suicide prevention and nursing management

SUICIDE AND ITS NURSING
MANAGEMENT

wisenurses.blogspot.com
INTRODUCTION
• According to the World Health Organization
(WHO), close to 800,000 people, one person
every 40 second, die due to suicide every year.
• The body says suicide is the second leading
cause of death among 15-29 years old globally.

DEFINITIONS
• SUICIDE : Is defined as death caused by self
directed injuries with intent to die as a result of
the behavior.
• SUICIDE ATTEMPT : Is a non fatal self
directed potentially injurious behavior with
intent to die as a result of the behavior
• SUICIDAL IDEATION : Refers to thinking
about considering or planning suicide.

According to Emile Durkheim theory on suicide,
there are four different types of suicide. Which
are:
• Egoistic suicide
• Fatalistic suicide
• Altruistic suicide
• Anomic suicide

TYPES OF SUICIDE
Egoistic Suicide
• When a man becomes socially isolated or feels
that he has no place in society he destroys
himself.
• This is the suicide of self-centered person who
lacks altruistic feelings and is usually cut off
from main stream of the society.

2. Altruistic Suicide
• This type of suicide occurs when social group
involvement is too high and the expectation
from a group is being met at a very high level
such as a sacrifice for a cult or religion.
Another example would be a suicide bomber.
• Person is willing to sacrifice himself / herself
for some greater cause.

3. Anomic Suicide
• Anomic suicide relates to a low degree of
social regulation and this kind of suicide is
carried out during periods of considerable
stress and frustration.
• A good example would be great financial loss
• Individual does not feel like they fit to society
anymore.

4. Fatalistic Suicide
• This type of suicide is due to overregulation in
society.
• Under the overregulation of a society, when a
servant or slave commits suicide, when a
barren woman commits suicide, it is the
example of fatalistic suicide.

RISK FACTORS IN TEENAGE
TEENAGE
POVERTY
STRESS GRIEF
MENTAL
ILLNESS
DISSABILITIES
ABUSE

FACTORS CONTRIBUTE TO
SUICIDE
• Relationship problem – 42%
• Crisis in the past or upcoming 2 weeks – 29%
• Problematic substance use – 28%
• Physical health problem – 22%
• Job/ Financial problem – 16%
• Criminal legal problem – 9%
• Loss of housing – 4%

MODIFIED SAD PERSON SCORE
MEANING SCORE
S SEX : MALE 1
A AGE : <19 OR >45 1
D Depression or Hopelessness 2
P Previous attempt or Psychiatric care 1
E Excessive alcohol or Drug use 1
R Rational thinking loss 2
S Separated/divorces/widowed 1
O Organized or Serious attempt 2
N No social support 1
S Stated future intent 2

• Score : more than or equal to 6 – High suicide
Risk
• Need psychiatry directed hospitalization

COMMON SUICIDE NOTE
CONTENT PERCENTAGE
Apology, shame, guilt 90
Love for those left behind 55
Instructions regarding practical
affairs
23
Life too much to bear 14
Hopelessness 14
Advise for those left behind 14

THREAT ASSESSMENT

SUICIDE RISK EVALUATION
VARIABLES HIGH RISK LOW RISK
SUICIDAL
IDEATION
Frequent,intense,prolonged Infrequent,low
intensity, transient
SUICIDAL
ATTEMPT
Multiple attempts First attempt
Planned Impulsive
Rescue unlikely Rescue inevitable
Unambiguous wish to die Primary wish for
change
Communication internalized Communication
externalized
Self blame Anger
Lethal method and available Low lethal method and

COMMON SUICIDE METHODS
• Hanging
• Poisoning
• Firearm
• Overdose
• Hit by train
• Drowning
• Charcoal burning
• Plastic bags
• Cutting
• Falls

PERCENTAGE(American Journal Of Public Health)
SUICIDE METHOD PERCENTAGE
FIREARM 82.5%
DROWNING/ SUBMERSION 65.9%
SUFFOCATION/HANGING 61.4%
POISON GAS 41.5%
JUMP 34.5%
DRUG/POISON INGESTION 1.5%
CUT/PIERCE 1.2%
OTHER 8%

OTHER CAUSES OF SUICIDE
• Relationship break-ups
• Family problems
• Sexual, physical or emotional abuse
• Drug or alcohol problems
• Mental illness, including schizophrenia, bipolar disorder and
depression
• Eating disorders like Anorexia
• Major loss and grief such as a death or the suicide of a friend, family
member, public figure
• Unemployment or being unemployed for a long time
• Feeling like they don’t belong anywhere
• Financial or legal problems
• Any problem that they can’t see a solution for

