)

A
  • have you ever had thoughts of harming yourself?
  • when was that?
  • what were you thinking, feeling at that time?
  • did you ever act on any thoughts of harming yourself?
  • tell me about those times?
  • big relief for patients to actually discuss with nurses, not doctors or family because afraid of their reactions.
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12
Q

questions to assess for a suicide plan (6)

A
  • are you thinking about killing yourself right now?
  • are you feeling so badly that you have thought of taking your own life?
  • have things been so bad that you feel you can’t go on?
  • what have you thought about doing?
  • have you thought about a specific time or place?
  • do you have access to a firearm, pill, knife?
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13
Q

immediate interventions for clients contemplating suicide (3)

A
  • removing the means of suicide to reduce the risk of it happening
  • if hospitalized, methods may include ensuring pills or medications are not available or being accumulated by clients
  • if in a community or home care setting, enlist the help of family or friends to remove the means and to provide immediate support, don’t be alone
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14
Q

helping loved ones cope with suicide (5)

A
  • offer support and guidance to survivors
  • explain that the emotions usually do subside with time, but there is no set time frame for the process (doesn’t always feel this bad)
  • let survivors know that painful feelings may recur
  • suggest that they seek professional mental health counseling for a time after the suicide
  • refer to support groups
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15
Q

in hospital (3)

A
  • precautions involve a metal detector for weapons
  • no metal utensils, knives, anything that cuts, no shoestrings, razors
  • may have a formal contract for safety
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16
Q

reaction to crisis (4)

A
  • adapt and return to the previous state of mental health
  • develop more constructive coping skills
  • decompensate to a lower level of functioning
  • either get better, back to where you were before, or get worse
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17
Q

factors influencing the outcome of a crisis (8)

A
  • previous problem-solving experience
  • perception or view of the problem (they may view the problem as a catastrophe/end of my life or believe that they can move on)
  • amount of help or hindrance from significant others
  • number and types of past crises (how much the person is dealing with total)
  • time since the last crisis (if its more recent its more difficult because of other crisis)
  • membership in a vulnerable population
  • sense of mastery (lacking confidence can contribute to crisis)
  • resilience
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18
Q

three types of crises (3)

A
  • maturational (developmental): results from normal life events that cause stress. ex: wedding, retirement, kid
  • situational: develops as a response to a sudden and unavoidable traumatic vent that dramatically alters a person’s identity and roles. ex. death, divorce, job loss
  • adventitious: outside external event that causes trauma and disruption, usually to many people. ex. flood, earthquake, crimes of violence
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19
Q

phases of a crisis (4)

A
  • phase 1: incr anxiety in response to trauma. use their prior problem solving and defense mech. if they don’t work then move onto phase 2
  • phase 2: if coping mech are ineffective, person enters this phase of crisis marked by further anxiety. trial and error problem solving. look scattered. (makes normal life probs more difficult)
  • phase 3: anxiety continues to escalate-withdrawal or fight or flight becomes nothing has worked
  • phase 4: active state of crisis occurs, inner resources and support systems are inadequate. precipitating event is not resolved, and stress and anxiety mount intolerably. disorganization. (I don’t know what i’m going to do)
20
Q

crisis intervention principles (4)

A
  • self-limiting, usually resolved in4-6 (8) wk
  • focuses on the immediate problem or stressor that precipitated the crisis rather than on personality traits
  • views people in crisis as normal and capable of problem solving and growth with assistance from others. for people with normal coping who can learn and grow, not mentally ill
  • goal is to assist people in distress to resolve the immediate problem and regain emotional equilibrium, not all prior probe
21
Q

crisis intervention (6)

A
  • problem solving should lead to enhanced coping to deal with future stressful events
  • resolution results in achievement of one of three different functional levels: higher level of functioning, same level, or lower level
  • people are more open to outside intervention during a crisis, want to be helped or taught
  • nurses take a more active role
  • early intervention is important
  • goals should be realistic and focus on current prob
22
Q

assessment for crisis (4)

A
  • is there suicidal or homicidal ideation?
  • perception of precipitating event
  • situational supports
  • personal coping skills
23
Q

general guidelines for crisis (7)

A
  • identify whether treatment is warranted
  • identify whether client is able to identify precipitating event
  • assess client’s understanding of situational supports
  • identify client’s usual coping styles and what coping mech might be helpful
  • are there religious or cultural beliefs that need to be considered
  • what type of intervention does the client need
24
Q

skills needed for crisis work (8)

A
  • communication
  • active listening
  • assessment
  • collaboration: work with other groups and family
  • advocacy
  • documentation
  • consultation
  • teaching and coaching, people are ready to learn and make a change
25
Q

nursing diagnosis (6)

A
  • ineffective coping
  • anxiety
  • disturbed thought processes
  • situational low self-esteem
  • social isolation
  • impaired social interaction
26
Q

tips for assessing (4)

A
  • make sure its the clients wishes, agenda, their support persons
  • dont make assumptions
  • questions: what is the precipitating event, what got you to this point, how have you coped/done before, what support do you have, what resources do you have, who can help, do they need to be in a hospital, are they safe?
  • how safe is the environment
27
Q

definitions of personality disorders (3)

A
  • a collection of personality traits that have become so fixed and rigid that they cause inner distress and behavioral dysfunction
  • lifelong behavioral pattern that negatively affects many areas of life, causes problems, and is not produced by another disorder or illness
  • an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individuals culture
28
Q

personality disorders (5)

A
  • inflexible, maladaptive response to stress
  • disability in working or loving, difficulty in having relationships or can’t
  • able to evoke interpersonal conflict
  • capacity to frustrate others
  • movie: fatal attraction
29
Q

theory of personality disorders (3)

