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Suicide (Latin suicidium, from sui caedere, "to kill oneself") is the act of a human being intentionally causing his or her own death. Suicide is often committed out of despair, or attributed to some underlying mental disorder which includes depression, bipolar disorder, schizophrenia, alcoholism and drug abuse.Financial difficulties, interpersonal relationships and other undesirable situations play a significant role. The Judeo- Christian belief has been that life is a gift from god and that taking it is a gift from God and that taking it is strictly forbidden (Carroll- Ghosh, Victor, & Bourgeois, 2003). A recent, and more secular, view has influenced how some individuals view suicide in our society. Growing support for an individual’s right to choose death over pain has been evidenced. Some individuals are striving to advance the cause of physician- assisted suicides for the terminally ill. Approximately 95 percent of all persons who commit or attempt suicide have a diagnosed mental disorder (Sadock & Sadock, 2003). Definition of Suicide: According to Durkheim, suicide refers to “every case of death resulting directly or indirectly from a positive or negative death performed by the victim himself and which strives to produce this result.” Epidemiological Factors: Approximately 30,000 persons in the United States end their lives each year by suicide. These statistics have established suicide as the third leading cause of death (behind accidents and homicide) among young Americans ages 15 to 24 years, the fifth leading cause of death for ages 25 to 44, and the eighth leading cause of death for individuals age 45 to 64 (National Center for Health Statistics, 2004). Many more people attempt suicide than succeed, and countless others seriously contemplate the act without carrying it out. Suicide has become a major health care problem in the United States today.
Risk Factors: Marital Status: The suicide rate for single persons is twice that of married persons, Divorced, separated, or widowed persons have rates four to five times greater than those of the married (Tondo and Baldessarini, 2001). Gender: Women attempt suicide more, but men succeed more often. Successful suicides number about 70 percent for men and 30 percent for women tend to overdose; men use more lethal means such as firearms. In the United States, from 1070 to 2002, annual suicide rates per 100,000 rose from 16.8 to 17.9 in men, but decreased from 6.6 to 4.3 in women (National Center for Health Statistics, 2004). Age: Suicide risk and age are positively correlated. This is particularly true with men. Although rates among women remain fairly constant throughout life, rates among men show a higher age correlation. The rates rise sharply during adolescence, peak between 40 and 50, and levels off until age 65, when it rises again for the remaining years (National Center for Health Statistics, 2004).
schizophrenia. is the most common method of completed suicide in children and adolescents Religion: Historically. but he or she also feels that life is impossible without such change. With desperation. lawyers. personality disorders. Theories of Suicide 1. and Asian Americans (Caroll-Ghosh. Psychological Theories: Anger Turned Inward. The anger had originated toward a love object but was ultimately turned inward against the self.hatred that an individual possessed. Guilt and self-recrimination are other aspects of desperation. Depressive disorders account for 80 percent of this figure. And Bourgeois (2003) identify hopelessness as a central underlying factor in the predisposition to suicide.000 in 2002 (National Center for Health Statistics. untreated mood disorders (e.1 per 100. suicide rates among Roman Catholic populations have been lower thn rates among Protestants and Jews (Sadock & Sadock. Socioeconomic status: Individuals in the very highest and lowest social classes have higher suicide rates than those in the middle classes (Sadock & Sadock.” Other psychiatric disorders that may account for suicidal behavior include psychoactive substance abuse disorders. Hispanic Americans. as another important factor in suicide. which accounts for about 49 percent of cases.000 and declined to 7.g. 2004). most studies demonstrate that whites are at highest risk for suicide. and anxiety disorders (Tondo & Baldessarini. & Burgeois. 2003). Freud believed that suicide occurred as a result of an earlier repressed desire to kill someone else.religious counterparts (Dervic et al. law enforcement officers. followed by Native Americans. 2001).The suicide rate among young people ages 15 to 19 peaked in 1990 at 11. Other Risk Factors: Individuals with mood disorders (major depression and bipolar disorder) are far more likely to commit suicide than those in any other psychiatric or medical risk group. Carol. Victor. In a recent study published in the American Journal of Psychiatry. With regard to occupation. firearms). The use of firearms. Hendin (1991) identified desperation.. 2003). musicians. and insurance agents.Ghosh. Ethnicity: With regard to ethnicity. Beck and associates (1990) also found a high correlation between hopelessness and suicide. Hopelessness. and substance abuse. Desperation and Guilt. 2003). Freud (1957) believed that suicide was a response to the intense self. including impulsive and high-risk behaviors. an individual feels helpless to change. 2004). African Americans. Sadock & Sadock (2003) report. “Almost 95 percent of all people who commit or attempt suicide have a diagnosed mental disorder. Victor. Several factors put adolescents at risk for suicide.. suicide rates are higher among physicians. .4 per 100. He interpreted suicide to be an aggressive act toward the self that often was really directed toward others. dentists. depressed men and women who consider themselves affiliated with a religion are less likely to attempt suicide than their non.
