chapter 16: SUICIDE

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Questions and Answers

What is the primary focus when providing care for a client at risk of suicide?

Addressing the client's feelings of despair

Exploring the client's past traumas

Ensuring the client's safety and preventing self-harm (correct)

Medicating the client immediately to reduce anxiety

Which of the following statements about suicide is considered a myth?

Suicide rates vary across demographic groups.

Suicide is a permanent solution to a temporary problem.

Suicide is often preceded by indications of distress.

Talking about suicide might increase the risk of suicide. (correct)

According to the provided data, which age group in Guam had the highest number of suicide deaths in 2018?

20-30 year olds

30-40 year olds (correct)

People over 75 years old

16 year olds

What is the significance of the statement 'Suicide Potential = NCLEX'?

The assessment and management of suicide risk is a crucial nursing competency. (B) Signup and view all the answers

Which of the following is NOT a factor contributing to an elevated suicide risk?

Being single and financially independent (A) Signup and view all the answers

What is the immediate nursing intervention a nurse should perform when caring for a suicidal client?

Ensuring a safe and observation environment. (C) Signup and view all the answers

What is the national ranking of suicide as a cause of death for people ages 15-24?

10th leading cause (D) Signup and view all the answers

Compared to the national average, what is the approximate suicide rate for males over 75?

Three times higher (A) Signup and view all the answers

What is the primary reason to take suicide precautions for a client?

To prevent the client from inflicting harm to themselves (D) Signup and view all the answers

What is the ultimate form of self-destruction mentioned in the provided text?

Suicide (D) Signup and view all the answers

Which of the following is NOT a component assessed when evaluating suicide potential?

Client's financial stability (C) Signup and view all the answers

According to the SAD PERSONS scale, what clinical action is suggested for a score of 5 to 6 points?

Strongly consider hospitalization (C) Signup and view all the answers

Which statement is TRUE regarding suicide attempts vs. successful suicides?

Suicide attempts are more common than successful suicides, with women more likely to attempt. (C) Signup and view all the answers

According to the provided information, what percentage of people who commit suicide had a diagnosable psychiatric condition?

Approximately 90% (C) Signup and view all the answers

What is a crucial consideration for a client who shows improvement in mood after beginning antidepressant therapy, with regards to suicide?

They may have increased energy to formulate a suicide plan. (A) Signup and view all the answers

While providing care for a suicidal patient, which of the following safety measures should be implemented?

Remove items such as belts, razors and shoe laces (A) Signup and view all the answers

What is the most appropriate nursing action when a suicidal client is on the phone?

Try and gather as many details of the situation while simultaneously seeking support. (A) Signup and view all the answers

What is Cyberbullicide?

A suicide that is linked to cyberbullying. (D) Signup and view all the answers

Which of the following groups is INCORRECTLY matched with a corresponding suicide risk factor?

Incarcerated - mostly higher risk in prisons (B) Signup and view all the answers

The crisis hotline receives a call from a person who says, “It’s over, I’ve done all I know how to do.” Which of the following responses by the nurse is MOST appropriate?

What do you mean ‘it’s over’? (B) Signup and view all the answers

Study Notes

Suicide Risk Assessment and Intervention

Suicide: Purposeful taking of one's own life, a devastating act involving intense feelings of fear, loss, anger, or despair. Suicide is preventable.
High-Risk Factors: Individuals with previous suicide attempts, terminal illnesses, job or financial loss, and social isolation are at increased risk. Males over 50 are at a higher risk than the general population. Adolescents and young adults are another vulnerable group.
Suicide Rates: Suicide is a significant public health concern, with varying rates across age groups and genders. Guam experiences particularly high suicide rates; in 2019, there were 31 deaths of people ages 20-30 from suicide. Illicit drug use contributes to suicide.
- 10th leading cause of death ages 15 - 24.
- Rates are 40% higher among the elderly population.
- Men who are divorced or separated are more likely to commit suicide.
- Males over 75 years old have suicide rates three times the national average.
Suicide Myths: Common myths about suicide include that those who talk about suicide never commit it, those who are suicidal only want to harm themselves and not others, there is no way to help those who want to die, and mentioning suicide will cause a suicidal individual to commit it. These are false.

