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CHAPTER 11 ■ Suicide Prevention
Table 11–3 | CARE PLAN FOR THE SUICIDAL PATIENT—cont’d
NURSING DIAGNOSIS: INEFFECTIVE COPING RELATED TO: Extreme stress, crisis, altered mental status, poorly developed coping skills, feeling trapped or hopeless, impulsivity EVIDENCED BY: Verbal cues (despondent content, “I can’t”); decreased affect; lack of initiative; suicidal ideas or attempts OUTCOME CRITERIA NURSING INTERVENTIONS RATIONALE
1. Patient’s awareness of triggers for increases in suicidal thinking, plans, and intentions promotes an understanding of situations requiring the implementa- tion of the safety plan. 2. Exploring the patient’s perception of effective coping skills promotes active engagement in the process of identify- ing and carrying out a safety plan. 3. A nonjudgmental attitude promotes open communication and collaboration. 4. This promotes the patient’s ability to develop a sense of personal control in response to suicide ideas. 5. External coping strategies, such as elic- iting support from a family member or friend, community resources, and social activities that may help the patient min- imize rumination about suicide, are all positive coping skills essential to a com- prehensive safety plan.
1. Assist the patient to identify stressors and other warning signs that are associated with thoughts and plans for suicide.
Patient identifies coping strategies and expresses commitment to incor- porate these as part of a plan to maintain per- sonal safety
2. Explore past coping skills that the patient identifies as effective
3. Maintain a nonjudgmental attitude when dis- cussing the patient’s suicide ideas, plans, and intentions. 4. Assist the patient to identify internal coping strategies for immediate response to a trig- ger event. 5. Assist the patient in identifying support sys- tems, resources, and social activities that the patient can use to support ongoing personal safety.
■■ Help the client identify areas of the life situation that are within their control and those that the client does not have the ability to control. Discuss feelings associated with these control issues. It is important for the client to feel some control over their life sit- uation in order to perceive a measure of self-worth. ■■ The physician or nurse practitioner may prescribe antidepressants for an individual who is experienc- ing suicidal depression. Initially a prescription is written for a small number of pills to minimize the risk of intentional overdose (potentially fatal con- sequences are a particular concern with tricyclic antidepressant overdose). ■■ Psychological interventions that have demon- strated effectiveness in reducing suicidal behavior include dialectical behavior therapy (DBT), cog- nitive behavior therapy, and CAMS (Jobes, 2015).
CLINICAL PEARL Be direct. Talk openly and matter-of-factly about suicide. Listen actively and encourage expression of feelings, including anger.
■■ Discuss the current crisis situation in the cli- ent’s life. Use the problem-solving approach. Offer alternatives to suicide while at the same time empathizing with the client’s pain that led to viewing suicide as an option (Jobes, 2012). An example of this kind of communication might be: “I understand how this emotional pain you’ve been experiencing led you to consider suicide, but I’d like to explore with you some alternative ways to decrease your pain and to identify some reasons for continuing to live.”
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