Podcast
Questions and Answers
According to the SAD PERSONS scale, which clinical action is recommended for an individual scoring 5 points?
According to the SAD PERSONS scale, which clinical action is recommended for an individual scoring 5 points?
Which demographic is more likely to have successful suicide attempts?
Which demographic is more likely to have successful suicide attempts?
According to the World Health Organization (WHO), what percentage of individuals who commit suicide have a diagnosed psychiatric illness?
According to the World Health Organization (WHO), what percentage of individuals who commit suicide have a diagnosed psychiatric illness?
Which of the following is a less typical sign of depression?
Which of the following is a less typical sign of depression?
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Which of the following can be the least suggestive aspect of a suicide plan?
Which of the following can be the least suggestive aspect of a suicide plan?
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Based on the provided information, which age group is the second highest group for suicide deaths?
Based on the provided information, which age group is the second highest group for suicide deaths?
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Which of these is least important for medical professionals to assess during a suicide risk evaluation?
Which of these is least important for medical professionals to assess during a suicide risk evaluation?
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Among the psychiatric illnesses listed, which condition is least likely to elevate an individual's suicide risk?
Among the psychiatric illnesses listed, which condition is least likely to elevate an individual's suicide risk?
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What is the primary focus when caring for a client who is suicidal?
What is the primary focus when caring for a client who is suicidal?
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What is the significance of the 'SAD PERSONS' tool in assessing suicide potential?
What is the significance of the 'SAD PERSONS' tool in assessing suicide potential?
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Which of the following is a MYTH about suicide?
Which of the following is a MYTH about suicide?
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In assessing a client's suicide potential, what does understanding their 'plan' primarily involve?
In assessing a client's suicide potential, what does understanding their 'plan' primarily involve?
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According to the content, which statement is accurate about the suicide rate on Guam?
According to the content, which statement is accurate about the suicide rate on Guam?
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Which age group is disproportionately affected by higher rates of suicide in the US compared to the national average?
Which age group is disproportionately affected by higher rates of suicide in the US compared to the national average?
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What does the term 'means' refer to when assessing suicide potential?
What does the term 'means' refer to when assessing suicide potential?
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Which of the following statements is NOT a risk factor associated with increased suicide potential?
Which of the following statements is NOT a risk factor associated with increased suicide potential?
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Which population is particularly vulnerable to suicide attempts due to drug ingestions performed at home?
Which population is particularly vulnerable to suicide attempts due to drug ingestions performed at home?
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What factor is particularly associated with increased suicide risk among elderly men?
What factor is particularly associated with increased suicide risk among elderly men?
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Which of the following is NOT considered a primary nursing diagnosis related to suicide risk?
Which of the following is NOT considered a primary nursing diagnosis related to suicide risk?
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Which of the following is a key component of a suicide safety plan?
Which of the following is a key component of a suicide safety plan?
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Within suicide prevention, what does 'tertiary prevention' specifically aim to achieve?
Within suicide prevention, what does 'tertiary prevention' specifically aim to achieve?
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What is the primary purpose of establishing a 'suicide contract' with a client?
What is the primary purpose of establishing a 'suicide contract' with a client?
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In the evaluation phase of suicide prevention, what aspect of the client's well-being should be continuously monitored?
In the evaluation phase of suicide prevention, what aspect of the client's well-being should be continuously monitored?
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Which of the following is an important action to perform related to a client following an intervention focused on reducing social isolation?
Which of the following is an important action to perform related to a client following an intervention focused on reducing social isolation?
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A client with depression suddenly appears cheerful and motivated. What is the MOST appropriate nursing action?
A client with depression suddenly appears cheerful and motivated. What is the MOST appropriate nursing action?
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Which of the following items should be removed from a client's room to ensure safety when they are on suicide precautions?
Which of the following items should be removed from a client's room to ensure safety when they are on suicide precautions?
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Why are paper plates and plastic utensils preferred over glass and metal when serving meals to a client on suicide watch?
Why are paper plates and plastic utensils preferred over glass and metal when serving meals to a client on suicide watch?
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What is a crucial action to ensure medication safety for a client with suicidal ideation?
What is a crucial action to ensure medication safety for a client with suicidal ideation?
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During which times in a hospital setting should precautions for a suicidal client be increased?
