Suicidal Ideation, Suicidal Ideation Nursing Assessment, Suicidal Ideation Nursing Interventions, and 1 Suicidal Ideation Nursing Care Plan.

Suicidal Ideation, Suicidal Ideation Nursing Assessment, Suicidal Ideation Nursing Interventions, and 1 Suicidal Ideation Nursing Care Plan.

This nursing guide is about suicidal ideation, suicidal ideation nursing assessment, suicidal ideation nursing interventions, and 1 suicidal ideation nursing care plan. Use it to create educational nursing care plans for suicidal ideation.

Suicidal Ideation

What is suicidal ideation?

Suicidal Ideation, Suicidal Ideation Nursing Assessment, Suicidal Ideation Nursing Interventions, and 1 Suicidal Ideation Nursing Care Plan.
Suicidal Ideation

Suicide is a serious public health problem that is increasing exponentially in every part of the world. The majority of patients who engage in suicidal attempts have a psychiatric disorder. Mood disorders such as depression and bipolar manic-depression are by far the most prevalent psychiatric conditions linked to suicide. Whereas patients with schizophrenia or an organic brain disorder are strongly linked to a higher-than-normal chance of suicide and suicide attempts with voices that tell them to hurt themselves. Other factors that may affect the risk for suicide include mental disorders, substance misuse, psychological states, cultural, family, and social situations, and genetics.

Common suicide methods in men include asphyxiation, hanging, firearms, jumping, moving objects, sharp objects, and vehicle exhaust gas, while women tend to use a vaster variety of suicide methods than men. Common suicide methods in women include self-poisoning, exsanguination, drowning, hanging, and firearms.

The role of the nurses particular to suicide prevention or patients at risk for suicide includes both systems and patient-level interventions. At the systems level, the nurse evaluates and controls environmental safety, improves protocols, policies, and practices consistent with zero suicide, and associates in training for all milieu staff. At the patient level, the nurse assesses outcomes of all interventions, evaluates risk for suicide, monitors and manages at-risk patients, and provides suicide-specific psychotherapeutic interventions. Nurses’ hands-on patient care is vital by taking all threats or suicide attempts seriously and emphasizing a relationship alliance by developing rapport for the patient.

Suicidal Ideation Nursing Assessment

How can nurses access for suicidal ideation?

Suicidal Ideation, Suicidal Ideation Nursing Assessment, Suicidal Ideation Nursing Interventions, and 1 Suicidal Ideation Nursing Care Plan.
Suicidal Ideation Nursing Assessment

Assessment is necessary in order to identify potential problems that may have led to suicide and also name any event that may happen during nursing care.

Assessment Rationale
Talk to the patient to evaluate the potential for self-injury. Patients considering suicide may display verbal and behavioral cues about their intent to end their life.
Ask the following questions:
  • “Have you ever considered harming yourself?”
Suicide ideation is the manner of thinking about killing oneself. The patient’s risk for suicide progresses as these thoughts become more frequent.
  • “Have you ever attempted suicide?”
The patient’s status of suicide risk is distinguished if there is a history of earlier suicide attempts.
  • “Do you currently consider killing yourself?”
This allows for the person to discuss feelings and issues openly.
  • “What are your plans with regard to killing yourself?”
Citing a plan and the ability to carry it out greatly increase the risk for suicide. The more harmful the plan, the more serious the risk for suicide.
  • “Do you trust yourself to maintain control over your insights, emotions, and motives?”
Patients with suicidal thoughts may sense their authority of suicidal thoughts slipping away, or they may feel themselves surrender to a desire to end their life.
Observe for risk factors that may increase the chance of suicide attempts. It is a myth that suicide occurs without forewarning. It is also a myth that there is a typical type of suicidal person. Anyone can be a victim of suicide.
  • History of suicide attempt by oneself or within the family
This increases the risk for suicide.
  • Suicidal thoughts or statements
Most of the patients with suicide attempts give verbal cues of their plans to do so. The person may talk idealistically about release from his or her life and the resolution of problems.
  • Substance use
Alcohol and drug abuse increase the risk of suicide. The highest risk is among patients who have substance abuse problems.
  • Sleep habits
History of severe insomnia is one factor associated with suicide risk.
  • History of mood disorders
Mood disorders such as depression and bipolar manic-depression are by far the most prevalent psychiatric conditions linked to suicide.
  • Unexplained happiness or drive
This sudden behavioral modification may represent the person’s decision to carry out a suicide plan.
  • Male gender
Men die by suicide around four times more frequently than women, whereas women attempt suicide two to three times more frequently than men.
  • Giving away personal possessions
This action signifies the person’s detachment and withdrawal from life.
Determine particular stressors. Determining causative factors aids in developing appropriate coping strategies. Suicide seemed to be an acceptable solution when a person can not find any more solution to his or her problem.
Appraise all possible and beneficial coping methods. Patients with a history of ineffective coping may need new resources.
Assess the need for hospitalization and safety precautions. Patient safety is always a priority. Patients with suicidal attempts should be in a setting with direct supervision.
Assess all support resources available to the patient. Depression leads to a sense of hopelessness and the person involved may isolate himself or herself and may be unable to consider available support.
Assess decision-making and problem-solving energy. Impulsivity may be an element of mood and bipolar disorder. Patients may need supervision in decision-making until the mood has been stabilized.

 Suicidal Ideation Nursing Interventions

What are the interventions for suicide?

Suicidal Ideation, Suicidal Ideation Nursing Assessment, Suicidal Ideation Nursing Interventions, and 1 Suicidal Ideation Nursing Care Plan.
Suicidal Ideation Nursing Interventions

The following are the therapeutic nursing interventions for Risk for Suicide nursing diagnosis:

Nursing Interventions Rationale
Render close patient supervision by sustaining observation or awareness of the patient at all times. Suicide may be an impulsive act with little or no warning. Close supervision is a must.
Provide a safe environment. Weapons and pills should be removed by friends, relatives, or the nurse. Removing potentially harmful objects prevents the patient from acting or sudden self-destructive impulses.
Present opportunities for the patient to express thoughts, and feelings in a nonjudgmental environment. It is helpful for the patient to talk about suicidal thoughts and intentions to harm themselves. Expressing their thoughts and feelings may lessen their intensity. Also, they need to see that staff are open to discussion.
Create a verbal or written contract stating that the patient will not act on impulse to do self-harm. This method establishes permission to talk about the subject.
Stay with the patient more often. This approach provides the patient with a sense of security and strengthens self-worth.
Disincline the patient in making decisions during severe stress. Patients can learn to recognize mood changes that indicate problems with impulsivity or indicate a deepening depressive state.
Help the patient with problem-solving in a constructive manner. Patients can get to identify situational, interpersonal, or emotional triggers and learn to assess a problem and implement problem-solving measures before reacting.
Arrange for the client to stay with family or friends. Hospitalization is considered if there is no one is available especially if the person is highly suicidal. Relieve isolation and provide safety and comfort.
Educate the patient in the appropriate use of medications to facilitate his or her ability to cope. Drug therapy may benefit the patient endure underlying health problems such as depression.
Contact family members, arrange for individual and/ or family crisis counseling. Activate links to self-help groups. Reestablishes social ties. Diminishes a sense of isolation, and provides contact from individuals who care about the suicidal person.
Educate the patient on cognitive-behavioral self-management responses to suicidal thoughts. The patient learns to identify negative thoughts and develops positive approaches and positive thinking.
Introduce the use of self-expression methods to manage suicidal feelings. Patients are better to acknowledge and safely handle suicidal feelings by programs such as keeping journals and calling hotlines.

1 Suicidal Ideation Nursing Care Plan

Nursing Diagnosis

  • Risk For Suicide

Risk Factors

  • 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 attempts.
  • Hopelessness/helplessness.
  • 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”.

Desired Outcomes

  • 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 the 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.
Nursing Interventions Rationale
In the Community:
Arrange for the client to stay with family or friends. 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 clients 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 the client has not slept in days, a tranquilizer might be prescribed. Only a 1 to 3 day supply of medication should be given. Family members or significant others 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 a 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: 

  1. The crisis is temporary.
  2. Unbearable pain can be survived.
  3. Help is available.
  4. You are not alone.
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.
Forensic Issues:
Follow unit protocol for suicide regarding creating a safe environment (taking away potential weapons– belts, sharp objects, items, and so on). Provide a safe environment during the time the 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 the client’s behaviors (verbal and physical) and all nursing/physician actions. These might become court documents. If client checks and attention to the client’s needs or requests 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 the level of suicide potential. Protection and preservation of the client’s life at all costs during a crisis is part of medical and nursing staff’s 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 the client’s “ongoing status,” intervention taken, and by whom.
Encourage the client to talk about their feelings and problem-solving 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 clients 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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