These results suggest a possible existence of genetic predisposition toward suicidal behavior. the less likely he or she was to commit suicide. A number of studies have been conducted to determine if there is a correlation between neurochemical functioning in the central nervous system (CNS) and .g. 2003). & Bourgeois. An interruption in the customary norms of behavior instills feelings of “separateness. or political ties. with results indicating significant association to suicidality (Abbar et al. He believed that the more cohesive the society. and the more that the individual felt an integrated part of the society. Integration is lacking and the individual does not feel a part of any cohesive group (such as a family or a church).Ghosh.” and fears of being without support from the formerly cohesive group. Developmental Stressors. and allegiance is so strong that the individual will sacrifice his or her life for the group. Some studies have indicated that violent behavior often goes hand – in –hand with suicidal behavior (Caroll. 2001).. loss of job) that disrupt feelings of relatedness to the group. divorce. Durkheim described three categories of suicide: Egoistic suicide is the response of the individual who feels separate and apart from the mainstream of society. Twin studies have shown a much higher concordance rate for monozygotic twins than for tryptophan hydroxylase.1991). Rich. Victor. The group is often governed by cultural. Some individuals have viewed suicide as a “face-saving” mechanism. Warsadt.a way to prevent public humiliation following a social defeat such as a sudden loss of status or income. religious.History of Aggression and Violence. These studies correlate the suicidal behavior in violent individuals to conscious rage. Altruistic suicide is the opposite of egoistic suicide. The individual who is prone to altruistic suicide is excessively integrated into the group. Medical illness plays an increasingly significant role after age 60 and becomes the leading predisposing factor to suicidal behavior in individuals older than age 80. Often these individuals are too embarrassed to seek treatment or other support systems. Sociological Theory: Durkheim (1951) studied the individual’s interaction with the society in which he or she lived. Shame and Humiliation. The stressors of conflict. therefore citing rage as an important psychological factor underlying the suicidal behavior (Hendin. Biological Theories: Genetics. Neurochemical Factors.. and Nemiroff (1991) have associated developmental level with certain life stressors and their correlation to suicide. and rejection are associated with suicidal behavior in adolescence and early adulthood. separation. The principal stressor associated with suicidal behavior in the 40 to 60 year old group is economic problems. Anomic suicide occurs in response to changes that occur in an individual’s life (e.
that results in his or her own death as well. both are most commonly a joint effect of depression. and was sentenced to prison time. There is a non-causal correlation between self-harm and suicide. initially self-harm was erroneously classified as a suicide attempt.hydroxyindole acetic acid of the cerebrospinal fluid) in depressed clients who attempted suicide (Sadock & Sadock. Philip Nitschke. 2003). An example is the mass suicide that took place by members of the Peoples Temple. Some changes in the noradrenergic system of suicide victims have also been reported. Some studies have revealed a deficiency of serotonin (measured as a decrease in the levels of 5. Euthanasia and assisted suicide Euthanasia machine invented by Dr. Mass suicide Some suicides are done under peer pressure or as a group. however. Classification of suicide Self-harm Self-harm is not a suicide attempt. or with a larger number of people. was found to have helped patients end their own lives. . Individuals who wish to end their own lives may enlist the assistance of another person to achieve death. typically to achieve a military or political goal. as seen in the scandal surrounding Dr. Assisted suicide is a contentious moral and political issue in many countries. in a "suicide pact". Mass suicides can take place with as few as two people. Suicide bombings are often regarded as an act of terrorism. on display at Science Museum. Suicide attack A suicide attack is when an attacker perpetrates an act of violence against others. a medical practitioner who supported euthanasia. an American cult led by Jim Jones in Guyana in 1978. The motivation for the murder in murder–suicide can be purely criminal in nature or be perceived by the perpetrator as an act of care for loved ones in the context of severe depression. usually a family member or physician. The other person. Jack Kevorkian. London. may help carry out the act if the individual lacks the physical capacity to do so even with the supplied means. Historical examples include the assassination of Czar Alexander II and the in-part successful kamikaze attacks by Japanese air pilots during the Second World War. Murder–suicide A murder–suicide is an act in which an individual kills one or more other persons immediately before or at the same time as him or herself.suicidal behavior.
