suicide Flashcards
suicidal ideation
thinking about death, wish to be dead, consider methods, formulate plans
all encompassing term
suicidal behavior
acts associated with suicidal intent, get means
suicide attempt
engage in potentially injurious behavior with intent of death
interrupted self directed
by other: take steps to injure self, stopped prior to fatal injury, during behavior or thought
by self: teak steps to injure self, stopped by self prior to fatal injury
suicide/death by suicide
death by self directed injurious behavior with intent to die as result
suicide survivor
survivors of person that died by suicide
postvention
mental hc and support to survivors, resoruces, referrals
cluster suicides
contagion, copycat
closer in time and space
inc when: stories inc, story reported at length, front page or beginning of broadcast, person broadly known, story spreads, dramatic headline
unacceptable terms
completed/committed suicide -> suicide/death by suicide
wrongdoing
successful (+ connotation), failed (cant do anything right), non fatal, suicidal gesture, suicidality (broad) -> suicide attempt
attempts
hx of attempt inc r/o death
general info
active duty higher, 11th leading COD, vets rising rate, mental health cinditon higher, middle aged white men, F more attempts, firearms
national pt safety goal, sentinel event -> screening, doc, training, monitor and assess
dx
not ideation or prep acts
w/n last 24 mo -> attempt, not just thoughts, plans, etc
not non suicidal self injury
not initiated in altered mental state -> delirium, confusion
not undertaken for religious or political objectives
prevent
know rf and warning s
screen by directly asking
identify protective factors, dev safety plan (recognize it can help keep safe), dec lethal access
provide individuals with resources and hot line
create com based systems to respond to risk
rf
multiple causes, not exhaustive, mod and non mod
rf - individuals
hx atempt, dep or MI, OH or substance use disorder (major R), phys health, chronic illness, criminal/legal problem, job/financial problem/loss, hx adverse childhood experiences, hopelessness
rf - relationships
bullying, fam/friend hx suicide, loss of relationship, high conflict/violent relationship, social isolation
rf - comm
dec access to healthcare/tm, suicide cluster, stress of acculturation, comm violence, hx trauma, discrimination
rf - societal
culture and env
stigma of help seeking and MI, easy access to lethal means
warning signs
trust instincts, not crisis, just something to pay attention to
hopeless/worthless, burden, preoccupation with death/lack of concern for personal safety, reckless, trapped, unbearable pain, inc substance use (esp OH), anger, irritable, resentment, isolated withdrawing from fam/friends
extreme mood swings, inc anx, sudden uplift in mood w/o reason, sleep too little too much, giving away possessions, look for way to access lethal means, make plans
protective factors
better coping skills
dec R, want to inc these factors -> resiliency
protective factors - individual
effective coping and problem solving skills
reasons to live
strong cultural identity
protective factors - relationships
strong connection and support from individuals, friends, fam
feel connected to others
protective factors - comm
connected to school, comm, social institutions
avail of and contact with consistent and high quality of phys and behavioral health care
protective factors - societal
dec access to lethal means
strong cultural identity; cultural, religious, moral objections, to suicide
assess
with C-SSRS
screen -> w/o action = no change
rf and protective factors, reassess
most share when asked directly
everyone screened = no stigma for asking
doesnt put thought in head
plan = high risk
starly brown safety plan
recognize and manage suicidal thoughts
dont use no suicide contract
recognizing cues
verbal and non verbal, body lang
overt statements: wish I were dead, cant take it
covert statements: soon everything will be fine, wont be a problem anymore, nothing feels good anymore
do verbal match nonverbal?
assess lethality of plan -> ask directly, time , plance
self assess -> our own suicidal ideation, grief, anger, countertransference
care plan
priority: suicide, coping, anx, social support, self care, sleep pattern
outcome: self restraint, coping, hope
planning: based on risk and protective factors
involve SO
treatment and management
reassess -> esp if change in conditoin
safety planning for all
env safety concerns -> search pt, mitigate ligature risks, plastic utensils, disposable tray, tubing, dispose outside
ob sitter
hand off comm
reg safety rounding -> even with sitter
means management -> no supplies in pt, discuss outpt
no private room (sitter), door open, jump and hang proof, lock other doors, inform and monitor sitter of risk -> observe even in bathroom monitor and remove things from visitors
monitor med ingestion
identify means to self harm prior to d/c
comm resources
involve social throughout stay
take care of self: exercise, nutrition, sleep, relax, outside, mindful, connect with others
communities: dec stigma, learn rf and warning s, QPR, know resources
treatment and management - support
direct Q, discuss current crisis, tc strategies, no judgement, trust, coping strategies, protective factors, educate about safety plan, comm resources
treatment and management - obs
level determined by provider, only dec with order but can inc or be initiated by RN
location: locked in pt -> based on acuity, higher at beginning; acute care -> 1:1
