Suicidal Thoughts & Behaviors

Question 1

Suicide is not a diagnosis or a disorder; it is a behavior/action.
Question: Does someone Commit Suicide or do they Die From Suicide? - think how respond to question is how care for someone/fam members or how approach subject; imp thing to think about in know self and know rxns

Answer 1

Intro

Question 2

Suicide in its many forms has inspired everything from condemnation to romanticism—most focusing on the morality of taking one’s own life and whether it can be justified as a reasonable option.
Not a case Most people do not want to die, they just do not know how to live with their prolonged deep psychic pain. - what often hear from people; in so much pain and feel hopeless - think suicide is the answee
What about a patient whose every moment is suffering intractable pain from a terminal illness and wants to leave life with some dignity?

Answer 2

Thoughts on suicide from your text - Ch.23

Question 3

The second leading cause of death among Americans 15 to 24 years of age - moving up in category
The fourth leading cause of death for ages 35 to 54
The eighth leading cause of death for ages 55 to 64

Answer 3

Epidemiological factors - Suicide is:

Question 4

Often 90% of suicide completers had a diagnosable condition.
Age
Psychiatric illness.
Severe insomnia is associated with increased risk of suicide - getting sleep is imp; when stressed and tired harder to be able to use healthy coping skills
Use of alcohol and barbiturates - drives up rate
Psychosis with command hallucinations - have command hallucinations
Affliction with a chronic, painful, or disabling illness - chronic illness
Family history of suicide - see increase in fams of indivs who attempt/die by suicide
Same sex gender individuals have a higher risk of suicide than their heterosexual counterparts.
Transgender individuals have 40-50% increase risk of suicide - sig risk
Having attempted suicide previously increases the risk of a subsequent attempt. About half of those who ultimately die of suicide have a history of a previous attempt.
Severe Loss of a loved one through death or separation - through indiv
Lack of employment or increased financial burden
Any losses that may cause depression increases risk for indiv

Answer 4

Risk factors

Question 5

50%: Mood disorders, MDD, and bipolar disorder
25%: Alcohol and substance abuse disorders
10%: Psychoses
5%: Personality disorders
5%: Physical illness (E.g., traumatic brain injuries [TBI], epilepsy, terminal and/or painful diseases like cancer, AIDS, MS, Huntington’s, and Parkinson’s) - chronic illness that are dealing with

Answer 5

Often 90% of suicide completers had a diagnosable condition.

Question 6

Risk of suicide increases with age, particularly among men
White men older than 80 years are at the greatest risk of all age/gender/race groups
Seen often in white older men

Answer 6

Age

Question 7

Mood and substance use disorders are the most common psychiatric illnesses that precede suicide. Other psychiatric disorders that account for suicidal behavior include:
Schizophrenia
Personality disorders
Anxiety disorders

Answer 7

Psychiatric illness.

Question 8

Second leading cause for 15-24
Children or teenagers who lost a parent to suicide are three times more likely to commit suicide - sig
Childhood maltreatment
Problematic family relations
History of bullying or victimization
Family history of suicide
Socioeconomic problems
Parental psychopathologic problems
Peer problems
Legal and/or discipline problems

Answer 8

Risk factors-youth

Question 9

Other vulnerable pop; suicide rates by veterans/active duty
Suicide studies among Iraq and Afghanistan veterans
More deaths in active duty are by suicide than combat - any death is tragic but that is surprising
Risky behavior among returning veterans:
Veterans with TBI (traumatic brain injury) more likely to commit suicide

Answer 9

Combat-related suicides

Question 10

Results in a disproportionate rate of death from accidents or unintentional poisonings
Common behaviors consistent with PTSD

Answer 10

Risky behavior among returning veterans:

Question 11

Demographics - overall look at these
Presenting Symptoms/Medical-Psychiatric Diagnosis
Analysis of the Suicidal Crisis
Psychiatric/Medical/Family History
Coping Strategies - have coping strategies that they can identify and are they realistic and things can use

Answer 11

Nursing process: Asessment

Question 12

Age
Gender
Ethnicity
Martial status - having support sys
Socioeconomic status
Occupation
Lethality and availability of method - means are considering
Religion
Family history of suicide
Note: A person may experience one or more risk factors and not be suicidal. - not mean if have sev risk factors that going to attempt/die by suicide but things to consider when doing assessment and working with indivs
Suicide is their availability/method they are choosing

Answer 12

Demographics - overall look at these

Question 13

Suicidal Ideas or Acts
Interpersonal Support System - assess for support sys and if present

Answer 13

Presenting Symptoms/Medical-Psychiatric Diagnosis

Question 14

Seriousness of intent
Plan
Means
Verbal and behavioral clues - kind of these that are giving
If voices that thinking of suicide/killing self, find out plan and if have means to carry out plan

Answer 14

Suicidal Ideas or Acts

Question 15

The precipitating stressor - look at stressors in front of them at moment
Relevant history
Life-stage issues