Suicide pact A suicide pact describes the suicides of two or more individuals in an agreed-upon plan. usually involve small groups of people (such as married or romantic partners. The latter refers to incidents in which a larger number of people kill themselves together for the same ideological reason. Approximately 33% . More than 50% of suicides are related to alcohol or drug use. Thus suicides are more likely to occur during periods of socioeconomic. such as a traumatic event. While external circumstances. often within a religious. for example political suicide. or separately and closely timed. including the United States. In approximately 75% of completed suicides the individuals had seen a physician within the prior year before their death. family and individual crisis. Depression in the United States alone affects 17. or friends) whose motivations are intensely personal and individual. The plan may be to die together. and is often a precipitating factor in suicide. Suicide pacts. Mental illness Mental disorders are frequently present at the time of suicide with estimates from 87%to 98% When broken down into type mood disorders are present in 30%. Depression. on the other hand. 45%-66% within the prior month. one of the most commonly diagnosed psychiatric disorders is being diagnosed in increasing numbers in various segments of the population worldwide. drug addiction. About 5% of people with schizophrenia die of suicide. family members. Both chronic substance misuse as well as acute substance abuse is associated with an increased risk of suicide. schizophrenia in 14%.0% of suicides. Up to 25% of drug addicts and . may trigger suicide it does not seem to be an independent cause. Causes A number of factors are associated with the risk of suicide including: mental illness. 20% within the prior month. This is attributed to the intoxicating and disinhibiting effects of many psychoactive substances. military or paramilitary context. political. and socio-economic factors. Metaphorical suicide The metaphorical sense of "willful destruction of one's self-interest". when combined with personal grief such as bereavement the risk of suicide is greatly increased. Within the next twenty years depression is expected to become the second leading cause of disability worldwide and the leading cause in high-income nations. substance abuse in 18%. and personality disorders in 13. Substance abuse Substance abuse is the second most common cause of suicide after mood disorders.6 million Americans each year or 1 in 6 people. Suicide pacts are generally distinct from mass suicide.41% of those who completed suicide had contact with mental health services in the prior year.
4 times the suicide risk. Biological Genetics has an effect on suicide risk accounting for 30–50% of the variance Much of this relationship acts through the heritability of mental illness . suicidal ideation and suicide attempts. Misuse of drugs such as cocaine have a high correlation with suicide. 25 cigarettes or more.alcoholics commit suicide. a definitive link between suicide and smoking was observed with those smoking over a pack a day having twice the suicide rate of non-smokers. than those who had never smokedIn a study of 300. In San Diego it was found that 30% of suicides in people under the age of 30 had used cocaine.000 male U. and alcoholics have a very high suicide rate. However. In a study conducted among nurses. In New York City during a crack epidemic one in five people who committed suicide were found to have recently consumed cocaine. gamblingrelated suicide attempts are usually made by older people with problem gambling. Cigarette smoking There have been various studies done showing a positive link between smoking. High rates of major depressive disorder occur in heavy drinkers and those who abuse alcohol. Early onset of problem gambling increases the lifetime risk of suicide. The "come down" or withdrawal phase from cocaine can result in intense depressive symptoms coupled with other distressing mental effects which serve to increase the risk of suicide. Suicide is most likely to occur during the "crash" or withdrawal phase of cocaine in chronic abusers.S. Polysubstance misuse has been found to more often result in suicide in younger adults whereas suicide from alcoholism is more common in older adults. those smoking between 1-24 cigarettes per day had twice the suicide risk. Army soldiers. In adolescents the figure is higher with alcohol or drug misuse playing a role in up to 70% of suicides. Controversy has previously surrounded whether those who abused alcohol who developed major depressive disorder were self medicating (which may be true in some cases) but recent research has now concluded that chronic excessive alcohol intake itself directly causes the development of major depressive disorder in a significant number of alcohol abusers. It has been found that drinking 6 drinks or more per day results in a sixfold increased risk of suicide. Both comorbid substance use and comorbid mental disorders increase the risk of suicide in people with problem gamblingA 2010 Australian hospital study found that 17% of suicidal patients admitted to the Alfred Hospital's emergency department was a problem gambler. Problem gambling Problem gambling is often associated with increased suicidal ideation and attempts compared to the general population. It has been recommended that all drug addicts or alcoholics are investigated for suicidal thoughts due to the high risk of suicide. Alcohol misuse is associated with a number of mental health disorders.