During which times in a hospital setting should precautions for a suicidal client be increased?
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When a suicidal client is on the phone, what is the MOST important action that should be taken?
When a suicidal client is on the phone, what is the MOST important action that should be taken?
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A health care provider (HCP) is aware that a client is at risk of suicide. What is the HCP's duty of care?
A health care provider (HCP) is aware that a client is at risk of suicide. What is the HCP's duty of care?
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What is the relationship between cyberbullying and suicide risk in children and adolescents?
What is the relationship between cyberbullying and suicide risk in children and adolescents?
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Study Notes
Suicide
- Suicide is the purposeful taking of one's own life, an ultimate form of self-destruction.
- It involves intense feelings of fear, loss, anger, or despair.
- Suicide can have devastating and long-lasting effects.
- Nurses should recognize suicidal risk.
- Suicide causes 11 deaths per 100,000 people per year, but it is preventable.
Learning Outcomes
- Identify conditions and circumstances that make an individual at high risk for suicide.
- Describe methods for assessing suicide potential in a client.
- Describe methods for providing a safe environment for a suicidal client.
Guam's Suicide Rates
- Suicide is the 8th leading cause of death on Guam.
- Someone dies by suicide on Guam every 6 days in the last 3 months.
- In 2019, 31 people aged 20-30 died by suicide.
- In 2018, 44 people aged 30-40 died by suicide.
- In 2010, 30 people died by suicide.
- In 2011, 7 people, including 4 16-year-olds, died by suicide.
- Illicit drug use contributes to suicide on Guam.
Suicide Statistics
- Suicide is the 10th leading cause of death in people aged 15 to 24.
- The suicide rate for males over 75 years old is three times the national average.
- The suicide rate is 40% higher among the elderly.
- Suicide is more common in divorced and separated men.
Myths About Suicide
- People who talk about suicide will never commit suicide.
- People who are suicidal only want to hurt themselves, not others.
- There is no way to help someone who really wants to kill himself.
- Mentioning the word "suicide" will cause the suicidal individual to actually commit suicide.
Main Priority
- Safety is the main priority when dealing with suicidal clients.
- Suicide precautions are taken to prevent suicidal clients from self-inflicting injuries or achieving death,
Suicide Potential
- Suicide potential is measured by the client's rationality, plan, and means of carrying out the plan.
- The SAD PERSONS tool is a handout to assess suicide potential.
- There are online resources like https://qxmd.com/calculate/calculator_201/modified-sad-persons-scale that provide tools to assess suicide potential.
Suicide Risk Assessment (SAD PERSONS)
- The SAD PERSONS tool assesses risk based on 10 factors.
- Sex (Male)
- Age (<20 or >45 years)
- Depression (major depression, history)
- Psychiatric history (previous attempts)
- Excessive drug use (alcohol or other drug abuse)
- Rationality loss (psychosis, severe depression)
- Separated/divorced/widowed
- Organized plan (suicide plan)
- No supports (lack of community support)
- Sickness (chronic illness)
Clinical Action Based on SAD PERSONS Score
- Clinical action depends on the total SAD PERSONS score:
- 0-2 points: Send home with follow-up
- 3-4 points: Close follow-up; consider hospitalization
- 5-6 points: Strongly consider hospitalization
- 7-10 points: Hospitalize or commit.
Suicide Attempts
- Some accidents may be suicides.
- Suicide attempts (unsuccessful) are more common than successful suicides, particularly in women.
- Successful suicide is more common in men.
- Suicidal ideation (thoughts) should not be ignored and may lead to attempts.
- Many suicide attempts involve firearms and/or medication overdoses.
Suicide and Psychiatric Illnesses
- 90% of those who commit suicide have a pre-existing psychiatric diagnosis (according to WHO).
- Unipolar (always down) and bipolar depression (up and down) are at the highest risk for suicide.
- Schizophrenia is also a significant risk factor.
- Alcohol and substance abuse are linked to increased risk.
Recognizing Signs and Symptoms
- Signs of depression (most common)
- Sudden changes in behaviour (reckless behaviour, talking about death, withdrawal, etc)
- Dramatic mood changes
- Improved mood after antidepressant therapy (early improvement could indicate a higher risk).
Formulation of a Suicide Plan
- Giving away possessions
- Access to weapons or pills (means)
- Getting finances in order
- Direct or indirect statements of suicidal intent.