Answer 15

Analysis of the Suicidal Crisis

Question 16

S: Male sex → 1; gender increases risk
A: Age If <19 or >45 years → 1
D: Depression or really hopeless/hopelessness → 2
P: Previous suicidal attempts or psychiatric care → 1
E: Excessive ethanol (alcohol) or drug use → 1
R: Rational thinking loss (psychotic or organic illness) → 2 - lose this thinking; is a factor if suicidal
S: Separated, widowed, or divorced → 1 - lost connections and not connected with other people
O: Organized plan or made a serious attempt → 2 - keys when doing assessment
N: No social support → 1
S: Stated future intent (determined to repeat or ambivalent) → 1
Doing for assessment who may be suicidal
Guidelines for Clinical Action - benchmark as doing assessment and if add up points that see behind each one factors

Answer 16

Modified SAD PERSONS ASSESSMENT SCALE - pg 368

Question 17

0-5: May be safe to discharge (depending upon circumstances)
6-8: Probably requires psychiatric consultation/treatment
>8: Probably requires hospital admission (voluntary or involuntary); need hospitilization either voluntary or involuntary

Answer 17

Guidelines for Clinical Action - benchmark as doing assessment and if add up points that see behind each one factors

Question 18

The nurse is caring for an actively suicidal client on the psychiatric unit. What is the nurse’s priority intervention?
A. Discuss strategies for the management of anxiety, anger, and frustration.
B. Provide opportunities for increasing the client’s self-worth, morale, and control.
C. Place client on suicide precautions with one-to-one observation.
D. Explore experiences that affirm self-worth and self-efficacy.

Answer 18

Correct answer: C
Placing the client on suicide precautions with one-to-one observation provides a safe environment for an actively suicidal client. Maintaining client safety should always be a priority nursing intervention
One-to-one: for their safety and are guidelines must follow when working with indiv on one-to-one for suicde precautions

Question 19

Do not leave the person alone - try not do this
Establish a no-suicide contract with the client - oral/written; both very effective; make sure if feel suicidal that contact someone
Enlist the help of family or friends - safety of indiv; imp time make sure contacting someone and sharing info; legally wondering if should share but if for pat’s safety may want to enlist the help of family or friends
Schedule frequent appointments
Establish rapport and promote a trusting relationship
Think actively suicide/high risk for suicide put on in-pat basis
Be direct and talk matter-of-factly about suicide - figure out way comfy asking if suicidal/thinking killing self or self-harm; figure out words that are genuine manner that is comfy for you
Discuss the current crisis situation in the client’s life - may be on antidepressant and not/antianxiety or not; depends on situation on indiv
Identify areas of self-control
Give antidepressant medications

Answer 19

Guidelines for treatment of suicidal clients on outpatient basis

Question 20

Crisis counseling with the suicidal client:
Identify experiences and actions that affirm self-worth and self-efficacy - crisis counseling with someone who is suicidal do this
Encourage movement towards the new reality - see progression and hope; continual message give someone
Be available for ongoing therapeutic support and growth - support sys and someone available and ongoing therapy

Answer 20

Crisis counseling with suicidal client

Question 21

Focus on the current crisis and how help them so it can be alleviated/make it better/see that is hope and things getting better
Note client’s reactivity to the crisis and how it can be changed
Work toward restoration of the client’s self-worth, status, morale, and control Introduce alternatives to suicide
Rehearse more positive ways of thinking - cognitive therapy; switching thinking around to more + thought pattern

Answer 21

Crisis counseling with the suicidal client:

Question 22

A client with a history of a suicide attempt has been discharged and is being followed in an outpatient clinic. At this time, which is the most appropriate nursing intervention for this client?
A. Provide the client with a safe and structured environment.
B. Isolate the client from all stressful situations that may precipitate a suicide attempt.
C. Observe the client continuously to prevent self-harm.
D. Assist the client to develop more effective coping mechanisms.

Answer 22

Correct answer: D
Assisting the client to develop more effective coping mechanisms is a nursing intervention that can and should be implemented in outpatient settings as ongoing follow-up

Question 23

Take any hint of suicide seriously - may think wanting to get attention but reality is but for safety but have to assume is serious
Do not keep secrets - if working with client and say not tell anyone cannot promise that; if harmful to self/others then have to tell others then on pat if tell you - may choose not tell you and wondering what going to say
Be a good listener - part therapeutic communication; teach for fams and friends on how be good listener
Express feelings of personal worth to the client - give affirmations
Know about suicide intervention resources - and numbers, people contact
Restrict access to firearms or other means of self-harm - having be aware of things that may promote and assist someone who is having suicidal ideation
Acknowledge and accept the person’s feelings
Provide a feeling of hopefulness
Do not leave him or her alone
Show love and encouragement
Seek professional help
Remove children from the home
Do not judge or show anger toward the person or provoke guilt in him or her - is hard; may really provoke guilt which drives up defense mechanisms - all shoulds in life; care without judgment
Imp to consider all of these

Answer 23

Information/teaching for the family and friends - also for someone who is suicidal

Question 24

Encourage the person to talk about the suicide - Help fam and friends ask question to someone/loved one/friend: thinking killing self; comfy and if is yes be able listen and allow talk about that
Discourage blaming and scapegoating
Listen to feelings of guilt and self-persecution
Talk about personal relationships with the victim
Recognize differences in styles of grieving
Assist with development of adaptive coping strategies
Identify resources that provide support - imp for people to have; text suicide hotline

Answer 24

Interventions With Family and Friends of Suicide Victims