Archive for the ‘Suicide’ Category

SUICIDE AN EPIDEMIC

August 2, 2010

On any given week at the hospital that I am employed by there are a number of clients on suicide watch. Many of these clients are also drug abusers, a very small minority have actually attempted suicide.
What brings so many to the hospital is the fact that everyone has to be taken seriously when they say they want to kill themselves. Whether it is the first or twentieth time they have said this.
Recently we had a young drug user hospitalized for stating she wanted to die, she had been cleared by the psychologist and was ready for discharge, when she found out she was not going to be discharged to the facility for rehab she had wanted, and was not going to be given the medication she had wanted once discharged she began crying and said she would jump off the roof. Once again she was given a 1:1 sitter to keep watch on her and the psychologist was re-consulted.
All patients whether we believe they are serious or using suicide as a manipulation, follow the same policy and procedure to assure the safety of those who may want to actually harm themselves. Even though this may be frustrating for all involved it is something that needs to be, if even just for that one client who may truly be in need.

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Suicide versus Hospice Care, comment

April 21, 2010

Many patients receive the diagnosis of cancer as a death sentence, even though advances in cancer therapy are occurring almost daily. Cancer is a disease that is non-selective in its victims, striking all ages, all nationalities and all socioeconomic areas. When a patient receives a diagnosis of cancer, it causes him to face his mortality – and often brings regrets of previous life choices. What can we as nurses do to help our patients receive a cancer diagnosis with hope and courage, rather than doom? First, we can teach; prior to diagnosis, each patient in our care should receive teaching on preventive measures to reduce cancer risk – diet, exercise, smoking cessation, screenings, etc. Second, when the physician tells the patient he has cancer, we can reinforce and teach on the interventions recommended by the doctor. This would include encouraging the patient to express his fears and concerns, and through patient teaching helping to reduce them. If the physician recommends surgery (tumor excision, debulking or palliative) we must address the concerns of anesthesia and pain management, both typical areas of patient fear. If chemotherapy is recommended, sometimes the fear might be as basic as alopecia or nausea and vomiting secondary to chemotherapy. We can assist the patient in choosing a hair piece prior to hair loss, and explain the regimen of combination antiemetics (i.e. aprepitant, dexamethesome and ondansetron) prior to the start of chemotherapy. When the patient is admitted to the hospital for chemotherapy, we must administer medications on the exact time schedule ordered by the physician, especially important in cytotoxic agents which act in a specific phase in the cell cycle. Cancer therapy can be extremely complicated, and nurses must teach the basics in terms that are both understandable and gentle, by choosing our words carefully. Thirdly, we must teach on the decision to treat (or not treat). Most patients perceive chemotherapy as highly toxic and damaging, and fear what it might do to normal cells. The patient must be given an idea of projected benefits versus risks – i.e. cure, palliation or extending a life that’s functional though not cancer free. If they are diagnosed with a highly responsive cancer, we must encourage them to treat, but the ultimate decision is theirs. If the patient decides against treatment, and Hospice is recommended, we must teach about Hospice care and approaching death with dignity. Most Hospice agencies have printed literature outlining pain management and services offered by Hospice (counseling, social services, pastoral care, etc.) for both the patient and the family. With a cancer diagnosis, comes the stages of grief. Nurses have a great responsibility to help the patient move through the stages of grief to acceptance,in a way that is empathic and supportive, but never encourages the option of suicide.

Original Post
April 10, 2010
Title: Suicide versus Hospice Care
What does it say for us as health care providers when a patient who receives a diagnosis of cancer commits suicide? The thought of enduring treatments without cure, suffering physical pain and medication side effects, not to mention facing one’s own mortality, can sometimes push even an individual over the edge. I have to wonder whether we are truly meeting the needs of our patients when I hear that someone has committed suicide because they couldn’t deal with the thought of dying a difficult death. And why does any death need to be "difficult"? It is sad that people perceive hospice as "The Grim Reaper coming through the door with a sickle and shroud to kill you with their morphine". Sadly, this perception is not limited to patients. Medical professionals are in serious need of education about end of life care and pain management and symptom management for a family to hear "you have to give up everything in order to be eligible for hospice" or "hospice means you’re dying" from a medical professional feeds the fears and stigma associated with the very term. Suicide should never be a mechanism in which to manage a life limiting illness. Should people choose to hear, they would learn that hospice can provide them excellent symptom management, allow for life closure, and place their needs at the center of care. Death can be peaceful, serene, and dignified. It is only difficult when fueled by ignorance.