India grapples with infectious diseases. including the Virginia Tech massacre. Chief among these is that suicide is a personal matter that should be left for the individual to decide. concluded with the perpetrator committing suicide.000 debt-ridden farmers in India have committed suicide in the past decade. poverty. and discrimination may trigger suicidal thoughts. infant and maternal mortality and other . a high-ranked Nazi and head of the Luftwaffe. for the overwhelming majority who engage in suicidal behaviour. Poverty may not be a direct cause but it can increase the risk of suicide. as it is a major risk group for depression. Suicide Prevention The view that suicide cannot be prevented is commonly held even among health professionals. Another belief is that suicide cannot be prevented because its major determinants are social and environmental factors such as unemployment over which an individual has relatively little control.Judicial suicide A person who has committed a crime may commit suicide to avoid prosecution and disgrace. Suicide is often a permanent solution to a temporary problem. there is a probably an appropriate alternative resolution of the precipitating problems. homelessness. Other factors Socio-economic factors such as unemployment. However. some people use suicide as a means of escape. Advocacy of suicide has sometimes been cited as a contributing factor. Selective interventions target subgroups whose members are not yet manifesting suicidal behaviour but exhibit risk factors that predispose them to do so in the future. committed suicide with cyanide capsules rather than be hanged after his conviction at the Nuremberg Trials. Mrazek and Haggerty's framework classified suicide prevention intervention as universal. malnutrition. According to a report by Tata Institute of Social Sciences in Mumbai. Some school shootings. Suicide as an escape In situations where continuing to live is intolerable. such as in murder–suicides. selective or indicated on the basis of how their target groups are defined. Indicated interventions are designed for people already beginning to exhibit suicidal thoughts or behaviour. Many beliefs may explain this negative attitude. Nazi leader Hermann Göring. Universal interventions target whole populations with the aim of favorably shifting proximal or distal risk factors across the entire population. 150. Some inmates in Nazi concentration camps are known to have killed themselves by delibertely touching the electrified fences.
policy makers. Hence. 2003. the NGOs have also undertaken education of gatekeepers. Each year the International Association for Suicide Prevention (IASP) in collaboration with WHO uses this day to call attention to suicide as a leading cause of premature and preventable death. reducing alcohol availability and consumption. volunteers and survivors in a concerted action. promoting responsible media reporting of suicide and related issues. low-cost intervention in developing countries. psychiatric/medical/family . police officers and practitioners of alternative system of medicine and faith healers. The enormity of the problem combined with the paucity of mental health service has led to the emergence of NGOs in the field of suicide prevention. For a population of over a billion. there is an emerging need for external emotional support. The priority areas are reducing the availability of and access to pesticide.500 psychiatrists.major health problems and hence. There is an urgent need to develop a national plan for suicide prevention in India. presenting symptoms/medical-psychiatric diagnosis. analysis of the suicidal crisis. there are only about 3. Rapid urbanization. ignored and stigmatized groups and also draw together researchers. It calls attention to the fact that suicide occurs at all ages and that suicide prevention and intervention strategies may be adapted to meet the needs of different age groups. The primary aim of these NGOs is to provide support to suicidal individuals by befriending them. Often these centers function as an entry point for those needing professional services.World Suicide Prevention Day: The World Suicide Prevention Day was formally announced on 10 th September. Apart from befriending suicidal individuals. 10 th September . raising awareness in the public and media and some intervention programmes. decriminalising attempted suicide is an urgent need if any suicide prevention strategy is to succeed in the prevailing system in India. The World Health Organization's (WHO's) suicide prevention multisite intervention study on suicidal behaviors (SUPRE-MISS). promoting and supporting NGOs. However. The diminishing traditional support systems leave people vulnerable to suicidal behavior. interpersonal support system. Quality control measures are inadequate and the majority of their endeavors are not evaluated. politicians. has revealed that it is possible to reduce suicide mortality through brief. societies. industrialization and emerging family systems are resulting in social upheaval and distress. an intervention study. The mental health services are inadequate for the needs of the country. There is a wide variability in the expertise of their volunteers and in the services they provide. suicidal ideas or acts. It is hoped that the theme will focus on vulnerable. Above all. improving the capacity of primary care workers and specialist mental health services and providing support to those bereaved by suicide and training gatekeepers like teachers. there are certain limitations in the activities of the NGOs. APPLICATION OF THE NURSING PROCESS WITH THE SUICIDAL CLIENT Assessment: The following items should be considered when conducting a suicidal assessment: demographics. clinicians. suicide is accorded low priority in the competition for meager resources. The theme for the year 2007 is " Suicide Prevention-Across the Life Span".
