Suicide is the 10th leading cause of death in the United States, according to the Center for Disease Control & Prevention. Some of the signs of suicide that everyone should know about are hopelessness, persistent sadness, anger, agitation, and lack of interest in activities. 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 Signs Of Suicide
I discussed the signs of depression in previous posts, and I mentioned that its complications can lead to adverse outcomes like suicide or death. There are some warning signs that everyone can identify early to prevent 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 Additional signs of suicide are severe agitation, irritation, anxiety, and anger.
Some of the prominent 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)
Clinical Management Of The 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 execute ideation) and active signs of suicide ideation. A multidisciplinary – multi-D team approach is often more beneficial to patients with the active participation of patients’ support systems.
Nurses must assess patients with suicide ideation and engage with them as much as possible. It is also essential to identify strategies to build rapport and trust to obtain essential 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.
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 patients’ personal belongings and remove additional items from patients.
Nursing staff should search visitors for contraband 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. Please check your state health department website for additional information. (mental illness policy)
Managing The Signs Of Suicide
Nursing staff should reduce stimuli and any 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, writing, reading, television, music, fine motor exercises, and more.
It can be challenging to manage patients in the medical ward, but 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 triggers and risk factors when possible. If symptoms persist, the team should consider all risk factors and revise the care plan. For instance, engage the patients and support systems in a team meeting and management plan.
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 spent with patients compared to other team members. It is vital to report significant deviation in mood and behavior to the primary Provider. 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 plans. Lastly, nurses should understand that the patients must accept clinical recommendations to comply with the care plan.
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 patients to manage mental health issues more effectively.
It is very complex to manage patients with the signs of suicide ideation. 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. Nursing staff also 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 or group outpatient. Suicide remains a challenge despite congressional support with protective legislation and funding of mental health. You can also learn about depression by accessing depression in women
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, and 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.
Nurse Sophie, MSN, RN, LNC
Legal Nurse Consultant
Patient Safety Specialist
Email: [email protected]