Chapter 27 Suicide - Elsevier PDF

Inward-Focused Emotions: Suicide Chapter 27 Copyright © 2021 by Elsevier, Inc. All rights reserved. 1  Learning Objectives Lesson 27.1: Inward- Focused Emotions: Suicide (Slide 1 of 2) 1. Explain the range of self...

Inward-Focused Emotions: Suicide Chapter 27 Copyright © 2021 by Elsevier, Inc. All rights reserved. 1  Learning Objectives Lesson 27.1: Inward- Focused Emotions: Suicide (Slide 1 of 2) 1. Explain the range of self-protective behavioral responses. 2. Discuss three myths about suicidal behaviors. 3. Identify two cultural or social factors that relate to suicide. 4. Examine four categories of motivation for attempting suicide. 5. Explain how suicide affects family members and friends. Copyright © 2021 by Elsevier, Inc. All rights reserved. 2  Learning Objectives Lesson 27.1: Inward- Focused Emotions: Suicide (Slide 2 of 2) 6. Describe three theories that attempt to explain the causes of suicide. 7. Discuss the occurrence of suicide throughout the life cycle. 8. Outline the process for assessing the suicidal potential of a client. 9. Choose three therapeutic goals and interventions for clients with suicidal behaviors. Copyright © 2021 by Elsevier, Inc. All rights reserved. 3 Continuum of Behavioral Responses (Slide 1 of 2) ⬤Maladaptive self-protective responses, if not changed, eventually can lead to self-destruction ⮚ Self-destructive behaviors are classified as direct or indirect Direct self-destructive behaviors ⮞ Any form of active suicidal behavior, such as threats, gestures, or attempts to end one’s life ⮞ Intends to commit suicide Indirect self-destructive behaviors ⮞ Any behaviors or actions that may result in harm to the individual’s well-being or death ⮞ No intention of committing suicde ⮞ Example: substance abuse, engaging in inappropriate or dangerous behavior Copyright © 2021 by Elsevier, Inc. All rights reserved. 4 Continuum of Behavioral Responses (Slide 2 of 2) ⬤Myths about suicide ⮚ Suicide has always been present in society, but little effort was made to understand its nature until the beginning of the twentieth century ⮚ Many false ideas about suicide exist (table 27.1) People who talk about it will not commit suicide One does not need to take a suicide threat seriously Only psychotic or depressed people commit suicide When people show signs of mood improvement, the threat of suicide is over Copyright © 2021 by Elsevier, Inc. All rights reserved. 5  Impact of Suicide on Society (Slide 1 of 3) ⬤Tenth leading cause of death in the United States ⬤Twenty percent of all suicides occur in white men older than 65 years of age ⬤It is important for nurses and other health care providers to be well versed in recognizing and intervening with clients who are suicidal Copyright © 2021 by Elsevier, Inc. All rights reserved. 6  Impact of Suicide on Society (Slide 2 of 3) ⬤Cultural factors ⮚ Culture usually includes a view of suicide Laws Customs Beliefs Values Norms ⮚ Cultures like Japan, believe suicide is honorable for transgressions ⮚ Others believe, through suicide thay can join loved ones in the after life ⮚ Customs and rituals may play a role in suicide ⮚ Caribbean islanders, suicide may be commited if cursed or hexed Copyright © 2021 by Elsevier, Inc. All rights reserved. 7  Impact of Suicide on Society (Slide 3 of 3) ⬤Social factors ⮚ Many social influences affect the incidence of suicide Social isolation -cause of crime, mistrust, individuals stay behind locked doors Inability to meet basic needs - mentally ill make up one third of homeless population. Inability to meet food, shelter and clothing needs Availability of weapons - in countries where firearm ownership is prohibited, suicide rates are lower One’s state of health - People who have HIV and AIDS - rational suicide, death with dignity philosophy, choose the time and place ⮚ Be aware of social changes in this world as they may offer clues to caring for clients who are thinking of ending their lives Copyright © 2021 by Elsevier, Inc. All rights reserved. 8  Dynamics of Suicide (Slide 1 of 3) ⬤Characteristics of suicide ⮚ Physical dimension Thoughts of suicide produce many of the same biochemical changes in the body as are produced by depression ⮚ Emotional dimension Clients are filled with feelings of ambivalence, anger, aggression, guilt, helplessness, and hopelessness Anger and aggression are turned inward Persons who feel trapped in a frustrating relationship react with rage that becomes self directed Guilt, individual feels sinful, they believe they have done something wrong to deserve the misfortune Emotional dimension is marked by feelings of helplessness and hopelessness Copyright © 2021 by Elsevier, Inc. All rights reserved. 9  Dynamics of Suicide (Slide 2 of 3) ⮚ Intellectual dimension Intense emotional suffering leads to distorted thinking and self-defeating thoughts Self becomes devalued and worth little Thinking is self centered rather than oriented toward solving problems ⮚ Social dimension Includes one’s views of others Suicidal individuals depend on others for feedback of self worth ⮚ Spiritual dimension Cultural, religious, and ethical dilemmas associated with one’s own demise Individuals make their peace Some believe they will be united with loved ones 10  Dynamics of Suicide (Slide 3 of 3) ⬤Categories of motivation ⮚ Suicide victims share two major viewpoints First: Deep despair, poor self-esteem, and feelings of being trapped. Other: logic, Relief from the miseries of this life and the need to connect with immortality ⮚ A cry for help - the wish to live and need to die ⮚ Refusal to accept a diminished quality, style, or pace of life ⮚ Need to affirm one’s soul - believe there are values more important than life ⮚ Relief from distress - ill ⮚ Preoccupation with suicide- set conditions for living and refuse to continue with life unless it is on thier terms Copyright © 2021 by Elsevier, Inc. All rights reserved. 