work.both through direct personal contact or inappropriate media representations • Cultural and religious beliefs-for instance. These risk and protective factors are given below in tables presents some additional guidelines for determining the degree of suicide potential. withdrawal INTENSITY OF RISK MODERATE Moderate Moderate of Some feeling of no helplessness.history. peers who have died by suicide. withdrawn.S Public Health Services. 1999).withdrawl LOW Mild Mild Some feeling isolation. a feeling of being cut off from other people Assessing the degree of Suicidal Risk: BEHAVIOR Anxiety Depression Isolation. and withdrawal HIGH High or panic Severe Hopelessness. in his “Call to Action to Prevent Suicide. whereas protective factors are associated with reduced potential for suicide. helplessness. and coping strategies. or financial loss • Physical illness • Influence of significant people-family members. and selfdeprecating PROTECTIVE FACTORS • Effective and appropriate clinical care for mental. conflict resolution. celebrities. hopelessness. . and nonviolent handling of disputes • Cultural and religious beliefs that discourage suicide and support selfpreservation instincts. the belief that suicide is a noble resolution of a personal dilemma • Isolation. social. and substance abuse disorders • Easy access to a variety of clinical interventions and support for help seeking • Restricted access to highly lethal methods of suicide • Family and community support • Support from ongoing medical and mental health care relationships • Learned skills in problem solving.” Speaks of risk factors and protective factors (U. physical. Suicide Risk Factors and Protective Factors RISK FACTORS • Previous suicide attempt • Mental disorders-particularly mood disorders such as depression and bipolar disorder • Co-occurring mental and alcohol and substance abuse disorders • Family history of suicide • Hopelessness • Impulsive and/or aggressive tendencies • Barriers to accessing mental health treatment • Relational. The Surgeon General. Risk factors are associated with a greater potential for suicide and suicidal behavior.
Socioeconomic Status. who are at higher risk than African Americans. Religion. Suicide is highest in persons older than 50. Marital status. Adolescents are also at high risk. Single. and moderately satisfied with results Moderately stable Frequently to excess Not good in activities Few or none Predominantly destructive Negative view help received Unstable Continual abuse any of One or more of Multiple attempts of moderate lethality high lethality Some Marked Some Frequently thoughts.Daily functioning Fairly good in most activities Resources Several Coping strategies Generally being used constructive significant others Psychiatric help in None.Psychiatric Diagnosis: . Professional health care personnel and business executive are at highest risk. Family History. Ethnicity. fleeting thoughts but no plan Moderately good in some activities Some Some that are constructive Yes. Use of firearms presents a significantly higher risk than overdose of substances. Caucasians are at higher risk than are Native Americans. Method. and widowed are at higher risk than married. Higher risk if individual has family history of suicide. Individuals who are not affiliated with any religious group are at higher risk than those who have this type of affiliation. Individuals in the highest and lowest socioeconomic classes are higher risk than those in the middle classes. Males are at high risk than females. Occupation. Gender. Presenting Symptoms/Medical. None disorganization Hostility Little or none Suicidal plan Vague. occasional ideas about a plan Marked Frequent or constant thought with a specific plan Demographics: The following demographics are assessed: Age. divorced. or positive past attitude toward Lifestyle Stable Alcohol or drug use Infrequently to excess Previous suicide None. or of low attempts lethality Disorientation.
