PSYCHIATRIC NURSING

SUICIDE

SUICIDE
y

VIOLENCE , SELF DIRECTED ; RISK FOR
Self destructive behavior(introjection)anfer and rage turned inwards or into an attempt to punish others Most common as depression is lifting 10-14 days after anti depressant medications/ new signs of energy or improvement Individual feels guilty and overwhelmed ± suicide seen as relief Ambivalence may lead to cry for help or attention Attempts to cope fail-hopelessness and helplessness

RISK FACTORS: y Sex ± white male divorced caucasian y Unsuccessful previous attempt y Identification with someone who commited suicide y Chronic y Illness y Depression/dependent personality y Age (18-25 and >40) , alcoholism y Lethality of previous attempts/losses

Three Categories: According to Intent
Complete suicide: all willful, self inflicted, life threatening acts leading to death. y Suicide attempt: all willful, self inflicted, life threatening acts that have not led to death. y Suicidal ideation : means that the person is thinking about harming her/himself.
y

NURSING ASSESSMENT SAD PERSONS SCALE y S EX: MEN 3X; ATTEMPTS WOMEN y A GE: 19 or below; 45 y/o; 60 y/o y D EPPRESSION: W/ DEPRESSION y P REVIOUS ATTEMPTS: y E ETOH : Alcohol y R ATIONAL THINKING LOSS y S OCIAL SUPPORT LOSS y O RGANIZED PLAN y N O SPOUSE
y SICKNESS

Nursing Diagnosis
1. 2. 3. 4. 5.

Risk for violence ± self directed Ineffective individual coping Ineffective family coping Hopelessness Powerlessness

Nurses attitude:
1. 2. 3. 4.

Remain calm Deal directly with the topic of suicide Encourage problem solving Get assistance

Guidelines Prevention of suicidal behavior in the hospital
the client: 1-on-1 monitoring; view all times; 2. Suicide observation: q 15 mins. 3. Behavior, mood, verbatim are recorded q 15 mins. ENVIRONMENt: 1. Use plastic utensils 2. Do not leave patient alone 3. Jump proof, hang proof 4. Lock all utility rooms, cabinets, etc. 5. Client¶s belonging¶s must be check thoroughly.
1.

In the community:
1. 2. 3. 4.

5. 6.

Relieve isolation Remove all weapons Encourage alternative expression of anger. Avoid final decision for suicide during crisis. ( assure ±suicide as temporary state) Re-establish social ties Relieve extreme anxiety and sleep loss.

KEY POINTS
y y y y y y y

One on one monitoring Frequent unscheduled rounds Safe environment(remove all potentially dangerous items Monitor for signs Discuss all behavior with team members Intervene quickly and calmly during attempts Provide afmily therapy / give client sense of control other rhan suicide(prob.Solving ,decision making,suicide contract)

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