A
  • bio determinants: seems to have a genetic component
  • chronic trauma: repeated trauma affects brain (abuse, traumatic childhood affects brain development)
  • psychosocial factors: use less healthy coping mech all the time, harsh or overprotective parenting
30
Q

personality disorder clusters (3)

A
  • cluster A: disorders with odd or eccentric behavior as the core characteristic
  • Cluster B: disorders with dramatic, emotional, or erratic manifestations. causes the most trouble
  • cluster C: represents disorders marked by anxious or fearful behaviors
31
Q

Cluster A-paranoid personality disorder-suspicious (5)

A
  • afraid someone will hurt them
  • hypervigilant, questioning others actions
  • attack, counter attack
  • well in streets bc paranoid, get into less trouble
  • straightforward explanations, be honest, as nurses
32
Q

Cluster A: schizoid personality disorder-avoids close relationships (5)

A
  • detached, loner, no good social awareness, afraid of relationships
  • simple and clear as nurses
  • rarely in hospital, bc afraid of the interaction
  • when you do see them bc some illness worsened to that point
  • anxious and fearful
33
Q

Cluster A: schizotypal personality disorder-odd (5)

A
  • theories, talk about weird things
  • “magical thinking”
  • belief that goes too far, “all is witchcraft”
  • slightly more reality based than schizophrenia
  • need to explain things, people are very anxious
34
Q

Cluster B: antisocial personality disorder-psychopath, sociopath (6)

A
  • they believe its ok to violate the rights of others
  • serial killers
  • lie, cheat, no remorse
  • manipulative, aggressive
  • very little that you can do as a nurse
  • work in a team to tx and take care of one another, protect yourself, need self-awareness
35
Q

Cluster B: borderline personality disorder (6)

A
  • unstable intense relationships, impulsivity, self-mutilation, mood shifts, chronic emptiness, intense fear of abandonment, splitting
  • most difficult pt to take care of (fatal attraction)
  • self-mutilate to feel real
  • splitting, pit one person against another
  • suicide threats, and commit suicide
  • afraid nobody will be there
36
Q

Cluster B: histrionic personality disorder- need to be center of attention

A
  • actors and actresses

- center of attention

37
Q

Cluster B: narcissistic personality disorder-needs to be admired, fantasies of power or brilliance (6)

A
  • sense of entitlement, arrogant, rude
  • inc estimate self-importance, dec estimate for others importance
  • fragile ego, sensitive
  • resist boundaries and limits
  • careful to not make them feel humiliated
  • believe only loved if pretty and successful
38
Q

Cluster C: avoidant personality disorder-social inhibition (2)

A

“i could never do that”

-social inhibition

39
Q

Cluster C: dependent personality disorder (6)

A
  • cant do anything without advice or reassurance
  • not really in hospital
  • “ask husband, can’t decide/do for self”
  • more often women
  • others responsible for imp areas of life
  • helpless, clingy
40
Q

Cluster C: obsessive compulsive personality disorder (5)

A
  • rigid preoccupation with rules
  • perfectionistic
  • superficial relationship
  • knows all risks and follows them
  • inflexible
41
Q

goals of tx of personality disorders (8)

A
  • immediate problem solving
  • enhancement of coping
  • improvement of social skills
  • increased tolerance of anxiety without resorting to maladaptive coping mech
  • incr self-awareness
  • amelioration of the more destructive personality traits
  • stop worst behavior first
  • “what can you do when you feel like this? journal, walk, relax”
42
Q

methods of tx of personality disorders (5)

A
  • psychopharmacology (for long-term therapy people)
  • individual psychotherapy
  • dialectical-behavioral therapy (borderline)
  • group therapy: can be helpful for long-term
  • family education and therapy
43
Q

assessment (7)

A
  • no specific physical findings are associated with any personality disorders
  • suicidal or homicidal ideation
  • current med/drug use
  • past history of abuse
  • clients with personality disorders seldom seek psychiatric assistance unless they experience comorbid conditions
  • don’t often come into hospital, sociopath because risk of other directed violence
  • assess for personality disorders in those with sx of depression and other mood disturbances, anxiety, psychosis, substance abuse, or suicide crisis
44
Q

nursing diagnosis (8)

A
  • ineffective coping
  • anxiety
  • risk for other directed violence
  • risk for self-directed violence
  • impaired social interaction
  • disturbed thought processes
  • chronic low self-esteem
  • self-mutilation
45
Q

goals for the care of clients with personality disorders (7)

A
  • risk control: client will experience physical safety
  • adherence behavior: client will participate in therapy
  • symptom control: client will exhibit improved oping and tolerance of anxiety
  • realistic small steps
  • list consequences of behaviors (don’t let people walk over you)
  • journaling
  • looking at functional alternatives
46
Q

interventions (8)

A
  • promoting participation in treatment
  • enlisting the family in the treatment plan
  • improving coping skills
  • reducing inappropriate behaviors
  • confronting the client
  • setting limits
  • providing for physical safety
  • give social feedback
  • dont reject or rescue
47
Q

nurses self-care (6)

A
  • monitoring oneself in terms of expressing concern and setting boundaries has been reported to inc the effectiveness of therapeutic relationships with clients with personality disorders
  • these are difficult clients to work with (create a lot of drama, on the light all the time, afraid they will be rejected and call more often, so tell them “ill be around every hr”)
  • clients tend to attack and blame others. it is important to remember that the attacks come from being threatened
  • let the client know that even though though you may have been insulted, the client will still be helped
  • be authentic, trustworthy, learn to set appropriate limits and deal with manipulation
  • you may wish to discuss emotional reactions to clients with knowledgeable and trusted nurse colleagues

crisis and suicide (1 decks)

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