does he or she have the means? How lethal are the means? Has the individual ever attempted suicide before? These are all questions that must be answered by the person conducting the suicidal assessment. Other psychiatric disorders in which suicide may be a risk include anxiety disorders. Examples of behavioral clues include giving away prized possessions. Has the individual experienced numerous failures or rejections that would increase his or her vulnerability for a dysfunctional response to the current situation? Life –Stage Issues. Relevant History.Assessment data must be gathered regarding any psychiatric or physical condition for which the client is being treated. or terminal illness. and has a close relative committed suicide in the past? Coping Strategies: How has the individual handled previous crisis situations? How does this situation differ from previous ones? .g. or for previous suicide attempts. writing suicide notes. changes in roles. Suicidal Ideas or Acts: How serious is the intent? Does the person have a plan? If so.” Interpersonal Support System: Does the individual have support persons on whom he or she can rely during a crisis situation? Lack of a meaningful network of satisfactory relationships may implicate an individual at high risk for suicide during an emotional crisis. Psychiatric/Medical/Family History: The individual should be assessed with regard to previous psychiatric treatment for depression.2002). midlife). problems in major relationships. adolescence. alcoholism. and borderline and antisocial personality disorders (Tondo & Baldessarini.. Medical history should be obtained to determine presence of chronic. Analysis of the Suicidal Crisis: The precipitating Stressor. 2001).” “I won’t be around much longer for the doctor to have to worry about.” or “I don’t have anything worth living for anyone. Adverse life events in combination with other risk factors such as depression may lead to suicide (NIMH. schizophrenia. Life stresses accompanied by an increase in emotional disturbance include the loss of a loved person either by death or by divorce. Verbal clues may be both direct and indirect. or serious physical illness.” Examples of indirect statements include “This is the last time you’ll see me. Individuals with substance use disorders are also at high risk. Is there a history of depressive disorder in the family. Mood disorders (major depression and bipolar disorders) are the most common disorders that precede suicide. Examples of direct statements include “I want to die” or “I’m going to kill myself. The ability to tolerate losses and disappointments is often compromised if those losses an disappointments occur during various stages of life in which the individual struggles with developmental issues (e. debilitating. or sudden lifts in mood. Individuals may leave both behavioral and verbal clues as to the intent of their act. getting financial affairs in order.
3. Planning/ Implementation: Below table provides a plan of care for the hospitalized suicidal client. Has experienced no physical harm to self. Risk for suicide related to feelings of hopelessness and desperation. 3. Create a safe environment for the client. Nursing Interventions not 1. belts. The client: 1. A degree of the responsibility for his or her safety is given to the client. Ask client directly: “Have you plan to do? Do you have the means to carry out this plan?” 2. The following criteria may be used for measurement of outcomes in the care of the suicidal client. The risk of suicide is greatly increased if the client has developed a plan and execute the plan. 3. glass items. 2. Rationales 1. When time is up. 2. Supervise closely during meals and medication administration.Diagnosis/ Outcome Identification Nursing diagnoses for the suicidal client may include the following: 1. and so forth. 2. CARE PLAN FOR THE SUICIDAL CLIENT: Nursing diagnosis: Risk for Suicide Related to: Feelings of hopelessness and description Outcome Criteria Client will harm self. make another. ties. Remove all potentially harmful objects from client’s access (sharp objects. Expresses some optimistic and hope for the future. straps. Formulate a short –term verbal or written contract that the client will not harm self. alcohol). Increased feelings of self-worth may be experienced when client feels accepted unconditionally regardless . Sets realistic goals for self. Secure a promise that the client will seek out staff when feeling suicidal. Client safety is a nursing priority. Hopelessness related to absence of support systems and perception of worthlessness.
