Suicide: Nursing Implications
Suicide :Defintions
• Suicidal threat: verbal or no-verbal expression of suicidal ideation (thinking)
• Suicidal gesture: milder form of attempt; usually with low lethality but still may
harm
• Suicidal attempt: makes a serious effort to kill self; often causes harm
Suicide: Epidemiology
• Over 25,000 suicide attempts yearly
• Over 25,000 suicides yearly
• Under-reporting of “accidents” and milder suicidal gestures
• Highest rates in elderly ( + teens high rate)
• Women make more attempts
• Men commit suicide more (use more lethal means)
Suicide: Psychodynamics
• Guilt: punish self for perceived wrongdoing
• Hopelessness: feel life is not worth living
(often related to depression)
• Psychosis: voices direct to self-harm
• Control others: threat used for manipulation
anger may cause attempt (murder/suicide)
want others to feel guilty
• Ambivalence: wish to escape bad situation
but don’t want to die (call for help)
• Poor impulse control: copycat suicides
panic (some have little prior suicidal thoughts)
Suicide Myths
• If someone talks about committing suicide, he/she will not do it.
• If someone wants to commit suicide, he/she will not talk about it
• If someone has had repeated attempts, he/she will not actually commit suicide.
• Suicide is always preventable.
• People from good home don’t kill themselves.
• If you ask someone about suicide, you will make the person consider it.
Suicide: Stressors/Risk Factors
• Age: elderly more at risk
• Gender: men more at risk
• Marital status: married less at risk
• Social support: social isolation increases risk
• Physical illness: chronic and painful illness increases risk
• Substance abuse: increases risk (overdose, intoxication, withdrawal)
• History of attempts: increases risk
• Specific plan: increases risk
• Lethality of means of suicide: increases risk
• Availability of means to commit suicide: increases risk
• Recent stressors: increases risk
• Psychiatric illness: depression & schizophrenia increases risk
• Poor coping skills: increases risk
• Religious/cultural attitudes: may effect risk
Suicide: Lethality of Means
People die from “lower lethality” methods.
All suicidal threats, gestures and attempts must be taken seriously
High :Hanging, Guns, Jumping
Lower: Overdose, Wrist cutting
Suicide:
Assessment & Adaptations
• Perform risk factor assessment
• Look for behavioral cues:
increasing isolation
hoarding pills or hiding “sharps”
gives away possessions; write a will
talks about death and hopelessness
excessive risk taking (teens especially)
poor impulse control; confusion
describes command hallucinations
sudden lifting in mood in a depressed patient
Patients who are ambivalent will give out behavioral cues
All depressed patients or anyone who seems at risk for suicide should be asked:
“Do you have any plan to hurt yourself?”
If the answer is “Yes,” the patient should be asked:“What is your plan?”
Suicide: Planning
Nursing Diagnoses:
potential for violence self-directed
ineffective individual coping
risk for injury
hopelessness
Goals:
The patient will not harm him/herself.
The patient will utilize appropriate social supports.
The patient will utilize healthier coping mechanisms.
The patient will comply with medical regimen.
Suicide: Interventions
• Increase observation (most important):
1 to 1 may be needed or q 15 minute
do not assign family task of observation
Patient is kept on constant observation until suicidal ideation has passed, impulsivity has
decreased, reality orientation has improved and behavioral cues to
suicide are gone.
• Place patient in safe environment:
check belongings
remove dangerous objects (see overview)
be especially careful with medications
• Pharmacology:
antidepressants
anti-psychotics
mood stabilizers
anti-anxiety agents
• Crisis intervention
• Enhance coping skills
• No suicide contract
• Cognitive therapy
• Grief counseling
• Family therapy
• Referral for long term follow-up (substance abuse, mood disorders)
If a suicide occurs on a psychiatric unit, staff must deal with
their own feelings as well as legal issues of death on the unit.
• If suicide occurs must deal with grief, guilt, anger and fear of survivors.
• Patients and families may blame staff and feel unsafe.
• Watch out for “copy cat” suicides, especially in school settings.
• Allow for expression of feelings and concerns.
• Education about suicide and suicide prevention.
• Refer for follow-up treatment.
Suicide: Evaluation
The patient did not harm him/herself.
The patient utilized appropriate social supports.
The patient utilized healthier coping mechanisms.
The patient complied with medical regimen.
Suicide: Ethical Considerations
• Suicide prevention is not directed to patients in the terminal stages of an illness
who choose to forgo further treatment or elect assisted suicide.
• These patients must be screened for underlying depression or coercion by others.