- Increase in energy levels
- Suicide notes
Risk Factors for Suicide
- Males over 50 years old
- The second leading cause of death in 15-19-year-olds
- Social isolation
- History of previous suicide attempts
- Terminal illness
- Job loss, financial loss.
- Causes – Mental health conditions – Drug and alcohol abuse – Depression
NCLEX Considerations for Suicide Potential
- Is there a suicide plan?
- How lethal is the proposed method?
- Is there access to the proposed method?
Warning Signs and Behaviors
- Clients emerging from depression may have increased energy to form a suicide plan.
- A sudden change in mood from depressed to cheerful/motivated may indicate an increased suicide risk.
Care of a Suicidal Patient
- First focus is client safety.
- One-on-one supervision
- Establish trust and non-judgmental approach
- Remove all dangerous items (belts, razors, knives, etc).
- Lock windows, remove blinds, and remove cords, scissors, shoelaces, and any other potential items used to harm oneself.
Constant Supervision
- Use paper plates and plastic utensils only.
- Ensure clients swallow medication.
- Clients are checked every hour, documented by nursing staff.
Danger Times
- Shift change (fewer staff available to supervise)
- Weekends
- Nightshift
- Increased precautions are needed during these times.
Suicidal Client on the Phone
- Keep them talking while getting help.
- Be compassionate and non-judgmental, and remain calm.
- If ingested drugs, try to get details like type, amount, and last meal.
Duty of Care
- When a healthcare provider (HCP) is aware that a client is at risk of dying by suicide, they have a duty to take reasonable care to prevent the suicide.
Social Media and Suicide
- Cyberbullying is a risk factor for suicide, particularly in adolescents.
- Children/teens intentionally and repeatedly targeted by another child/teen (threats, harassment, humiliation) for a possible increased risk for suicide.
- Adults - Cyberstalking
- Bullying suicide (Cyberbullicide)
Case Example of Amanda Todd
- A 15-year-old Canadian student who was a victim of cyberbullying.
- She posted a YouTube video before her death to share her experience of being blackmailed into exposing her breasts via webcam, bullied, and physically assaulted.
Special Populations
- Adolescents and young adults (drug ingestion often at home)
- Elderly (>75 years old), potentially experiencing losses, loneliness, and alcohol abuse.
- Incarcerated individuals (holding facilities, local jails)
- Military combatants
Suicide Survivors
- Friends and families of successful suicides may experience a more stressful grieving process, experiencing anger and sadness.
- Nursing tip: Seek guidance on how to help survivors.
Nursing Diagnoses
- Spiritual well-being
- Spiritual distress
- Hopelessness
- Powerlessness
Outcome Identification
- Prevent harm
- Develop a suicide safety plan.
- Ensure client safety.
- Establish a reduced-risk environment.
Suicide Safety Plan Components
- A written set of instructions (with a healthcare professional's/therapist's help) for the client to follow if they have thoughts of self-harm.
- Steps the client can take to ensure personal safety
- Warning signs to recognize
- Reasons for living
- Trusted contacts
- Suicide lifeline numbers and other resources
Planning/Interventions
- Prevention (Tertiary, Secondary, Primary)
- Controlling access to dangerous items
- Media responsibility (in preventing and understanding suicide)
- Crisis intervention
- Listening to the client
- Encourage hospitalization
- Establish a suicide contract
- Decrease social isolation
- Reduce psychological symptoms (anxiety and stress).
Evaluation
- Prevent attempts or completions
- Monitor the client's view of themselves and their life situation.
- Evaluate if hope has been restored.
- Involve the client's family or significant others.
- Perform continued care and evaluation.
Crisis Hotline/Client Example
- An individual called the crisis hotline and said "It's over; I've done everything I know how to do." The best response from the nurse is to ask: "What do you mean it's over?" OR "Are you thinking of hurting yourself?"
Therapeutic Response
- Need to get to the point quickly in dealing with suicidal clients.
- The critical question is: Is there a plan?
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Description
Test your knowledge on suicide assessment tools like the SAD PERSONS scale and understand critical factors related to suicide risk, including demographics and psychiatric illnesses. This quiz will explore signs of depression, myths around suicide, and appropriate clinical actions based on risk evaluations.