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Suicide versus Hospice Care

April 2, 2010

What does it say for us as health care providers when a patient who receives a diagnosis of cancer commits suicide? The thought of enduring treatments without cure, suffering physical pain and medication side effects, not to mention facing one’s own mortality, can sometimes push even an individual over the edge. I have to wonder whether we are truly meeting the needs of our patients when I hear that someone has committed suicide because they couldn’t deal with the thought of dying a difficult death. And why does any death need to be "difficult"? It is sad that people perceive hospice as "The Grim Reaper coming through the door with a sickle and shroud to kill you with their morphine". Sadly, this perception is not limited to patients. Medical professionals are in serious need of education about end of life care and pain management and symptom management for a family to hear "you have to give up everything in order to be eligible for hospice" or "hospice means you’re dying" from a medical professional feeds the fears and stigma associated with the very term. Suicide should never be a mechanism in which to manage a life limiting illness. Should people choose to hear, they would learn that hospice can provide them excellent symptom management, allow for life closure, and place their needs at the center of care. Death can be peaceful, serene, and dignified. It is only difficult when fueled by ignorance.

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Suicide, comment

January 11, 2010

Over 90 percent of the people who die by suicide have a mental illness at the time of their death. Examples of the mental illnesses include depression, schizophrenia, and bipolar disorder. Unfortunately, most of these mental illnesses are undiagnosed. Untreated depression is the number one mental illness associated with suicide. Also, people with genetic disposition to depression may manifest no signs or symptoms of depression, but may still commit suicide. The question, tragically, is why were these illnesses undiagnosed? Where were the comprehensive health assessments? We are taught our first semester in nursing school to always obtain a comprehensive assessment at the client’s initial visit. This includes a family history, personal history, and social history. The family history section identifies illnesses of genetic, familial, or environmental nature that may affect the client’s current or future health. History of mental illness is one of the questions in this assessment. The personal history section asks the client for a general statement of feelings about themselves, and the family and social section asks about general satisfaction with interpersonal relationships, including significant others, other people in the house hold, etc. Questions are asked about diet and nutrition and changes in eating habits. Mental health questions are asked to assess stress, depression, irritability, etc. As an adult, I have no recollection of ever answering questions of these types for any doctor/clinic/medical facility I have visited.  If a comprehensive health history had been correctly administered to the over 90 percent, would they have remained alive? We as healthcare providers need to remember that the information we are taught in classroom settings is not intended for regurgitation on an exam. It is designed to be a tool in increasing the wellness of our clients – even to the point of saving their lives.

Original Post
July 14, 2009
Title: Suicide, comment
Suicide is known to be associated with mental disorder. It may be in form of major depression or some sudden trigger which causes an individual to act irrationally. The ideation of suicide can be very subtle especially when nurses do not detect the signs. some patients are very crafty and may disguise very professionally as well. So the duty is on the nurses to pry deeply on the patients when assessing life stressors which may likely make patients to contemplate suicide. Often, known patients with mental illnesses are protected by HIPPA except cases that are already committed to psychiatric settings. For adolescents, they often display their emotions which helps nurses to quickly act on the information observed or stated but when it becomes a case of prolonged ideation for which the patient has had a means and time to do the act then nurses must still be vigilant. One cannot overemphasis the pivotal importance of detailed assessment and constant reevaluation of any event or attitude which may suggest that a patient is in danger of committing suicide. Once at a psychiatric hospital, a room mate committed suicide suddenly. Nurses were surprised because the patient most have acted within the spur of the moment while disguising the traits associated with suicide ideation. Quality and risk analysis in hospital settings are still open to these investigations. Nurses can also use support groups as well.

Original Post:
June 5, 2009
Title: Suicide
Suicidal ideation is more common than completed suicide. Most persons who commit suicide have a psychiatric disorder at the time of death. Because many clients with psychiatric disorders are seen by family physicians and other primary care practitioners rather than by psychiatrists, it is important that these practitioners recognize the signs and symptoms of the psychiatric disorders (particularly alcohol abuse and major depression) that are associated with suicide. Although most patients with suicidal ideation do not ultimately commit suicide, the extent of suicidal ideation must be determined, including the presence of a suicide plan and the patient’s means to commit suicide.
Many clients who commit suicide have seen their primary care physician within several months before their death and many of these physicians were unaware of the clients’ intentions or that the clients had previously attempted suicide.
The best way to prevent suicide is to ask clients with symptoms of these disorders more specific questions about recent stressors and their thoughts about suicide, excellent history taking is essential to help diagnose clients with suicidal ideation. Reviewing the clients medical history for chronic illness, obtain a drug history and ask the client about family…listen for clues!

