1998 Biennial Convention “Uniting Nurses: One Strong Voice” June 27, 1998 Session 003 “Suicide...
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Transcript of 1998 Biennial Convention “Uniting Nurses: One Strong Voice” June 27, 1998 Session 003 “Suicide...
1998 Biennial Convention1998 Biennial Convention“Uniting Nurses: One Strong Voice”“Uniting Nurses: One Strong Voice”
June 27, 1998 Session 003June 27, 1998 Session 003
“Suicide Prevention Strategies for
Families and Consumers”
American Psychiatric Nurses AssociationPhyllis M. Connolly PhD, RN, CSPresidenthttp://www.apna.org
OverviewOverview Quality mental health care consist of four
main elements: prevention, early detection, treatment and education. This session, including a mini teaching activity, will provide you with an increased understanding of the content, skills and methods of suicide prevention teaching for families and consumers with psychiatric disorders.
ObjectivesObjectives Discuss the statistics of suicide in persons with psychiatric
disorders. Describe the myths related to suicide. Identify the relevant theoretical frameworks which guide
the teaching of families and consumers. Examine the components and methods of teaching and the
specific content for teaching. Analyze culturally sensitive approaches to teaching
ethnically diverse families and consumers. Participate in teaching simulation exercises. Compare a family fire/disaster and emergency medical
plan with a plan for possible suicide prevention.
Suicide: 8th leading cause of Suicide: 8th leading cause of death in USdeath in US
90% associated with mental & addictive behaviors
Highest rates for elderly white males Firearms account for 60% of all suicides
across all ages Substance abuse found in most Family violence and physical & sexual abuse
increase risk
Persons with schizophreniaPersons with schizophrenia
10% -13% commit suicide
Leading cause of premature death
18% - 55% will make a suicide attempt
Depressive DisordersDepressive Disorders
Up to 15% requiring hospitalization eventually die by suicide
10% - 15% of untreated persons with bipolar I commit suicide
Risk FactorsRisk Factors
History of suicide attempts Hopelessness Physical illnesses Family history of substance abuse Caucasian race Male gender
Risk Factors ContinuedRisk Factors Continued
Advanced age Presence of psychotic symptoms Living alone Unemployment Depression Substance abuse Relapse
Having a positive supportive Having a positive supportive and helpful relationship with and helpful relationship with a mental health provider may a mental health provider may reduce the risk of suicide.reduce the risk of suicide.
Suicide MythsSuicide Myths People who think about suicide must be
crazy Talking about suicide may give a person the
idea If a person really wants to kill themselves
there is nothing you can do People who talk about suicide never follow
through
Identifying TriggersIdentifying Triggers Alcohol and/or drugs Stopping psychotropic medications Lack of sleep Increased stress: losses, changes,
interpersonal relationships Increased anxiety Reactions to prescription /over the counter
drugs Nutritional imbalances Medical conditions
Interventions: Step 1Interventions: Step 1
Check out your concerns--ask the person If the person says “YES,” stay calm--take a
deep breath Ask the person what their thoughts are like--are
they hearing voices If, Yes, get the person to a suicide or crisis
center immediately
Interventions: Step 2Interventions: Step 2
Determine if they have a plan What exactly do they intend to do How will they do it When will they do it
If the plan is lethal, concrete, specific, and available, get them to a suicide or crisis center immediately
Interventions: Step 3Interventions: Step 3
If no plan, ask about medications taken within the last 24 hours ask about any over the counter medication ask about alcohol/street drugs
Interventions: Step 4Interventions: Step 4
The person should be seen by a mental health professional as soon as possible
Call the primary therapist or case manager If unable to contact the therapist, call the
crisis help line for a referral
Suicidal gesturesSuicidal gestures
Get the person to the nearest hospital or emergency service as soon as possible
You may need to call 911 Stay calm Stay with the person, unless you have been
the targeted person who may have failed to meet the person’s expectations
Assessment at Crisis CenterAssessment at Crisis Center
Hospitalization may be needed Medications Identifying precipitating factors Assessing for medical problems Facilitating feelings of hope Facilitating sense of competency & efficacy
Someone needs to stay with Someone needs to stay with the person at all timesthe person at all times
The person is experiencing strong feelings of abandonment, loneliness, guilt and hopelessness
Adaptive Problem SolvingAdaptive Problem Solving
Assist with basics Living arrangements Food availability
Identify past coping mechanisms
Identify person(s) available in the support system
Competency & EfficacyCompetency & Efficacy
Set achievable short term goals
Encourage & give positive feedback
Family & support persons are critical in providing positive feedback
In Home SupportIn Home Support
Family can be instrumental providing basic critical components in reestablishing the person’s equilibrium.
