Suicide, Violence and the Mental Health Act (Case Study #1) Flashcards
What is suicide?
- Intentional, voluntary act of killing oneself,
- An action, NOT an illness
- Aggression directed inwardly
What is parasuicide?
Gestures and attempts that are unsuccessful and of low lethality
What is suicidal ideation?
- Thinking about suicide and death, and planning one’s own death
- Legal responsibility to assess and document ideation as a nursing responsibility
What are common risk factors for suicide?
- Ethnicity (more common among Caucasians and Aboriginals)
- Age (more common in youth and elderly)
- Gender (more attempts by females, more completion in males)
- Socioeconomic status (financial burden)
- Health (psychiatric disorders like schizophrenia with auditory hallucinations; physical illness; chronic pain)
- Family disruption and dysfunction (adolescent especially prone)
- Family or personal hx of suicide
- Widowed, divorced, separated, single individuals
- Recent losses
- Alcohol use
What are the five levels of suicidal behaviour?
1) Ideation (thoughts of suicide/death, direct or indirect, may have a plan but not going to carry out)
2) Threats (no attempt, but verbally threatening to kill self) (ex. saying will go buy pills, but have not yet)
3) Gestures (may not have intent to die, but harms self, and/or has means to do so) (ex. has access to firearms)
4) Attempts (actual suicide attempt with plan to kill self; can result in major or minor self-inflicted harm)
5) Completed suicide (self-inflicted death
What is the assessment criteria for suicide?
- Observe Behavior
- Assess risk factors
- History from the Patient
- Information from Family/Friends
- History of Previous Gestures or Attempts
- Mental Status Exam
- Physical Exam
- Nursing Intuition
- Imminence vs. non-imminence
- Ideation vs. intent (is intent to act on ideation present?) If yes, requires immediate intervention)
- Severity index for suicide risk
What is imminence vs. non-imminence?
- Imminence refers to suicide plan to be carried out
- Immediate danger within a specific time period (24 hours)
- Admission of wanting to die, and having access to the means to do so (ex. they have easy access to firearms in their house)
- Think SLAP (specificity, lethality, access, proximity [to help])
What are the treatment goals for the nursing diagnosis of “risk for suicide/self-directed violence”?
- Free from self-harm/SI
- Verbalizes desire to live, self-worth, goals, future plans, etc.
- Contracts for safety
- Mood improved
- Spontaneous interactions
- Effective coping, support systems
What are nursing interventions for suicidal patients?
- Safety
- Coping skills
- Documentation
- Follow-up with ongoing assessments, and ensure crisis planning is prioritized when feeling better
What is the difference between anger and aggression?
ANGER: an affective state experienced as the motivation to act in ways that warn, intimidate, or attack those who are perceived as challenging or threatening; temporary state of emotional arousal; strong and uncomfortable (i.e. the EMOTION)
AGGRESSION: behaviours or attitudes that reflect rage, hostility, and
the potential for physical or verbal destructiveness (i.e. the ACTION)
What are risk factors for violence?
- Aggression learned, family role modeling
- Alcohol and drug abuse
- History of violence
- Mental health disorders
- Lack of coping skills
- Medical conditions
- Mental disabilities, low IQ
How can we assess violence in an individual?
- Watch for risk factors
- Increase in motor agitation (pacing, inability to sit still, sudden cessation of motor activity, clenched fists/jaw)
- Threatening verbalization’s (retaliation toward those seen as threats; response to threatening visual/auditory hallucinations; response to delusional thinking)
- Intensification of affect (tense expression, jumpiness, elated expression)
- Prior hx of assaultive behavior is the best predictor (ex. has acted violently in past, esp under stress)
What are the four levels of crisis development in relation to violence?
1) Anxiety (change; restless; excess energy; pacing; muttering)
2) Defensive/anger and hostility (verbal/nonverbal cues; screaming/swearing; loss of control)
3) Acting out (total loss of control; physical assault)
4) Tension reduction (emotional drained, withdrawn, remorseful, apologetic)
How do you respond during the anxiety phase of crisis development?
SUPPORTIVE
- Respectful
- Empathetic
- Listen
- Validate
- Reassure
- Encourage
- Help
How do you respond during the defensive phase of crisis development?
DIRECTIVE
- Limit choices
- Be clear/calm
- Offer information
- Discuss consequences