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Suicide, comment

December 24, 2009

Suicide is a very serious issue which needs to be treated with great precaution when the possibility of suicide is suspected. Around the time of the holidays suicide rates often rise. This is typically attributed to the stress many people feel around this time of year. My younger sister’s best friend’s father committed suicide last month and greatly affected my family personally. The girl’s father had been diagnosed with bipolar disorder and was being treated with medication but had recently been laid off from his job and ceased his medication treatment and ultimately committed suicide leaving three children and a wife behind. When I heard this news it struck me as extremely sad, as any suicide does. However this seemed even more upsetting to me because it was known that the man suffered from a mental disorder which was being treated. It brought to my attention how crucial it is that people have a strong support system they can turn to at all times, especially those who are treated for mental illness. It is important for signs of suicide to be taken with the utmost seriousness. Bipolar disorder is a chemical imbalance in the brain and may be caused by varying function of the structure and function of certain brain circuits. Bipolar disorder is highly associated with suicide and it is important to look for signs of depression or suicide so as to help the person as soon as possible.

Original Post
July 15, 2009
Title: Suicide, comment
Suicide is known to be associated with mental disorder. It may be in form of major depression or some sudden trigger which causes an individual to act irrationally. The ideation of suicide can be very subtle especially when nurses do not detect the signs. some patients are very crafty and may disguise very professionally as well. So the duty is on the nurses to pry deeply on the patients when assessing life stresssors which may likely make patients to contemplate suicide. Often, known patients with mental illnesses are protected by HIPPA except cases that are already committed to psychiatric settings. For adolescents, they often display their emotions which helps nurses to quickly act on the information observed or stated but when it becomes a case of prolonged ideation for which the patient has had a means and time to do the act then nurses must still be vigilant. One cannot overemphasis the pivotal importance of detailed assessment and constant reevaluation of any event or attitude which may suggest that a patient is in danger of committing suicide. Once at a psychiatric hospital, a room mate committed suicide suddenly. Nurses were surprised because the patient most have acted within the spur of the moment while disguising the traits associated with suicide ideation. Quality and risk analysis in hospital settings are still open to these investigations. Nurses can also use support groups as well.

Original Post:
June 5, 2009
Title: Suicide
Suicidal ideation is more common than completed suicide. Most persons who commit suicide have a psychiatric disorder at the time of death. Because many clients with psychiatric disorders are seen by family physicians and other primary care practitioners rather than by psychiatrists, it is important that these practitioners recognize the signs and symptoms of the psychiatric disorders (particularly alcohol abuse and major depression) that are associated with suicide. Although most patients with suicidal ideation do not ultimately commit suicide, the extent of suicidal ideation must be determined, including the presence of a suicide plan and the patient’s means to commit suicide.
Many clients who commit suicide have seen their primary care physician within several months before their death and many of these physicians were unaware of the clients’ intentions or that the clients had previously attempted suicide.
The best way to prevent suicide is to ask clients with symptoms of these disorders more specific questions about recent stressors and their thoughts about suicide, excellent history taking is essential to help diagnose clients with suicidal ideation. Reviewing the clients medical history for chronic illness, obtain a drug history and ask the client about family…listen for clues!

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Psychiatric Nursing And Self-Injurious Behavior

December 16, 2009

In the forensic psychiatric setting, patients who express feelings of suicide are put on a one to one staff to patient observation, also known as suicide watch. It is my opinion that patients who exhibit “self injurious” behavior should not be placed on this same continuous one to one staff to patient observation. A distinction between suicidal behavior and self-injurious behavior must be made. Self-injurious behavior can be defined as deliberate, direct injury to one self that causes tissue damage (www.selfinjury.org). Unlike suicide, it is not an attempt to cause death. Self-injurious behavior includes acts such as cutting, pinching, burning, scalding, scratching, inserting objects into body cavities, and breaking one’s own bones etc. It is usually an attempt to deal with an emotionally overwhelming or distressing situation that the patient cannot deal with in any other manner. Other reasons given by patients for self-injurious behavior are: distraction from emotional pain, calming intense feelings, self-punishment, expression of feelings that they can’t put into words (www.selfinjury.org). Common myths about self-injurious behavior are: it is a failed suicide attempt, it is a psychotic act, it’s an attempt to get attention, and it’s an attempt to manipulate (www.selfinjury.org). The self-injurious behavior serves a function for each patient. A patient that I worked with for several years stated that his anxiety from his childhood sexual molestation would build and build for days or weeks. The only way he could alleviate the anxiety was by cutting. He tried not to cut but could find no other way to stop the guilt, anxiety, and emotional pain. The function that the cutting served was as a coping mechanism. If he had placed on suicide watch, he would have been unable to cut and would have not been able to deal with his anxiety. The literature states that individuals have actually attempted suicide when they were unable to perform their self-injurious behavior. It is up to the psychiatric nurse and the interdisciplinary team members to figure out what function the self-injurious behavior serves for the patient and help him learn alternate ways and skills to get those needs met.