SYMPTOMS OF SUICIDE
• Hopelessness
• Depression
• Despair
• Dramatic mood swings
• Anger
• Anxiety
• Sudden change to extreme happiness
• Talking about wanting to die
• Talking about having no reason to live
• Forming a plan for the suicide attempt

• Wanting to be left alone
• Violent or rebellious behaviors
• Running away
• Difficulty concentrating
• Vague somatic physical symptoms
• Decline in work or scholastic performance
• Withdrawing from once-pleasurable feelings
• Neglecting personal appearance

WARNING SIGNS
The National Alliance of Mental Illness (NAMI), cites the
warning signs below:
• Threats or comments about killing themselves, also
known as suicidal ideation.
• Increased alcohol and drug use
• Aggressive behavior
• Social withdrawal from friends, family and the
community
• Dramatic mood swings
• Talking, writing or thinking about death
• Impulsive or reckless behavior

WARNING SIGNS
TALK
• Being a burden to others
• Experiencing unbearable pain
• Having no reason to live
• Feeling trapped

MOOD
• Depression
• Rage
• Humiliation
• Anxiety
• Irritability
• Loss of interest

BEHAVIOR
• Increased use of alcohol or drug
• Acting recklessly
• Sleeping too much or too little
• Giving away priced possession
• Aggression
• Isolating family and friends
• Saying good bye to people
• Withdrawing from activities

FACTS ABOUT SUICIDE
F
A
T
C
S
Future Hopelessness
Overwhelming pain
Changes in behavior
Threat
Stressful situations

Effects Of Suicide On Family and
Friends
• Extreme guilt for not preventing
the suicide
• Failure because a person they loved
felt unloved
and completed suicide
• Anger or resentment at the person who
chose to take his or her own life
• Confusion
• Distress over unresolved issues

SUICIDE PREVENTION
Here are the few tips on how to prevent individuals
from suicidal thought or attempt.
• Communication & Reach out
1.Ask them directly if they are
thinking about suicide.
2.It needs to be a direct question
that can’t be misinterpreted.
3.They desperately need someone to hear their pain .
4.Don’t be afraid to ask them if they are thinking
about suicide. This shows you care and they are not
alone.

• Listen To Them
• Check Their Safety

Decide And Take Action
• Provide assistance with
the help of doctor, counsellor,
psychologist, social worker,
school counsellor,
• community health centres crisis support services like
lifeline, kids helpline.
• Also, seek support from family and friends, priests
and other religious leaders

• Talk To someone You Trust

HOW TO TALK TO A SUICIDAL
PERSON
• Be yourself
• Be sympathetic
• Listen
• Offer hope
• Take the person seriously
• Don’t promise confidentiality
• Don’t offer ways to fix their problem

NURSE’S ROLE
The psychiatric nurse
• Understands the phenomenon of suicide.
• Manages personal reactions, attitudes, and
beliefs
• Develops and maintains a collaborative,
therapeutic relationship with the patient.
• Collects accurate assessment information and
communicates the risk to the treatment team
and appropriate persons

• Formulates a risk assessment.
• Develops an ongoing nursing plan of care based
on continuous assessment.
• Performs an ongoing assessment of the
environment in determining the level of safety
and modifies the environment accordingly.
• Understands legal and ethical issues related to
suicide.
• Accurately and thoroughly documents suicide
risk.

ENVIRONMENTAL
MODIFICATION
• Identifies environmental hazards :-
At the unit level (ligature points and lanyards).
At the personal level (belts, shoelaces, sharp
items, etc.).
• Identifies environment conditions that would
indicate higher risk of patient suicide :–
example of items not accounted for (knives,
forks, CD, hording of towels, linen, etc.).

• Removes potentially harmful items if patient
is at risk of utilizing items to harm self
(remove or modify access to means of suicide).
• Determines level of supervision needed for
the patient.

ASSESSMENT(SBARR)
• Situation: The immediate relevant events
related to the patient, including subjective and
objective observations, what was
communicated and to whom.
• Background: Pertinent history about the
patient.
• Assessment: The nurse’s current assessment
including labs and current risk assessment.

• Recommendations: What the reporting person
believes needs to happen at this point.
• Response feedback: “Do you have any
questions?” to verify the understanding of the
handoff.

DOCUMENTATION
• Documents suicidal risk assessment and
intervention(s) during hospitalization at key
times.
• Documents the initial assessment.
• Documents risk level during hospitalization on
an inpatient psychiatric unit.
• Documents risk level at discharge.

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