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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.
wisenurses.blogspot.com
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.
wisenurses.blogspot.com
According to Emile Durkheim theory on suicide,
there are four different types of suicide. Which
are:
• Egoistic suicide
• Fatalistic suicide
• Altruistic suicide
• Anomic suicide
wisenurses.blogspot.com
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.
wisenurses.blogspot.com
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.
wisenurses.blogspot.com
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.
wisenurses.blogspot.com
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.
wisenurses.blogspot.com
wisenurses.blogspot.com
RISK FACTORS IN TEENAGE
TEENAGE
POVERTY
STRESS GRIEF
MENTAL
ILLNESS
DISSABILITIES
ABUSE
wisenurses.blogspot.com
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%
wisenurses.blogspot.com
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
wisenurses.blogspot.com
• Score : more than or equal to 6 – High suicide
Risk
• Need psychiatry directed hospitalization
wisenurses.blogspot.com
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
wisenurses.blogspot.com
THREAT ASSESSMENT
wisenurses.blogspot.com
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
wisenurses.blogspot.com
COMMON SUICIDE METHODS
• Hanging
• Poisoning
• Firearm
• Overdose
• Hit by train
• Drowning
• Charcoal burning
• Plastic bags
• Cutting
• Falls
wisenurses.blogspot.com
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%
wisenurses.blogspot.com
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
wisenurses.blogspot.com
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
wisenurses.blogspot.com
• 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
wisenurses.blogspot.com
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
wisenurses.blogspot.com
WARNING SIGNS
TALK
• Being a burden to others
• Experiencing unbearable pain
• Having no reason to live
• Feeling trapped
wisenurses.blogspot.com
MOOD
• Depression
• Rage
• Humiliation
• Anxiety
• Irritability
• Loss of interest
wisenurses.blogspot.com
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
wisenurses.blogspot.com
FACTS ABOUT SUICIDE
F
A
T
C
S
Future Hopelessness
Overwhelming pain
Changes in behavior
Threat
Stressful situations
wisenurses.blogspot.com
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
wisenurses.blogspot.com
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.
wisenurses.blogspot.com
• Listen To Them
• Check Their Safety
wisenurses.blogspot.com
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
wisenurses.blogspot.com
• Talk To someone You Trust
wisenurses.blogspot.com
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
wisenurses.blogspot.com
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
wisenurses.blogspot.com
• 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.
wisenurses.blogspot.com
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.).
wisenurses.blogspot.com
• 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.
wisenurses.blogspot.com
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.
wisenurses.blogspot.com
• 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.
wisenurses.blogspot.com
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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suicide prevention and nursing management

  • 1. SUICIDE AND ITS NURSING MANAGEMENT
  • 2. 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.
  • 3. wisenurses.blogspot.com 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.
  • 4. wisenurses.blogspot.com According to Emile Durkheim theory on suicide, there are four different types of suicide. Which are: • Egoistic suicide • Fatalistic suicide • Altruistic suicide • Anomic suicide
  • 5. wisenurses.blogspot.com 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.
  • 6. wisenurses.blogspot.com 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.
  • 7. wisenurses.blogspot.com 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.
  • 8. wisenurses.blogspot.com 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.
  • 10. wisenurses.blogspot.com RISK FACTORS IN TEENAGE TEENAGE POVERTY STRESS GRIEF MENTAL ILLNESS DISSABILITIES ABUSE
  • 11. wisenurses.blogspot.com 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%
  • 12. wisenurses.blogspot.com 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
  • 13. wisenurses.blogspot.com • Score : more than or equal to 6 – High suicide Risk • Need psychiatry directed hospitalization
  • 14. wisenurses.blogspot.com 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
  • 16. wisenurses.blogspot.com 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
  • 17. wisenurses.blogspot.com COMMON SUICIDE METHODS • Hanging • Poisoning • Firearm • Overdose • Hit by train • Drowning • Charcoal burning • Plastic bags • Cutting • Falls
  • 18. wisenurses.blogspot.com 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%
  • 19. wisenurses.blogspot.com 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
  • 20. wisenurses.blogspot.com 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
  • 21. wisenurses.blogspot.com • 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
  • 22. wisenurses.blogspot.com 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
  • 23. wisenurses.blogspot.com WARNING SIGNS TALK • Being a burden to others • Experiencing unbearable pain • Having no reason to live • Feeling trapped
  • 24. wisenurses.blogspot.com MOOD • Depression • Rage • Humiliation • Anxiety • Irritability • Loss of interest
  • 25. wisenurses.blogspot.com 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
  • 26. wisenurses.blogspot.com FACTS ABOUT SUICIDE F A T C S Future Hopelessness Overwhelming pain Changes in behavior Threat Stressful situations
  • 27. wisenurses.blogspot.com 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
  • 28. wisenurses.blogspot.com 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.
  • 29. wisenurses.blogspot.com • Listen To Them • Check Their Safety
  • 30. wisenurses.blogspot.com 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
  • 32. wisenurses.blogspot.com 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
  • 33. wisenurses.blogspot.com 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
  • 34. wisenurses.blogspot.com • 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.
  • 35. wisenurses.blogspot.com 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.).
  • 36. wisenurses.blogspot.com • 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.
  • 37. wisenurses.blogspot.com 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.
  • 38. wisenurses.blogspot.com • 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.
  • 39. wisenurses.blogspot.com 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.