If the person is not hospitalized they should not be left alone
Establish support system: Family, friends, church members, roommates
Psychiatric home care may be provided
Facilitating HopeFacilitating Hope
Provide a supportive climate Facilitate a hopeful perception Help the person to restructure the situation Assist the person in making plans Assist the person in taking action, and
establishing goals for living
DiscoveryDiscovery CreativityCreativity
Concept of NewnessConcept of Newness
ResourcesResources InsightInsight PlansPlans OutcomesOutcomes
Facilitating HopeFacilitating Hope
Stress ManagementStress Management
Crisis Intervention Deep breathing Self talk Time out Visualization Leaving the situation Talking to someone Music
Prevention Diet & nutrition Exercise & physical
activity Self-help groups Having fun Playing Massage Progressive relaxation Assertiveness training
Care for Support PersonCare for Support Person
Stay calm Get support for yourself Utilize formal mental health professionals or
spiritual guides Utilize the Alliance for the Mentally Ill
800- 950-6264 Once the person is stable and restored, debrief
the incident with them
You should have an You should have an emergency plan for handling emergency plan for handling a suicide gesture or ideation.a suicide gesture or ideation.
Theoretical FrameworksTheoretical Frameworks
Crisis Intervention Orem’s Self-care Knowles, Adult Learning Yalom, Group Theory Carl Rodgers, student-centered
Knowles Assumptions:Knowles Assumptions: Adult Learners Adult Learners
Desire and enact toward self-directedness as they mature
Experiences are rich resource for learning Awareness of specific learning needs
generated by real life Competency based and wish to apply
knowledge to immediate circumstances
Teaching Families & Consumers: Teaching Families & Consumers: Suicide preventionSuicide prevention
Assessing the learners including culture Identifying specific content Developing teaching objectives Developing learner outcomes Instructional planning Implementation Evaluation
Belief Systems: Health & IllnessBelief Systems: Health & IllnessMagico-Religious
Scientific/Biomedical
Holistic
Fate of worldundersupernaturalforces
Control byphysical &biochemical
Harmony,natural balance
Cause of illness,mystical
Cause/effectrelationship,pathogens
Diseaseimbalance, lawsdisturbed
Gift or reward Illnessprevention,meds, treatments
Environment,socioculturalfactors
World View
Illness/disease
Health
Ethnic group
Hispanic AmericansBlack Americans
White Americans Native AmericansAsian Americans
Teaching DesignsTeaching Designs
Learner-Development
Topic Centered
Distance Education Telecommunication
Instructional TechniquesInstructional Techniques
Discussion Lecture Role Play Questioning Skits Simulations Audiovisual CAI
Web Resources APNA & links
http:www.apna.org
Suicide Helplinehttp:www.grohol.com/helpme.htm
KENhttp:www.mentalhealth.org
NDMDAhttp://www.ndmda.org
Selected BibliographySelected Bibliography Aguilera, D. C. (1994 ). Crisis intervention: Theory
and methodology (7th ed.).St. Louis: Mosby-Year Book.
Babcock, D., & Miller, M. (1994). Client education: Theory and practice. St. Louis: MO..
Campinha-Bacote, J. (1994). Cultural competence in psychiatric mental health nursing: A conceptual model. Nursing Clinics of North America, 29(1), 1 - 9.
Cowan, C. F., & Bowie-Guillory, J. A. (1995). Teaching patients with low literacy skills In B. Fuszard, Innovative teaching strategies in nursing 2nd ed.) (pp. 231 - 241). Gaithersbrg, MD: Aspen.
Selected BibliographySelected Bibliography Depression Guideline Panel (1993). Depression in primary
care: Volume 1, Diagnosis and detection. Clinical practice guideline, Number 5. Rockville, MD. U. S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 93-0550.
Depression Guideline Panel (1993). Depression in primary care: Volume 2, Treatment of Major Depression. Clinical practice guideline, Number 5. Rockville, MD. U. S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 93-0551.
Selected BibliographySelected BibliographyFalvo, D. (1994). Effective patient education (2nd ed.).
Gaithersburg, MD: Aspen.
Hoff, L. (1995). People in crisis: Understanding and helping (4th ed.). San Francisco: Jossey-Bass Publishing.
Jack, R. (1992). Women and attempted suicide.
Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers. Knowles, M. S. (1980). The modern practice of adult education: From pedagogy to andragogy (2nd ed.). New York: Cambridge University Press.
Moller, M., & Murphy, M. (1997). The three R’s rehabilitation Program: A prevention approach for the management of relapse symptoms associated with psychiatric diagnoses. Psychiatric Rehabilitation Journal, 20(3), 42 – 48.
Selected BibliographySelected Bibliography
Palmer-Erbs, V., & Anthony, W. (1995). Incorporating psychiatric rehabilitation principles into mental health nursing. Journal of Psychosocial Nursing, 33(3), 36 – 44.
Palmer-Erbs, V., & Manos, E. (1997). New thoughts on promoting collaborative partnerships with consumers, survivors, and family members. Journal of Psychosocial Nursing, 35(1), 3-5.
Silverman, M., & Maris, R. (Eds.). (1995). Suicide prevention toward the year 2000. New York: Guilford Press.