Nursing care for suicidal patients

1. Nursing care for suicidal patients Rebecca Sposato MS, RN

2. What does a drowning person look like?

5. Terminology • Completed suicide – self administered action resulting in death • Suicideattempt – self administered act with intent of death, but did not result in death • Parasuicide/Suicide Gesture - act of self harm, but lacked the lethality to cause death • Unintentional Suicide – self-administered action without the intent of death, but results in death • Suicide Ideation- thoughts of ending own life

6. Signs of impending suicide • Increase use of alcohol and drugs • Increase in risky and reckless behaviors • Confrontational, moody, irritable, sad, angry, uninterested, hopeless, helpless, withdrawn • poor work/school performance, eating and sleeping • Seriously or sarcastically talking about killing self • Giving possessions away or finalizing a will • Access to a weapon • (http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml)

7. Other signs of impending suicide • Visiting friends and family • Apologizing for past wrongs • Improved mood • (http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml, 2011)

8. Prevalence (http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml, 2011 and Pikris et al, 2010)

9. Men account for 75% of completed suicides and women account for 75% of attempts • Men: 56% firearms, 24% suffocation, 13% poison • Women: 30% firearms, 21% suffocation, 40% poison • 10th leading cause of death in the United States • 7th for males, and 15th for females • 3rd among 15-24 year olds 15% leave behind a suicide note or recorded message (http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml#factors, 2011) Statistics

10. 90%: history of depression, bipolar, substance abuse, PTSD, schizophrenia • Previous attempts • Victim of physical and sexual abuse • Incarceration • Suicidal family member or friend • Weapon in the home • Recent bad news • http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml#factors, 2011) Risk Factors

11. Males >75 is the highest demographic for completed suicide. Females 40-55 have highest rate of suicide • Teenagers have >100 attempts per completed suicide • At time of suicide 1/3 test positive for alcohol, and 1/5 test positive for opiates • (www.cdc.org, 2009) Other Facts

12. Nursing Assessment • Follow-up and act upon every reference to self-harm or ending life • Have you thought about hurting yourself? • Do you have a plan? Taken steps? • Do you have access to a weapon? • Assess: comorbid mental illness, stressors, support resources

13. Assess and treat physiological injury • BLS/ACLS • Wound care • Administer antidote for drug overdose • Inventory Belongings • No weapons, blades, cords, strings, plastic bags, pills, liquids Nursing Interventions

14. Refer to therapist, psychiatrist • 72hr Mental Health Hold • No Harm/Suicide Contract – Informs pt to take alternative actions when ideation is present • Safety net • Suicide Precautions • Level 1: seclusion room or close proximity to staff member • Level 2: within view of staff at all times • Level 3: safety checks every 15min Nursing Interventions

15. Centers for Disease Control (2009) Suicide facts: At a glance. Retrieved online www.cdc.gov/violenceprevention/pdf/Suicide-DataSheet-a.pdf • National Institute of Mental Health (2011) retrieved from http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml#factors, 2011) • Pirkis, J., Burgess, P., & Dunt, D. (2000). Suicidal ideation and suicide attempts among Australian adults. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 21(1), 16-25. doi:10.1027//0227-5910.21.1.16 References