Anger turned inward: anger that was previously directed at someone else is turned inward.
Hopelessness, depression, and guilt: desperate feelings of the client.
A history of aggression and violence: rage and violent behavior is correlated with suicides.
Shame and humiliation: suicide viewed as a “saying face” or saving the family name following a suicidal defeat.
Developmental stressors: certain stressors at developmental stages have been identified as precipitating factors to suicide.
Generic tendency: Twin studies have indicated a predisposition toward suicidal behavior.
Neurochemical factors: Postmortem studies have revealed a decreased serotonin level in the brainstem and spinal fluid.
Signs and Symptoms
Unexplained decrease in daily functioning
Isolation and withdrawal, decreased social interaction
Channeling of anger and hostility towards self
Inability to discuss the future
Destructive coping mechanisms
Express anger toward self
Previous suicide attempts
Anxious and apprehensive
Non-verbal cues such as giving away possessions
Suicidal Assessment: Question to ask the client to assess how realistic the client’s plan is.
Do you have thoughts of harming or killing yourself?
Do you have a plan to harm or kill yourself?
What is the plan?
Is it possible to implement the plan?
When do you plan to do it?
A person is considered at a high-risk for suicide if the plan could be carried out within 24-48 hours. Other issues in determining risk include the lethality of the method and the plan of discovery after death.
High risk for violence, self-directed or directed at others
Risk for self mutilation
Ineffective individual coping
Ineffective family coping
Therapeutic Nursing Management
Establish a therapeutic relationship
Talk directly with the client about suicide and plans
Communicate the potential for suicide to team members and family
Stay with the client
Accept the person. Listen to the person.
Secure a “no suicide/harm” contract
Give the person a message of hope based on reality
When client is able, encourage gradual increase in activities
Maintain suicide precautions, be particularly concerned with personal items the client may used to harm self, remove all dangerous and potentially dangerous items (belts, glass, sharps).