11  Theories About Suicide ⬤Psychoanalytical theory- all humans have the instinct for life and death. ⬤Sociologic theory - consider relationship between suicide and social conditions. Lack of support, social changes ⬤Interpersonal theory - failure to work with or resolve interpersonal conflicts ⬤New biological evidence ⮚ Anxiety and depression are often the forerunners of suicidal thoughts Copyright © 2021 by Elsevier, Inc. All rights reserved. 12  Effects of Suicide on Others ⬤Suicide has a strong effect on those left behind ⮚ Survivor guilt Survivors often think that they could have done something to prevent the suicide Anger may be expressed Socially, the stigma of suicide is felt. The interactions with healthcare providers, police and media bring feelings of rejection ⬤The survivors of suicide, no matter who they are, must grieve and learn to heal Copyright © 2021 by Elsevier, Inc. All rights reserved. 13  Suicide Throughout the Life Cycle (Slide 1 of 4) ⬤Suicide and children ⮚ Suicide in children is most often the result of family conflict or disruption ⮚ Suicide in children usually is not planned ⮚ Any child whose attitudes, behaviors, or habits change dramatically in a short time, especially following a stressful event or situation, is a candidate for suicide Copyright © 2021 by Elsevier, Inc. All rights reserved. 14  Suicide Throughout the Life Cycle (Slide 2 of 4) ⬤Suicide and adolescents ⮚ Adolescents, especially those with low self-esteem, may consider suicide as an option for solving their problems ⮚ Factors in adolescent suicide Depression Poor impulse control Emotional isolation Dysfunctional or disrupted family (divorce or separation) ⮚ Adolescents with anorexia nervosa have higher rates of suicide ⮚ Teens have been bullied to suicide called bullicide ⮚ Lack of security or present dangers, teens feel life will be short and they will not live until adulthood Copyright © 2021 by Elsevier, Inc. All rights reserved. 15  Suicide Throughout the Life Cycle (Slide 3 of 4) ⬤Suicide is a significant problem in adulthood ⮚ Women attempt suicide three times more frequently than men ⮚ Men are more successful at completing the act ⮚ Young adults commit suicide if they are unable to cope with pressures of adulthood ⮚ Loneliness is a factor in adult suicides ⬤Do not hesitate to ask clients if they ever think about suicide Copyright © 2021 by Elsevier, Inc. All rights reserved. 16  Suicide Throughout the Life Cycle (Slide 4 of 4) ⬤Suicide and older adults ⮚ As age increases, so does the rate of suicide Older adults choose, Passive suicide: Refusal to eat, drink, or cooperate with care ⮚ Most older adults view the timing of death in one of the following ways: God-controlled Physician-controlled Individual-controlled ⮚ Controlled by the individual alone ⮚ Older adults tend not to communicate their intentions unless directly asked; thus suicidal attempts in older adults are more successful Copyright © 2021 by Elsevier, Inc. All rights reserved. 17  Assessment of Suicidal Potential ⬤Assessment of suicidal potential ⮚ Evaluate every client for the potential by first assessing the risk factors for the age of the client ⮚ Then, Ask the client directly whether he or she has any thoughts related to suicide ⮚ Obtain drug and medication history Copyright © 2021 by Elsevier, Inc. All rights reserved. 18  Suicide Assessment (table 27.3) ⬤Suicide ideation (thoughts) ⬤History of suicide attempts ⬤Existence of a suicide plan ⬤Availability of items to carry out plan ⬤Substance use or abuse ⬤Level of despair ⬤Ability to control own behavior Copyright © 2021 by Elsevier, Inc. All rights reserved. 19  Levels of Suicide Behaviors (table 27.2) ⬤Thoughts about suicide can be described by: ⮚ Suicidal ideation ⮚ Suicidal threats ⮚ Suicidal gestures ⮚ Parasuicidal behaviors ⮚ Suicidal attempts ⬤The last level is completed suicide—the successful attempt to end one’s life Copyright © 2021 by Elsevier, Inc. All rights reserved. 20  Therapeutic Interventions for Suicidal Clients ⬤Interventions ⮚ First priority: Protect from harm If risks are high implement suicide precautions (table 27.5) ⮚ Most important therapeutic intervention after ensuring safety is establish rapport with the client Make a no self-harm agreement, a promise not to engage in self destructive behaviors ⮚ With the encouragement and advocacy of their caregivers, many suicidal clients are able to develop effective strategies for living satisfying lives Copyright © 2021 by Elsevier, Inc. All rights reserved. 21  Question Mr. Toad has major depressive disorder and has not responded well to treatments in the past. The current treatment method has resulted in slight improvement in his symptoms. Today, Mr. Toad has a very positive affect and says he feels “amazingly better.” The nurse should: 1. Assess Mr. Toad for signs and symptoms of suicidal thoughts 2. Document the improvement. 3. Ask him what he feels has helped him feel better so suddenly. 4. Tell Mr. Toad how happy you are for his recovery. Copyright © 2021 by Elsevier, Inc. All rights reserved. 22  Answer 1. Assess Mr. Toad for signs and symptoms of suicidal thoughts This behavior is frequently seen when a depressed individual has made the decision to commit suicide. The other options ignore this important sign. 23