This document discusses suicide risk assessment and prevention from a nursing perspective. It begins by defining key terms like suicide, suicidal ideation, suicide attempt, and parasuicide. It then covers risk factors for suicide like gender, ethnicity, marital status, mental illness, and prior attempts. The document outlines a mental status examination and risk assessment approach. It proposes the SAD PERSONS scale for risk assessment. Finally, it details nursing management of suicidal patients, which includes close observation, environmental safety precautions, developing a care plan, and multidisciplinary involvement. The overall goal is vigilance and a collaborative approach to treatment and prevention of suicide.

1. SUICIDE RISK ASSESSMENT AND
PREVENTION:
NURSING MANAGEMENT
By WONG PEI YIN (Charissa)
BSN, SRN

2. LEARNING OUTCOME
By the end of the lecture, the leaners will be able to:
• Define suicide.
• Explain the phenomenology of suicide as the
foundation the assessment is built on.
• Demonstrate how to document the risk assessment
for suicide.
• Construct nursing management of suicidal patient.

3. WHAT IS SUICIDE?
• Self murder
• Suicide is an irrational
desire to die.
• Suicide is a sign and
symptom of serious
depression.

4. OTHER DEFINITIONS
• Suicidal ideation,
- thoughts or act of killing own
self and does not include the
final end of killing oneself.
• Suicidal intent,
- is to have suicide as one’s
purpose.
SUICIDAL
IDEATION
WITH
INTENTION
WITHOUT
INTENTION

5. • PARASUICIDE
- who injured themselves by self mutilation but usually
do not wish to die
- Do it due to anger or release tension
• Having personality disorders and usually more
introverted, neurotic and hostile.

6. LETHALITY TO SUICIDE BEHAVIOUR
• Objective danger to life associated with a suicide
method or action.
(eg: jumping from heights is highly lethal, while
cutting wrist is less lethal)

7. • SUICIDALATTEMPT ,
- Non-fatal self inflicted destructive act
with explicit or inferred intent to die
• ABORTED SUICIDALATTEMPT ,
- An event when an individual comes close to the attempting
suicide but he does not complete the act
- No injury

8. WARNING SIGN AND RISK ASSESSMENT
• 'l can't go on', ‘Nothing matters any more', 'I want to end it all'
• Becoming withdrawn and depressed.
• Behaving recklessly, such as crossing the road without looking or
driving carelessly.
• A marked change in behaviour, attitudes or appearance, such as
not grooming or shaving
• Getting things in order, such as writing a will, and giving away
valued possession
• These may be accompanied by erratic mood swings and
behaviours, including constant crying, impulsiveness, self-
mutilation and impulsiveness.

9. CONTINUE…..
• Often find hard talk to anyone about their problems because
they cannot pinpoint what is wrong with themselves.
• The loneliness adds on to the emotional pressure.
• They feel that they are trapped in their own world.

10. ASSOCIATED RISK FACTORS-
CONTINUATION
1) GENDER
• Men kill themselves three times more frequently than
women. (National Suicide Registry Malaysia, 2009)
However, Women attempt suicide four times more than
men.
Methods
• Men’s higher rate of successful suicide is related to the
methods they use. (eg: firearms, hanging)
• While women more commonly take an overdose of
psychoactive substances or poison.

11. 2) ETHNICITY
• Indians had the highest suicide rate
• Followed by the Chinese
• The Malays and the Bumiputera had lower rates.
3) RELIGION
The highest rate of suicide was among the Hindus followed by
the Buddhists.
The lowest rate of suicide was among the Muslims.
(National Suicide Registry Malaysia, 2009)

12. 4) MARITAL STATUS
• The highest rate of suicides was in the
divorced/separated group followed by the
widowed group
5) PHYSICAL HEALTH
• Medical or surgical illness is a high risk
factor, especially if associated with pain,
chronic or terminal illness.