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Attorney Lawyer handling involuntary commitment for suicide and self-injury

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Sucide, comment

July 16, 2009

Suicide is known to be associated with mental disorder. It may be in form of major depression or some sudden trigger which causes an individual to act irrationally. The ideation of suicide can be very subtle especially when nurses do not detect the signs. some patients are very crafty and may disguise very professionally as well. So the duty is on the nurses to pry deeply on the patients when assessing life stresssors which may likely make patients to contemplate suicide. Often, known patients with mental illnesses are protected by HIPPA except cases that are already committed to psychiatric settings. For adolescents, they often display their emotions which helps nurses to quickly act on the information observed or stated but when it becomes a case of prolonged ideation for which the patient has had a means and time to do the act then nurses must still be vigilant. One cannot overemphasis the pivotal importance of detailed assessment and constant reevaluation of any event or attitude which may suggest that a patient is in danger of committing suicide. Once at a psychiatric hospital, a room mate committed suicide suddenly. Nurses were surprised because the patient most have acted within the spur of the moment while disguising the traits associated with suicide ideation. Quality and risk analysis in hospital settings are still open to these investigations. Nurses can also use support groups as well.

Original Post:
June 5, 2009
Title: Suicide
Suicidal ideation is more common than completed suicide. Most persons who commit suicide have a psychiatric disorder at the time of death. Because many clients with psychiatric disorders are seen by family physicians and other primary care practitioners rather than by psychiatrists, it is important that these practitioners recognize the signs and symptoms of the psychiatric disorders (particularly alcohol abuse and major depression) that are associated with suicide. Although most patients with suicidal ideation do not ultimately commit suicide, the extent of suicidal ideation must be determined, including the presence of a suicide plan and the patient’s means to commit suicide.
Many clients who commit suicide have seen their primary care physician within several months before their death and many of these physicians were unaware of the clients’ intentions or that the clients had previously attempted suicide.
The best way to prevent suicide is to ask clients with symptoms of these disorders more specific questions about recent stressors and their thoughts about suicide, excellent history taking is essential to help diagnose clients with suicidal ideation. Reviewing the clients medical history for chronic illness, obtain a drug history and ask the client about family…listen for clues!

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Suicide Risk Assessment, comment

July 16, 2009

It’s a great relief to comment on this topic because it is one of the reasons why nurses should be well rounded. One of the most important skills to develop is sound assessment technique. Unbiased attitude on the nurse’s side so that patients will open up and give vital information which could help save a sentinel event from happening. Last year, my workplace lost an elder patient due to inability to see in between. The patient was depressed and was treated for just his physical diagnosis, and not detecting his emotional state. When he got discharged, patient went home and hanged himself.Very sad and such should not have been the case. l support the concept of prying into the patient’s life to ascertain areas which may need further investigation. For instance, as nurses taking assessment, we ask if patients take street drugs like cocaine, heroin and the likes. sometimes patients tell nurses out right that they have major issues like loosing their houses to foreclosure. This should trigger closer look into the patients demeanor to see if she or he is deeply affected. Some may mask their emotional state initially and then open up as they build trust with their nurses. We are responsible for these group of individuals who depend on us to model ways to handle life stressor at least as their advocates. There are always methods of gathering such information when nurses take them seriously. With the state of the our nations economy, more people will be getting depressed and suicide may be on the increase. Nurses please beware.

Original Post:
July 13, 2009
Title: Suicide Risk Assessment in Nursing Practice, comment
Nurses should not find themselves in uncomfortable positions when they reach the psychiatric section of an intake assessment. We must remember that medicine is holistic. The mental health of our patients is just as important as their physical health. If the patient is on psychiatric medications, we need to know that. We must know what the medications are, their doses, and their actions. If a person states that they have “chronic back pain”, this should not be any worse for an RN to hear than “I am chronically depressed”. Since depression can lead to suicidal thoughts, it should only be natural that the RN asks the patient if they have ever thought about suicide. It is of utmost importance to treat the entire person.