causative or contributing factors in order to plan appropriate assistance. suicidal behaviors may be Provide hostility release if needed. provide one-to-one contract. do not assign to private room. . 5.It is important to identify previously used and client’s perception client’s strengths and of effectiveness then and now. lack of initiative. 6.Identification of feelings verbalize feelings and perceptions. Depending on level of suicide precaution. If this anger can be verbalized in a nonthreatening environment. 2. Encourage client to express 6. 5. Nursing diagnosis: Hopelessness Related to: Absence of support systems and perception of worthlessness Evidenced By: verbal cues.4.Identify stressors in client’s life that 1. Being alert for suicidal escape attempts facilitates being able to prevent or interrupt harmful behavior. Prevents saving up to overdose or discarding and not taking. underlying behaviors helps client to begin process of taking control of own life. or every 15 minute checks. May need to accompany to bathroom. Place in room close to nurse’s station.Important to identify precipitated current crisis. viewed as anger turned inward On the self.Encourage client to explore and 3. 4.Determine coping behaviors 2. Maintain close observation of client. including anger. suicidal ideas or attempts Outcome criteria Client will verbalize a measure of hope and acceptance of life and situations over which he or she has no control. constant visual observation. Accompany to off unit activities if attendance is indicated. Nursing Intervention Rationales 1. 3. decreased affect. Maintain special care in administration of medications. encourage their use in current crisis situation. the client may be able to eventually resolve these feelings. of thoughts or behavior. Depression and honest feelings. Close observation is necessary to ensure that client does not harm self in any way.
Enlist the help of family or friends to ensure that the home environment is safe from dangerous items. Give support persons the telephone number of counselor is not available. Establish rapport and promote a trusting relationship.” or “I will call the suicide hotline (or go to the emergency room) if I start to feel like harming myself. . Instead. Intervention with the Suicidal Client Following Discharge (or Outpatient Suicidal Client): In some instances. The person should not be left alone. It is important for the suicide counselor to become a key person in the client’s support system at this time. 2.Client should be made aware of local suicide hotlines or other local support services from whom he or she may seek assistance following discharge from hospital. Formulate a written contract that the client will not harm himself or herself in a stated period of time. A concrete plan provides hope in the face of crisis situation. the client writes. Establish a no-suicide contract with the client. “I will not harm myself in any way between now and the time of our next counseling session. it may be determined that suicidal intent is low and that hospitalization is not required. such as firearms or stockpiled drugs. Appointments may need to be scheduled daily or every other day at first until the immediate suicidal crisis has subsided. Guidelines for treatment of the suicidal client on an outpatient basis include the following: 1. condition may interfere with ability to problem solve. Assistance may be required to perceive the benefits and consequences of available alternatives accurately. 4. a new contract is negotiated. The client’s emotional situation that are under own control. 5.Help client identify areas of life 4. the client with suicidal ideation may be treated in an outpatient setting.” When the time period of this short-term contract has lapsed.4.Identify sources that client may use after discharge when crisis occur or feelings of hopelessness and possible suicidal ideation prevail. Arrangements must be made for the client to stay with family or friends. For example. If this is not possible. hospitalization should be reconsidered. 5. 5. 3.
The prescription can then be renewed at the client’s next counseling session. Suicidal individuals are ambivalent about dying. 9. Listen actively and encourage expression of feelings. with the coping skills required to manage adaptively. Introduce alternatives to suicide. events. Identify experiences and actions that affirm self-worth and self-efficacy. and the future. Note how these appraisals change in changing contexts. Identify the client’s appraisals of how things are. and suicidal behavior is a cry for help. the past. Take any hint of suicide seriously. anger and frustration. Note the client’s reactivity to crisis and how this can be changed. Get help for the person and for you. It is wise to prescribe no more than a 3 day supply of the medication with no refills. 10.” do not make that promise. including anger. Talk openly and matter-of-factly about suicide. the present. Anyone expressing suicidal feelings needs immediate attention. Accept the client’s feelings in a nonjudgmental manner. Macnab (1993) suggests the following steps in crisis counseling with the suicidal client: a) Focus on the current crisis and how it can be alleviated. Help the client identify areas of life situation that are within his or her control and those that client does not have the ability to control. It is the part of the person that wants to stay alive that tells you about it. Use the problem-solving approach. Rehearse cognitive reconstruction –more positive ways of thinking about the self. The physician may prescribe antidepressants for an individual who is experiencing suicidal depression. Discuss feelings associated with these control over his or her life situation in order to perceive a measure of self-worth. Be direct. Encourage movement toward the new reality. 7. and control. If a suicidal person says. 2. Do not keep secrets. b) c) d) e) f) Information for family and friends of the Suicidal Client: The following suggestions are made for family and friends of an individual who is suicidal: 1. “Promise you won’t tell anyone. 8. status.6. . Discuss the current crisis situation in the client’s life. Work toward restoration of the client’s self-worth. Discuss strategies and procedures for the management of anxiety. 1-800-SUICIDE is a national hotline that is available 24 hours a day. morale. and how things will be.