13. MENTAL ILLNESS
• One thousand and seven (17%) suicide attempters were
diagnosed with some form of mental illness ranging from
adjustment disorder to schizophrenia. (NRSM 2009)
1) Depressive disorders
2) Schizophrenia
3) Alcohol and substance dependence
4) Personality disorders
5) Dementia and delirium
6) Anxiety disorder

14. OTHERS
• Unambiguous wish to die
• Unemployment
• Sense of hopelessness
• Access to lethal agents or firearms
• Fantasies of reunion with deceased loves ones
• Previous suicide attempts
• History of childhood or physical abuse
• History of impulsive or aggressive behaviour

15. MENTAL STATUS EXAMINATION
1. Identify predisposing factors:
• (e.g. physical problem, psychiatric illness, history of suicide attempts, substa
nce abuse)
2. Identify contributing factors
• (e.g. family background, current difficulties, coping skills,
demographic factors)
3. Assessment on suicidal risk
• (e.g. suicide plan/action, psychiatric symptom and mental state)
4. Formulating nursing diagnosis and level of care.
5. Multidisciplinary approach to solve relevant problems.
6. Enlist intervention from patient’s available resource
• (family/social/religious support).
7. Close monitoring and observation on progress.
8. Document the assessment and plan.

16. SAMPLE OF ONE OF THE SIMPLEST ASSESSMENT
FORM THE SAD PERSONS SCALE:
• S - Sex (male higher risk)
• A -Age (Adolescents and elderly)
• D - Depression
• P - Previous attempt
• E - Ethanol abuse
• R - Rational thinking loss
• S - Social supports lacking
• O - Organized plan
• N - No spouse
• S - Sickness
• One point is scored for each factor deemed
present. The total score thus ranges from 0 (very low risk) to 10
(very high risk).

17. PROTOCOL ON NURSING
MANAGEMENT OF SUICIDAL PATIENT
a) Nursing assessment:
• Scrutinize the relevant clinical information,
admission history and personal profile.
• Detect any suicidal risk through interaction with
patient
• Apply suicide/selfharm assessment to
check with the risk level.
• Communicate among clinical team members.
• Invite case doctor’s assessment.

18. b) Formulating patient’s suicidal idea:
• What is the patient’s diagnosis?
• What are the physical state, mental state and behavioral state?
• What are the current nursing problems?
• What are the coping methods of patient?
• What is the suicidal plan of patient?
• What is the positive strength of patient?
• What is the attitude of patient?
• What is the effectiveness of treatment?

19. c) Risk factors for suicidal patients:
• Physical: e.g. terminal pain, incurable illness, permanent
disability, intoxication and drugs effect.
• Personal/Social: e.g. history of previous attempt, loneliness,
social isolation, divorce, personal failure, unworthiness,
low self-esteem.
• Mental illness: e.g. schizophrenia, depression, dementia,
psychopath

20. NURSING MANAGEMENT
• Apply close observation and care according to risk level – near to nurses
counter.
• Do not leave a suicidal patient alone.
• Take environmental precaution - remove dangerous items from the room.
• Establish therapeutic relationship.
• Provide emotional support.
• Assist to solve precipitating problem.
• Provide adequate observation and supervision.
• Develop nursing care plan.
• Make a written contract for safety (optional).
• Alert to team members.
• Documentation of mental state.
• Evaluation and reassessment at intervals.

21. OTHER BASIC SUICIDAL PRECAUTIONS:
1. Ensure that all potentially dangerous instruments/fluids are safely kept and removed
from the patient’s immediate environment.
eg. dressing scissors, surgical blade, syringe & needle, I.V. fluid drip set,
antiseptic solutions.
2. Serve meals with plastic plates and utensils.
3. Instruct visitors not to leave potentially dangerous articles to patient.
4. Glass thermometer should not be given orally.
5. Allow patient to leave bed only if accompanied
e.g. when using toilet / bathroom.
6. Check to ensure that all oral medicines are swallowed.
7. Ensure that patient wears hospital clothing.
8. Immediately search hospital compound for patient if found missing. Inform relatives
if not promptly found.
9. Inform doctor of any act/ speech alluding to suicide.

22. IN SUMMARY
• Knowing of risk factor and severity of suicidal.
• Closely observe and vigilance is essential.
• Management multidisciplinary approach.
• Hospital staff should be familiar with suicide
prevention policies and policies should be revised
and tested.
• New staffs must be trained.
• The best measures, suicidal patient who are really
vent on ending their lives will still succeed in doing
so. Not withstanding, we should still preserve in
our effort for in so doing, we might save many
from an untimely death.

23. THANK YOU!!