The document defines suicide as self-imposed death stemming from depression. It lists several risk factors for suicide including anger turned inward, feelings of hopelessness and guilt, a history of aggression and violence, and shame and humiliation. Biological theories suggest a genetic predisposition and decreased serotonin levels in the brain. Signs of risk include self-mutilation, social withdrawal, inability to discuss the future, and previous suicide attempts. Assessment involves asking about suicidal thoughts and plans, and determining how realistic and imminent the plan is. Nursing diagnoses for at-risk individuals include risk for self-harm and ineffective coping. Therapeutic management involves establishing trust, communicating risk levels, providing support, securing a no-harm contract, and removing dangerous items.

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Suicide
Definition
Self imposed death stemming from depression.
Risk Factors
1. Theories ofSuicide
o Anger turned inward: anger that was previously directed at someone else
is turned inward.
o Hopelessness, depression, and guilt: desperate feelings of the client.
o A history of aggression and violence: rage and violent behavior is
correlated with suicides.
o Shame and humiliation: suicide viewed as a “saying face” or saving the
family name following a suicidal defeat.
o Developmental stressors: certain stressors at developmental stages have
been identified as precipitating factors to suicide.
2. Biological theories
o Generic tendency: Twin studies have indicated a predisposition toward
suicidal behavior.
o Neurochemical factors: Postmortem studies have revealed a decreased
serotonin level in the brainstem and spinal fluid.
Signs and Symptoms
1. Self mutilation
2. Unexplained decrease in daily functioning
3. Isolation and withdrawal, decreased social interaction
4. Channeling of anger and hostility towards self
5. Inability to discuss the future
6. Destructive coping mechanisms
7. Express anger toward self
8. Previous suicide attempts
9. Low self-esteem
10.Anxious and apprehensive
11.Non-verbal cues such as giving away possessions

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Assessment
1. Suicidal Assessment: Question to ask the client to assess how realistic the client’s
plan is.
o Do you have thoughts of harming or killing yourself?
o Do you have a plan to harm or kill yourself?
o What is the plan?
o Is it possible to implement the plan?
o When do you plan to do it?
2. A person is considered at a high-risk for suicide if the plan could be carried out
within 24-48 hours. Other issues in determining risk include the lethality of the
method and the plan of discovery after death.
Nursing Diagnoses
High risk for violence, self-directed or directed at others
Risk for self mutilation
Ineffective individual coping
Ineffective family coping
Spiritual distress
Therapeutic Nursing Management
1. Establish a therapeutic relationship
2. Talk directly with the client about suicide and plans
3. Communicate the potential for suicide to team members and family
4. Stay with the client
5. Accept the person. Listen to the person.
6. Secure a “no suicide/harm” contract
7. Give the person a message of hope based on reality
8. When client is able, encourage gradual increase in activities
9. Maintain suicide precautions, be particularly concerned with personal items the
client may used to harm self, remove all dangerous and potentially dangerous
items (belts, glass, sharps).