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CHAPTER 11 ■ Suicide Prevention
Table 11–3 | C ARE PLAN FOR THE SUICIDAL PATIENT NURSING DIAGNOSIS: RISK FOR SUICIDE RELATED TO: Feelings of hopelessness and desperation OUTCOME CRITERIA NURSING INTERVENTIONS
RATIONALE
1. The risk of suicide is greatly increased if the patient has developed a plan and particularly if means are accessible for the patient to execute the plan. Suicide- specific rumination is associated with suicide attempts. 2. Patient safety is a nursing priority.
1.
Ask directly: “Have you thought about harming yourself in any way? If so, what do you plan to do? Do you have the means to carry out this plan? How strong are your intentions to die? How often do you think about suicide?”
Patient will not harm self.
2. Create a safe environment for patient. Remove all potentially harmful objects from patient’s access (sharp objects, straps, belts, ties, glass items, alcohol). Supervise closely during meals and medication administration. Perform room searches as deemed necessary. 3. Maintain close observation of patient. Depending on level of suicide precaution, provide one-to-one contact, constant visual observation, or every-15-minute checks. Place in room close to nurse’s station; do not assign to private room. Accompany to off-unit activities if attendance is indicated. May need to accompany to bathroom. 4. Maintain special care in administration of medications. 5. Make rounds at frequent, irregular intervals (especially at night, toward early morning, at change of shift, or other predictably busy times for staff).
3. Close observation is necessary to ensure that the patient does not harm self in any way. Being alert for suicidal and escape attempts facilitates being able to prevent or interrupt harmful behavior.
4. Prevents saving up to overdose or discarding. 5. Prevents the patient from saving up to overdose or discarding medication. Pre- vents staff surveillance from becoming predictable. To be aware of the patient’s location is important, especially when staff is busy and least available and observable. 6. Depression and suicidal behaviors may be viewed as anger turned inward on the self. If this anger can be verbal- ized in a nonthreatening environment, the patient may be able to eventually resolve these feelings. 1. Establishing trust and open communi- cations encourages the patient to share thoughts and feelings. 2. Development of a comprehensive col- laborative safety plan concretizes resources and management strategies. Actively engaging the patient in collab- oration on the development of a safety plan promotes ownership and invest- ment in the process.
6. Encourage patient to express honest feelings, including anger. Provide activities for appro- priate outlets for anger if needed.
1. Establish a trusting, therapeutic relationship to encourage open discussion of suicide.
Patient develops a safety plan for man- agement of suicidal thoughts and urges.
2. Collaborate with the patient to develop a safety plan that includes recognition of warning signs, coping strategies, support- ive people and places, resources and con- tact information for crisis management, and plans to restrict access to lethal means.
Continued
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