Intervention with Families and Friends of Suicide Victims: Suicide of a family member can induce a whole gamut of feelings in the survivors. Hold them. f) Remove any items from the home with which the person may harm himself or herself. such as mental health centers and suicide hotlines. try to remove them from the home. g) If there are children present. The centers for Disease Control(CDC. Perhaps another friend or relative can assist by taking them to their home. Allow them to cry and express anger. d) Show love and encouragement. hopeless. be supportive. c) Stay with them. Macnab (1993) identifies the following symptoms. if necessary. d) Familiarize yourself with suicide intervention sources. which may be evident following the suicide of a loved one. b) Try to give them hope and remind them that what they are feeling is temporary. and touch them. resentment. e) Ensure that access to firearms or other means of self-harm is restricted.3. The Mental Health Sanctuary (2004) offers the following tips: a) Acknowledge and accept their feelings and be an active listener. hug them. e) Help them seek professional help. Let them know you are there for them and are willing to help them seek professional help. b) Many people find it awkward to put into words how another person’s life is important for their own well-being. and rage that can never find its “object” . but it is important to stress that the person’s life is important to you and to in which the person’s suicide would be devastating to you and to others. 2002) offer the following suggestions for families and friends of suicidal persons: a) Be a good listener. The individual may be withdrawn and reluctant to discuss what he or she is thinking. Acknowledge the person’s pain and feelings of hopelessness. 1. If people express suicidal thoughts or feel depressed. 4. Anger. or worthless. Go to where they are. Do not leave them alone. c) Express concern for individuals who express thoughts about committing suicide. A sense of guilt and responsibility 2. and encourage the individual to talk to someone else if he or she does not feel comfortable talking with you. This type of situation can be extremely traumatic for children.
it is not because they “care less. Be aware of any blaming or scapegoating of specific family members. A recurring self-searching: “If only I had done something.” Variables that enter into this phenomenon include individual past experiences. personal relationship with the deceased person. Evaluation: . Discuss coping strategies that have been successful in times of stress in the past. 6. Listen to feelings of guilt and self-persecution. and individual temperament and coping abilities.” If only I had not done something. irritability. Focus on both positive and negative aspects of the relationships. point out the irrationality of any idealized concepts of the decreased person. The family must be able to recognize both positive and negative aspects about the person before grief can be resolved. Discuss how each person fits into the family situation. and work to reestablish these within the family. Gradually. each responding to the other’s viewpoints. All family members must be made to understand that if this occurs. 7. 8. Encourage the clients to talk about the suicide. A sense of impatience. survivors of suicide support groups. failure. Identify new adaptive coping strategies that can be incorporated. close friends and relatives. Identify resources that provide support: religious beliefs and spiritual counselors. and anger exists between family members. 3. No two people grieve in the same way. Recognize how the suicide has caused disorganization in family coping. A severe strain is placed on relationships. Share memories. The family feels wounded. A sense of inner injury. both before and after the suicide. Reassess interpersonal relationships in the context of the event. It may appear that some family members are “getting over” the grief faster than others. A heightened sense of emotionality. They do not know how they will ever over it and get on with life. and despair 4.” “If only……. A sense of confusion and search for an explanation: “Why did this happen?” “What does it mean?” “What could have stopped it?” “What will people think?” 6. Gently move the individuals toward the reality of the situation. 2.” If only I had not done something. A heightened vulnerability to illness and disease exists with this added burden of emotional stress.3. Encourage the family members to discuss individual relationships with the lost loved one. 5. helplessness.” just that they “grieve differently.” 5. 7. and reconstructing of events. 4. Strategies for assisting survivors of suicide victims include: 1.
Learn more effective ways to express feelings to others. 3. Achieve successful interpersonal relationships. . Feel accepted by others and achieve a sense of belonging. Develop and maintain a more positive self-concept. 2. as well as determination of goal achievement. Once the immediate crisis has been resolved.Evaluation of the suicidal client is an ongoing process accomplished through continuous reassessment of the client. 4. The long-term goals of individual or group psychotherapy for the suicidal client would be for him or her to: 1. extended psychotherapy may be indicated. These goals serve to instill a sense of self-worth. while offering a measure of hope and a meaning for living. A suicidal person feels worthless and hopeless.
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