Suicide is the intentional act of killing oneself. Suicidal thoughts are common in people with depression, schizophrenia, alcohol/substance abuse and personality disorders (antisocial, borderline, and paranoid). Physical illness (chronic illness such as HIV, AIDS, recent surgery, pain) and environmental factors (unemployment, family history of depression, isolation, recent loss) can play a role in the suicide behavior.
Nursing Care Plans
The nursing care plan for suicidal patients involves providing a safe environment, initiating a no-suicide contract, creating a support system and ensuring close supervision.
Risk For Suicide
- Risk For Suicide
- Alcohol and substance abuse/use.
- Abuse in childhood.
- Family history of suicide.
- Fits demographic (children, adolescent, young adult male, elderly male, Native American, Caucasian).
- Grief, bereavement/loss of an important relationship.
- History of prior suicide attempt.
- Legal or disciplinary problems.
- Physical illness, chronic pain, terminal illness.
- Psychiatric illness (e.g., bipolar disorder, depression, schizophrenia).
- Poor support system, loneliness.
Possibly evidenced by
- Statements of despair, helplessness, hopelessness and nothing left to live for.
- Suicide plan (clear and specific, lethal method and available means).
- Suicide behavior (attempt, ideation, talk, plan, available means).
- Suicide cues
- Covert: Making out a will, giving valuables away, writing forlorn love notes, taking out large life insurance policy.
- Overt: “No one will miss me”; “No reason to live for”; “I’d be better off dead”.
- Patient will refrain from attempting suicide.
- Patient will make a no-suicide contract with the nurse covering the next 24 hours, then renegotiate the terms at that time (If in hospital and accepted at your institution).
- Patient will remain safe while in the hospital, with the aid of nursing intervention and support (if in the hospital).
- Patient will stay with a friend or family if the person still has the potential for suicide (if in the community).
- Patient will join family in crisis family counseling.
- Patient will have links to self-help groups in the community.
- Patient will keep an appointment for the next day with a crisis counselor (if in the community).
- Patient will identify at least one goal for the future.
- Patient will uphold a suicide contract.
- Patient will state that he or she wants to live.
- Patient will name at least one acceptable alternative to his or her situation.
- Patient will name two people he/she can call if thoughts of suicide recur before discharge.
|In the Community:|
|Arrange for the client to stay with family or friends. A hospitalization is considered if there is no one is available especially if the person is highly suicidal.||Relieve isolation and provide safety and comfort.|
|Encourage the client to avoid decisions during the time of crisis until alternatives can be considered.||During crisis situations, people are unable to think clearly or evaluate their options readily.|
|Encourage the client to talk freely about feelings and help plan alternative ways of handling disappointment, anger, and frustration.||Gives client other ways of dealing with strong emotions and gaining a sense of control over their lives.|
|Weapons and pills are removed by friends, relatives, or the nurse.||To provide a safe environment, free from things that may harm the client.|
|If anxiety is extremely high, or client has not slept in days, a tranquilizer might be prescribed. Only a 1 to 3 day supply of medication should be given. Family member or significant other should monitor pills for safety.||Relief of anxiety and restoration of sleep loss can help the client think more clearly and might help restore some sense of well-being.|
|Contact family members, arrange for individual and/ or family crisis counseling. Activate links to self-help groups.||Reestablishes social ties. Diminishes sense of isolation, and provides contact from individuals who care about the suicidal person.|
|In the Hospital:|
|During the crisis period, health care workers will continue to emphasize the following four points:
||Because of “tunnel vision“, clients do not have perspective on their lives. These statements give perspective to the client and help offer hope for the future.|
|Follow unit protocol for suicide regarding creating a safe environment (taking away potential weapons– belts, sharp objects, items, and so on).||Provide safe environment during time client is actively suicidal and impulsive; self-destructive acts are perceived as ties, the only way out of an intolerable situation.|
|Keep accurate and thorough records of client’s behaviors (verbal and physical) and all nursing/physician actions.||These might become court documents. If client checks and attention to client’s needs or request are not documented, they do not exist in a court of law.|
|Put on either suicide precaution (one-on-one monitoring at one arm’s length away) or suicide observation (15-minute visual check of mood, behavior, and verbatim statements), depending on level of suicide potential.||Protection and preservation of the client’s life at all costs during crisis is part of medical and nursing staff responsibility. Follow unit protocol.|
|Keep accurate and timely records, document client’s activity, usually every 15 minutes (what client is doing, with whom, and so on). Follow unit protocol.||Accurate documentation is vital. The chart is a legal document as to client’s “ongoing status,” intervention taken, and by whom.|
|Encourage the client to talk about their feelings and problem solve alternatives.||Talking about feelings and looking at alternatives can minimize suicidal acting out.|
|Construct a no-suicide contract between the suicidal client and nurse. Use clear, simple language. When the contract is up, it is renegotiated (If this is accepted procedure at your institution).||The no-suicide contract helps client know what to do when they begin to feel overwhelmed by pain (e.g., “I will speak to my nurse/counselor/support group/family member when I first begin to feel the need to end my life”).|
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Mental Health and Psychiatric Care Plans
Care plans about mental health and psychiatric nursing: