Identify the most prominent signs of suicide can be complex. The symptoms are hopelessness, persistent sadness, anger, agitation, and lack of interest in activities. It requires meticulous assessment and observational skills. The 10th leading cause of death in the United States, according to the Center for Disease Control & Prevention- CDC. Suicide is the act of killing yourself ( assisted or unassisted). It is mostly associated with Major Depression Disorder or other mental illnesses.
Suicide is prevalent in older men, teenagers, and young adults (15-24 years old ). The Joint Commission National Patient Safety Goal (NPSG 15.01.01) requires all psychiatric facilities and general hospitals that provide care to mental health patients to identify all patients at risk for suicide and develop a safety plan to manage those patients.
Identify The Most Prominent Signs Of Suicide
I discussed the signs of depression in previous posts, and I mentioned that its complications could lead to adverse outcomes like suicide or death. There are some warning behaviors that everyone should know to identify the most prominent signs of suicide.
Please seek medical assistance if you or someone else feel very sad or unhappy, lonely, or demonstrate a lack of interest in activities and friendships, give away valuable belongings for unexplained reasons. Some of the additional symptoms of suicide are severe agitation, irritation, anxiety, and anger.
Some of the early warning signs of suicide in teens
Involvement in substance abuse
Use of illegal drugs, risky behaviors
Lack of interest in friendships and lack of interest in social activities
Poor performance in school
Engagement in self-mutilation. ( cutting, burning)
Risk Factors Of Suicide
Family history of suicide
History of mental illness
Sudden life-changing events ( divorce, marriage, newborn, death, chronic conditions, terminal illness, financial hardship, loss of employment, trauma and more)
Management Of The Most Prominent Signs Of Suicide
As a nurse, I had the privilege to care for many patients with both passive signs of suicide ideation ( no concrete plan to commit suicide) and active signs of suicide ideation. A multidisciplinary – multi-D team approach is often more beneficial to patients with the active participation of the patients’ support systems. It takes an individual care approach to identify and manage the most prominent signs of suicide.
Nurses must assess patients with suicide ideation and engage with them as much as possible. The Columbia Suicide-Severity Rating Scale-C-SSRS is the most used form. It is also essential to identify strategies to build rapport and trust to obtain crucial data. Confabulation ( false information) is very common, and nurses should be vigilant when collecting initial information. Following data collection, nurses will collaborate with the multi-D team to discuss a safety plan and progress.
The patients are usually on 1:1 observation in a lockdown unit unless medical management is necessary. Nursing staff should monitor the patients’ environments for ligature risk and all other safety hazards. Besides, nursing staff should secure the patients’ personal belongings and remove additional items and all contrabands from the patients.
The nursing staff has to search visitors for contrabands before granting access to the nursing ward. Note that Behavioral Health providers can admit patients who express active suicide ideation for seventy-two hours to prevent self-harm in most states in the United States. Please check your state health department website for additional information. (mental illness policy)
Additional Suicide Prevention Interventions
Nursing staff should reduce stimuli and all triggers that might escalate the patients’ behaviors or moods. Furthermore, staff should encourage patients to engage in preferred activities like playing cards, mental stimulation games, crossword, writing, reading, television, music, fine motor exercises, and more.
It can be challenging to manage patients in the medical ward, but patient safety should remain a priority. Nurses should administer medication as prescribed and encourage the patients to comply with the prescribed regimen. Medications are not the 1st line of treatment in suicidal patients.
The treatment goal is to reverse or manage the triggers and risk factors when possible. If the symptoms persist, the team should consider all risk factors and revise the care plan. For instance, engage the patients and their support systems in a team meeting and management plan. The approach will promote the effective management of the most prominent signs of suicide.
Implications For Nurses
Nurses should maintain behavioral health training competency to manage patients safely. For example, nurses should complete a comprehensive initial assessment and obtain pertinent information from each patient. Furthermore, it can be time-consuming for nursing staff to build rapport and engage in therapeutic conversations with patients. Therefore, management should consider this factor when approving direct care hours.
Nursing is a valuable member of the multi-D team because of the number of direct care hours they spend with the patients in comparison with other team members. It is vital to report significant deviation in mood and behavior to the primary Provider. Besides, nurses should maintain the patients’ wellbeing, safety, and integrity.
It is also essential to monitor all activities in the patients’ room and ensure 1:1 supervision is adequate. Progressive documentation is crucial and should help guide the treatment plan. Lastly, nurses should understand that the patients must accept clinical recommendations to comply with the care plan. Compliance often promotes improvement in the most prominent signs of suicide.
Some risk factors are more challenging to manage. For instance, It can be challenging to reverse financial hardship and massive debt within a short period. However, positive coping mechanisms will enable the patients to manage mental health issues more effectively. The treatment team can recommend that the patients seek advice from a licensed financial advisor.
It is very complex to manage patients with the signs of suicide ideation. Thus, everyone should learn about early warning signs of suicide to prevent adverse patients’ outcomes. It is beneficial to adopt a multidisciplinary team approach when caring for patients with active suicide ideation.
Nursing staff often modifies the patients’ immediate environment for safety, which can be a burden on staff. Furthermore, the nursing staff supports 1:1 observation while caring for patients on the medical wards and should engage in therapeutic conversations. The patients’ treatment plan promotes person-centered care.
The ultimate goal for the patients with signs of suicide is safety with the hope of transitioning to subsequent therapy sessions or group outpatient. Besides, suicide prevention remains a challenge despite congressional support with protective legislation and funding of mental health. You can also learn about depression by accessing another article that I wrote aboutdepression
Please call the National Suicide Prevention Lifeline at 1-800-273-8255 for immediate assistance. By July 2022, 988 will become the new number to report suicidal ideation and obtain help. Do you find the article helpful? Please leave a comment, subscribe, and share!
Nurse Sophie has been a registered nurse for over a decade. I have a Master's degree in nursing, and my clinical experiences include staff nurse, clinical nurse supervisor, nurse manager, and most recently, nurse consultant in Patient Safety and legal nursing. I was always passionate about system operations and practice standards.
I have completed over 2000 hours of medical chart reviews. I am an expert in clinical investigations, and I also develop event timelines. I can assist the legal team with the Discovery process: Deposition, Interrogatories questionnaire, event timelines, locate expert witnesses, and more. I provide and formulate clinical opinions based on the investigative summary.
I also provide nurse coaching services to nurses who experience burnout and looking for a career transition. I have been there! Done that! I was overwhelmed when I as a bedside nurse and wanted to quit nursing until I changed my mindset and faced my fear of the unknown. After multiple failures, I successfully transitioned out of the direct care settings.
It was the best decision that I have ever made. Please send me a request to receive 1:1 career coaching from Nurse Sophie.
Nurse Sophie, MSN, RN, LNC
Legal Nurse Consultant
Patient Safety Specialist
Email: [email protected]