Chapter 16 Suicide PDF

Chapter 16 The Client Who Is Suicidal Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  LEARNING OUTCOMES Identify conditions & circumstances that make an individual at high risk for suicide Describe a means of assessing suicide potential in a client Know the means of providing a...

Chapter 16 The Client Who Is Suicidal Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  LEARNING OUTCOMES Identify conditions & circumstances that make an individual at high risk for suicide Describe a means of assessing suicide potential in a client Know the means of providing a safe environment for the suicidal client Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Suicide Purposefully taking one’s own life Ultimate form of self-destruction Involves intense feelings of fear, loss, anger, or despair Effects can be devastating and long lasting Nurses must recognize suicidal risk Causes 11 deaths per 100,000 per year IS PREVENTABLE!!! (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Guam’s Suicide Rates 8th leading cause of death on Guam. Every 6 days in last 3 months on Guam someone has died by Suicide on Guam 2019: 31 deaths, 20-30 yr age group 2018: 44 deaths: 30-40 yrs 2010: 30 deaths from suicide 2011: 7 cases, 4 were 16-year-olds. Illicit drug use contributes to suicide Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Suicide 10th Leading cause of death in people ages 15 to 24 Rate for males more than 75 years old is three times national average Rate is 40 % higher among elderly More common in divorced and separated men Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  ‘MYTHS’ People who talk about suicide never commit it People who are suicidal only want to hurt themselves, not others There is no way to help someone who really wants to kill himself Mention of the word suicide will cause the suicidal individual to actually commit suicide Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Main Priority SAFETY SAFETY SAFETY!!! Suicide Precautions…..taken to prevent suicidal client from self-inflicting injuries or achieving death Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Suicide Potential = NCLEX!! Measured by: – Rationality of client – Plan - know how – Means of carrying out plan – Table 16-1 Assessment of Suicide Potential – SAD PERSONS tool (Handout) https://qxmd.com/calculate/calculator_201/mo dified-sad-persons-scale Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Sad Person Acronym Based on 10 Suicide Risk Factors Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Clinical Action based on Sad Persons Total Points Proposed Clinical Action 0-2 points Send home with follow-up 3 to 4 points Close follow-up, consider hospitalization 5 to 6 points Strongly consider hospitalization 7 to 10 points Hospitalize or Commit Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Suicide Attempts Some accidents may be suicides More common than successful suicides More suicide attempts (unsuccessful) women – Successful suicide more common in men Suicidal ideations – Suicidal thoughts; not to be left unattended to; may attempt Many involve firearms and medication overdoses Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Suicide and Psychiatric Illnesses According to WHO- 90% of those who commit suicide had a psychiatric dx Unipolar (always down) and bipolar depression (up or down)- highest at risk Schizophrenia Alcohol and substance abuse Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Recognize Signs & Symptoms Signs of Depression (most common) Sudden change in Behavior (reckless behavior, talking about death, withdrawn) Dramatic mood changes? Improved mood post anti-depressant therapy (medication not therapeutic yet) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Formulation of a Suicide Plan!! Look Out For….. Giving away possessions Has the means = access to weapons, pills Gets finances in order Direct or indirect statements Increase in energy Suicide note? Must determine if there is a SUICIDE PLAN!! Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Risk for Suicide Males >50 yrs old 2nd leading cause of death in 15-19 yr old Social Isolation Hx previous suicide attempts Terminal disease Job, financial, loss Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  NCLEX Is there a PLAN How lethal is proposed method Is there access to proposed method https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC2864482/ Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Warning Warning Warning!! Clients emerging form depression have more energy to formulate a suicide plan Depression Clients who suddenly appear cheerful, motivated = INC risk for suicide!! Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Care of Suicide Pt First Focus is client safety 1 to 1 supervision Establish trust, non judgmental Remove all dangers -no belts, razors, knives, shoe laces, bra wires, lock windows, remove blinds, cords, strings, anything that can be used to harm self Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Always 1:1 Supervision Paper plates, plastic utensils only (glass, plates, metal silverware can be used to harm self) Always make sure PT swallows pills as can spit out & hoard for future suicide attempt Client is checked on every hour & documented by nursing staff Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Danger Times in Hosp SHIFT CHANGE!!! Fewer staff may be available to observe client 1:1 handover WEEKENDS!! NIGHTSHIFT!! *should increase precautions during shift change!! Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Suicidal Client If suicidal client on the phone…. Keep them talking….while getting help to the client!! Be sympathetic, non-judgmental, listen, keep calm!! If ingested drugs…try to get details…type, amount, alcohol, last meal etc. Be sympathetic, non-judgmental, listen Avoid giving advise, belittling, quick referrals Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Duty of Care Legal System: when HCP is aware client is at risk of dying by suicide HCP have a duty to take ‘reasonable’ or ‘appropriate’ care to prevent the suicide. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Social Media-Suicide Cyberbullying!! X2 likely to commit suicide/self harm (child/adolescent intentially/repeatedly targeted by another child/teen: threats, harassment, humiliation via txt/internet ) Cyberstalking = Adults Cyberbullicide – suicide Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Amanda Todd 15 yr Canadian student Victim of cyberbullying Hanged herself at home She posted a youtube before her death of flashcards to tell her experience of being blackmailed into exposing her breasts via webcam, bullied, physically assaulted. https://www.youtube.com/watch?v=vOHXGNx-E7E&bpctr=1599740740 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Special Populations Adolescents/young adults- drug ingestions done at home Elderly-losses; alcohol; loneliness men >75 years old Incarcerated- holding facilities/local jails than in prisons; Military combatants Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Suicide Survivors Friends and families of successful suicides May have more stressful grieving process Experience anger and sadness Nursing tip How to help survivors of suicide 16-1, pg. 383 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Nursing Diagnosis Spiritual well-being Spiritual distress Hopelessness Powerlessness Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Outcome Identification Prevent harm Develop Suicide Safety Plan* Ensure client safety Establish reduced-risk environment Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Suicide Safety Plan Written set of instructions client develops (with HCP/therapist assistance) Used by client when develops self harm thoughts Proceed thru steps until safe Warning signs—isolate self Reasons for living Trusted contact Resources: suicide lifeline 1-800-273-8255 & professionals Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Planning/Interventions Prevention – Tertiary- lives saved after attempt, secondary- displays recognizable factors, and primary- general public especially youth Control access Media responsibility Perform crisis intervention Listen to client (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Planning/Interventions Encourage hospitalization Establish suicide contract Decrease social isolation Decrease psychological symptoms- reducing anxiety and stress Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Evaluation Prevent attempts or completions Monitor client’s view of self/life situation Evaluate restoration of hope Involve family/significant others Perform ongoing care and evaluation Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. An individual calls the crisis hotline and says “It’s over I’ve done all I know how to do” Which response by the nurse is best? 1.What do you mean ‘its over?’ 2.Have you shared your feelings with your family 3.3. Have you been taking antidepressant medication 4.Are you thinking of hurting yourself? Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.  Therapeutic Response? Need to get to the point… When someone at risk for SELF HARM …IS THERE A PLAN…… Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.