1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 31Suicidal Clients

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Suicide may be the culmination of self- destructive urges that have resulted from the client’s internalizing his or her anger or a desperate act by which to escape a perceived intolerable psychological state or life situation. The client may be asking for help by attempting suicide, seeking attention, or attempting to manipulate someone with suicidal behavior. —Schultz & Videbeck, 2009

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Recognize the genetic, biologic, sociologic, and psychological factors believed to precipitate suicidal behavior Compare and contrast the theory of self with the theory of parasuicidal behavior Identify those clients or groups of individuals considered to be at risk for suicide Illustrate at least two examples of verbal, behavioral, and situational suicidal clues

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) Distinguish among suicidal ideation, intent, threat, gesture, and attempt Differentiate three cultural beliefs about suicide Discuss primary, secondary, and tertiary suicide prevention Describe the purpose of suicide precautions, no- suicide contracts, and seclusion and restraints in the clinical setting

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) Explain the rationale for the use of medication, interactive therapies, and family and client education when providing care for clients who are exhibiting suicidal behavior Articulate the importance of self-assessment when providing care for suicidal clients Discuss the purpose of a psychological autopsy Describe the term postvention Reflect on the impact of physician-assisted suicide (PAS) on the nursing profession

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology Genetic and biologic theories –Genetic markers –Endocrine basis –Relationship of neurochemical binding sites –Protein kinase C abnormality –Familial suicidal behavior –Twin and adoption studies Sociological theory Psychological theories –Theory of self –Theory of parasuicidal behavior –Other psychological factors

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Individuals at Risk for Self-Destructive Behavior Clients with a psychiatric disorder Clients with alexithymia Clients with medical illnesses –Euthanasia and PAS Adolescents High-risk population groups –Ethnic minorities, homosexuals, incarcerated, elderly –Divorced, separated, widowed, unemployed, socially isolated –High-risk occupations: anesthesiology, psychiatry, dentistry –Masochistic sexual acts, daredevils –History of previous suicide attempts

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process Assessment Nursing diagnoses Outcome identification Planning interventions Implementation Evaluation

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Assessment of suicide risk Assessment after a suicide attempt Assessment tools Assessment tools for adolescents Transcultural considerations

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Risk for injury Risk for suicide Risk for violence: self-directed Hopelessness Impaired social interaction Ineffective coping Chronic low self-esteem

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome Identification Outcomes focus on the following: Client safety Development of positive coping skills and self-esteem Ability to disclose feelings regarding suicide Taking steps to resolve issues that increase suicide risk

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning Interventions Interventions are planned to Establish a safe environment Assist the client in meeting basic needs Administer and monitor prescribed medications Assist with interactive therapies Provide client and family education Provide continuum of care

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Establishment of a safe environment – Suicide prevention – Suicide precautions – No-suicide contract – Seclusion and restraint Assistance in meeting basic human needs

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation (cont.) Medication management Interactive therapies Client and family education Continuum of care Special considerations: adolescent clients Signs of suicide prevention program

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation (cont.) Interventions after a successful suicide attempt – Psychological autopsy – Postvention for bereaved survivors – Empowering the survivors of suicide

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation Reassessment of information obtained from the client, family, or significant others regarding the following: –The client’s mood, affect, and behavior –Plan of care –Continuum of care

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Alexithymia Altruistic suicide Anomic suicide Dermatillomania Egoistic suicide Euthanasia Interpersonal–psychological theory of suicidal behavior Parasuicide Physician-assisted suicide (PAS) Postvention Primary prevention Psychological autopsy Secondary prevention Tertiary prevention Theory of self Trichotillomania

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection Think back to the quote presented at the beginning of the chapter. Incorporate that quote in the following scenario: The parent of an adolescent client who attempted suicide approaches you privately and asks you to explain how suicide can be considered manipulative behavior. ? What explanation could you give to the client’s parent? What additional educational material could you provide to support your response?