Original Post:
May 26, 2009
Title: Suicide Risk Assessment in Nursing Practice
I wanted to briefly address the need to emphasize suicide risk assessment in the acute care setting. I see in this inpatient setting a hesitancy by many nurses to assess patients for suicide risk. As acute care nurses, we often overlook the psychiatric components to our patients health and as a result, do not give the care often needed by our patient population. As psychiatric illness can play the role of contributing factor in some physical illness, I do see it as necessary to not forget this aspect of our nursing assessment, especially on patient admission. We are often afraid of offending or creating an awkward introduction to our patient/ nurse relationship, however I do see this as an obstacle that we, as nurses need to overcome to provide adequate care to our patients. The more open we are in addressing psychiatric needs, such as suicide risk or other chronic psych illnesses, the better trust we will build with our patients.

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Suicide Risk Assessment in Nursing Practice, comment

July 14, 2009

I recently was invited to help create a suicide risk screening form for our busy ER. With the help of our Psyche Nurse Clinician and Nurse Manager, we came up with a form that consists of several "observations" as well as questions to ask the patient. Their responses dictate a score and the score dictates the severity. Since the creation of the form, nurses are having difficulty assessing for this risk because they are uncomfortable and feel the questions are intrusive. A good interviewer will find a way to incorporate the questions into the interview. We have counseled several nurses regarding the interview process, having to work closely with them to find that level of comfort and professionalism that "allows" other nurses to comfortably ask questions. Some other barriers are nurses perceptions to mental illness. Some nurse believe that ALL psyche patients will lie or try to cover the truth, when in fact if you treat the psyche patient like they have an acute illness or a chronic illness, they are more likely to open up. Nurses should not be afraid to ask about diagnoses or medications. I have actually had one patient respond to this question: "Sir, what do you take this medicine for?" His response: "I take it so I don’t do what the voices tell me to do." Of course I was taken aback at first, but allowed my professionalism to rise up and move right on to the next question in my interview. He was very matter-of-fact about his mental illness and actually seemed at ease in speaking with someone without feeling judged. Embracing mental illness like heart disease and lung disease will only help the nurse in the care of this patient population.

Original Post:
July 13, 2009
Suicide Risk Assessment in Nursing Practice, comment
Nurses should not find themselves in uncomfortable positions when they reach the psychiatric section of an intake assessment. We must remember that medicine is holistic. The mental health of our patients is just as important as their physical health. If the patient is on psychiatric medications, we need to know that. We must know what the medications are, their doses, and their actions. If a person states that they have “chronic back pain”, this should not be any worse for an RN to hear than “I am chronically depressed”. Since depression can lead to suicidal thoughts, it should only be natural that the RN asks the patient if they have ever thought about suicide. It is of utmost importance to treat the entire person.

Original Post:
May 26, 2009
Title: Suicide Risk Assessment in Nursing Practice
I wanted to briefly address the need to emphasize suicide risk assessment in the acute care setting. I see in this inpatient setting a hesitancy by many nurses to assess patients for suicide risk. As acute care nurses, we often overlook the psychiatric components to our patients health and as a result, do not give the care often needed by our patient population. As psychiatric illness can play the role of contributing factor in some physical illness, I do see it as necessary to not forget this aspect of our nursing assessment, especially on patient admission. We are often afraid of offending or creating an awkward introduction to our patient/ nurse relationship, however I do see this as an obstacle that we, as nurses need to overcome to provide adequate care to our patients. The more open we are in addressing psychiatric needs, such as suicide risk or other chronic psych illnesses, the better trust we will build with our patients.

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Suicide Risk Assessment in Nursing Practice, comment

July 13, 2009

Nurses should not find themselves in uncomfortable positions when they reach the psychiatric section of an intake assessment. We must remember that medicine is holistic. The mental health of our patients is just as important as their physical health. If the patient is on psychiatric medications, we need to know that. We must know what the medications are, their doses, and their actions. If a person states that they have “chronic back pain”, this should not be any worse for an RN to hear than “I am chronically depressed”. Since depression can lead to suicidal thoughts, it should only be natural that the RN asks the patient if they have ever thought about suicide. It is of utmost importance to treat the entire person.

Original Post:
May 26, 2009
Title: Suicide Risk Assessment in Nursing Practice
I wanted to briefly address the need to emphasize suicide risk assessment in the acute care setting. I see in this inpatient setting a hesitancy by many nurses to assess patients for suicide risk. As acute care nurses, we often overlook the psychiatric components to our patients health and as a result, do not give the care often needed by our patient population. As psychiatric illness can play the role of contributing factor in some physical illness, I do see it as necessary to not forget this aspect of our nursing assessment, especially on patient admission. We are often afraid of offending or creating an awkward introduction to our patient/ nurse relationship, however I do see this as an obstacle that we, as nurses need to overcome to provide adequate care to our patients. The more open we are in addressing psychiatric needs, such as suicide risk or other chronic psych illnesses, the better trust we will build with our patients.

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