Assessing Suicide Potential

Assessment: The assessment of suicide potential involves exploring the client's rationality, plan (how they would carry it out), and means of carrying out the plan. The SAD PERSONS scale (a tool for assessing suicide risk) guides clinical action.
SAD PERSONS Scale: A tool (handout) used for evaluating the degree of suicide risk, scores, and proposed clinical actions are based on 10 factors. Scores of 0-2 recommend home follow-up, while scores of 7-10 indicate immediate hospitalization.

Suicide Precautions

Safety: The priority is client safety. All potential means of self-harm—belts, razors, knives, shoelaces, bra wires, etc.—should be removed from the client's environment to prevent self-inflicting injury.
Supervision: Continuous 1:1 observation is essential, particularly during shift changes, weekends, and night shifts.
Medications: Carefully monitor clients taking medications; ensure they swallow pills, and avoid providing glass, metal utensils or any other potential means to harm oneself.
Suicide Attempts: Suicide attempts are more frequent than successful suicides, and some accidents may be disguised as suicides. Women more frequently attempt suicide but men more frequently succeed.

Signs and Symptoms of Suicide

Depression: Be alert for warning signs of depression, including sudden changes in behavior (reckless behavior, withdrawn, talking about death) and dramatic mood changes. A sudden improved mood following antidepressant therapy could indicate further risk, as medication's therapeutic effects take time.
Possessions: Giving away possessions, financial arrangements, notes.
Increased energy and changes to mood: An unexpected increase in energy following a depressive period could indicate a heightened risk of suicide.
Direct/Indirect statements: Pay attention to statements about suicide or death.
Means: Assess the client's access to means of self-harm (firearms, medications).

Suicide and Psychiatric Illness

High Risk: Individuals with unipolar or bipolar depression, schizophrenia, and those abusing alcohol or substances have a significantly higher risk of suicide. The World Health Organization reports that 90% of people who commit suicide have a prior psychiatric diagnosis.

Suicide Survivors

Grief Reactions: Friends and family of suicide victims may experience unique grief and anger.
Resources: Resources are available to assist survivors of suicide.

Interventions and Prevention

Suicide Safety Plans: Encourage the development and usage of a safety plan, which includes reasons for living, trusted contacts, and available resources.
Risk Reduction: Reduce social isolation, lessen psychological symptoms (stress & anxiety) by taking steps to reduce social isolation and to improve psychological well-being, and establish a suicide support contract, if appropriate.
Prevention Levels: Suicide prevention measures include tertiary prevention for those who survive attempts, secondary prevention to identify those at risk, and primary prevention to address warning signs in the general public, specifically young people.
Crisis Intervention: If someone reveals suicidal ideations on the phone, listen carefully, try to understand their feelings and encourage them to share their thoughts and feelings; avoid offering advice and keep them talking until help arrives. Establish rapport and try to get details or if drugs have been consumed: type, amount, alcohol and food intake that may have been consumed).

Duty of Care

Liability: Healthcare professionals have a legal duty to ensure the safety of clients at risk of suicide.

Cyberbullying: Cyberbullying is a significant risk factor for suicide, especially among adolescents and young adults.
Specific warning signs: Cyberbullying may include intentional targeting by another person/teen via text or internet with threats, harassment, humiliation.
Cyberstalking: Adults also experience cyberstalking, which could be a factor.

Special Populations by Risk

Military Combatants: Military combatants may be at elevated risk for suicide.
Incarcerated Individuals: Individuals in holding facilities or local jails may need heightened monitoring.
Elderly: The elderly may be at risk for suicide due to losses, loneliness, or alcohol abuse.

Nursing Diagnoses & Outcomes

Nursing Diagnoses: Relevant diagnoses for suicidal clients may include spiritual distress, hopelessness, and powerlessness.
Outcome Identification: The focus is on preventing harm, prioritizing safety, developing a suicide safety plan, creating a reduced-risk environment, and fostering hope.

NCLEX Focus

Key Concepts: NCLEX focus on assessing client's rationality, plan, means of harm, and implementing safety measures.

Important Considerations

Shift Changes/Weekends/Nights: Increased vigilance is needed during these periods when staff may be fewer.
Therapeutic Responses: When a client expresses suicidal thoughts or feelings, focus should be on gaining understanding first (e.g., open-ended questions eliciting information on the client's feelings).

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