Crisis And Suicide, Mod#3 Nursing Program

Front 1

Sudden event in one's life that disturbs homeostasis; usual coping mechanisms cannot resolve the problem, personal in nature; an emotionally significant event which acts as a turning point, for better or worse, in one's life; one's perception of the magnitude of the problem as well as the immediate resources available to the indivdual = imbalanced; disorganized thinking and behavior; confusion.

Back 1

Crisis

Front 2

Does not know what to do; usual problem solving behaviors not working; seems as if there is no solution to the problem; no one can help.

Back 2

These happen during crisis.

Front 3

1.Increased anxiety in response to stressor/trauma. Attempts usual coping skills.
2.Increased anxiety due to failure of usual coping behaviors.
3. Anxiety escalates. Usually feels compelled to reach out for help.
4.The active state of crisis. Stress and anxiety continue to increase - intolerable level. Short attention span, distressed, behavior impulsive and unproductive. Feel as if "losing their mind", "going crazy", major disorganization occurs. Tension mounts to a breaking point.

Back 3

The four phases of Crisis

Front 4

Previous problem-solving experience.
Their perception of the problem.
Support systems.
Number and types of past crises.

Back 4

Factors that Influence the Outcome of a Crisis.

Front 5

1. Maturational (Anticipated, Developmental)
2. Situational (Unanticipated)
3. Adventitious (Social, Unplanned, Accidental)

Back 5

Types of Crises

Front 6

"What do you usually do to feel better?"
"Did you try it this time? If so, what happened?"
"Has anything like this ever happened before?"
"What do you think might happen now?"
"Have you thought of killing yourself or someone else?"

Back 6

Assessing Coping Skills and Usual Problem Solving Behaviors

Front 7

"What has happened to you in the past day or two that has been upsetting?"
"What was happening in your life before you started to feel this way?"
"What caused you to come for help?"
"Describe how you are feeling right now."
"How is this affecting your life?"
"How do you see this problem affecting your life in the future?"

Back 7

Assessing Perception of the Event

Front 8

"With whom do you live?"
"To whom do you talk when you feel upset?"
"Whom can you trust?"
"Who is available to you?"
"Where do you go to church, school, or other community based activity?"

Back 8

Assessing Supports

Front 9

Focus on immediate problem that precipitated the event; display acceptance and concern; encourage expression of feelings - do not probe; explain that emotions are a normal reaction, make person feel safe; avoid false reassurances; client must be actively involved in problem solving; seek help from friends, family, etc.;determine safety; active phase so distressing - cannot be tolerated, emotionally or physically, for more than 4 to 6 weeks; if crisis not resolved in 4 to 6 week timeframe:
Exhausted, physically ill, emotionally ill, violent, attempt suicide.

Back 9

Crisis Intervention

Front 10

How long can the risk for suicide persist after the crisis has abated.

Back 10

Risk for suicide can persist for 2 to 3 months after the crisis has abated.

Front 11

Self Destructive Behaviors - Sub-intentional suicide; suicidal ideation; suicidal gestures; suicidal threats; suicidal attempt; ultimate act of self destruction; a cry for help; in most cases, a crisis precedes the suicide attempt.

Back 11

Suicide

Front 12

1 million die/year - globally
10-20 million - self destructive behavior
32,000 suicide U.S. = 89/day
11th leading cause of death - 15 to 24 y/o
Females attempt more often (OD & Poisoning)
4 x's more males die by suicide.(2/3 use firearms)
Men>85 years of age have highest rate suicide.

Back 12

Incidence of Suicide

Front 13

Increased risk with family hx-2 to 8 x's higher among 1st degree relatives of those who died by suicide; Predispositions (sexual & physical abuse in childhood, recent life events, impulsive & aggressive personality traits); Biological changes - reductions in serotonergic functions & alterations in noradrenergic function in CNS.

Back 13

Genetic Factors Involved in Suicidal Behavior

Front 14

Psychological - >90% who die by suicide have a mental illness, substance abuse or both.
Mood Disorders-predominant (major depression) - hoplessness; also bipolar d/o, schizophrenia, personality d/o's, anxiety d/o's, somatoform d/o's, eating d/o's; Hx of previous suicide attempt is most significant predictor of suicide; key psychological factor is unbearable PSYCHOLOGICAL PAIN; Did not so much want to die but wanted to be free from psychological pain; loss.

Back 14

Factors Involved in Suicidal Behavior

Front 15

Key factors with those who wanted to die is hopelessness & heplessness!
Major Depression: Assess for Suicide.
Hopelessness is the worst place to be.
"Tunnel vision"
Ambivalence!

Back 15

Factors Involved in Suicidal Behavior

Front 16

Certain chronic illnesses. (no hope)
Neurological diseases.
HIV & AIDS.
Chronic pain.
Terminal illness.

Back 16

Factors Involved in Suicidal Behavior

Front 17

Types of Crises

Anticipated, Developmental

Back 17

Types of Crises

Maturational

Front 18

Types of Crises

Unanticipated

Back 18

Types of Crises

Situational

Front 19

Types of Crises

Social, Unplanned, Accidental

Back 19

Types of Crises

Adventitious

Front 20

Exhausted, physically ill, emotionally ill, violent, attempt suicide.

Back 20

Crisis unsolved for 4 to 6 weeks.

Front 21

If a nurse has worked with a patient for 4 to 6 weeks in a crisis situation and the crisis is unsolved, what should the nurse do?

Back 21

Refer the patient out.

Front 22

In assessing suicide, nurses should?

Back 22

Listen openly and nonjudgmentally, use open ended questions.

Front 23

Ask: Are you thinking of harming yourself?
Assess plan
Safety contract
Acute suicide situations are psychiatric emergencies!
Client must not be left alone.
SAFETY is #1 priority!

Back 23

Nursing Interventions for Suicide

Front 24

What has increased three-fold over the last 2 decades?

Back 24

Suicide in children.

Front 25

What is understimated?

Back 25

Suicide in children. They are many times reported as accidents.

Front 26

Children do not see death as, what?

Back 26

Irreversible.

Front 27

How do children commit suicide?

Back 27

Children commit suicide by simple but lethal means (poisoning, shooting with firearms, hanging, darting in front of moving vehicles)

Front 28

Only accidents and homicides account for more deaths than, what?

Back 28

Suicide in adolescents.

Front 29

Depression, Low self-esteem and lack of basic trust in self and others, family problems, handicap that makes adolescent "different", intrapersonal/interpersonal problems, and presence of a "suicidal model"

Back 29

Factors increasing the risk for adolescent suicide.

Front 30

Who has 2 to 3 x's higher risks than all other age groups for suicide?

Back 30

The elderly.

Front 31

Who has the highest attempt to completion ratio?

Back 31

The elderly.

Front 32

Which group choose high lethality methods?

Back 32

The elderly.

Front 33

Which group is less likely to have the physiologic strength to recover from a suicide attempt?

Back 33

The elderly.

Front 34

Serious illness, bereavement and loss, self-medicate, and change in socioeconomic status, work status, etc.?

Back 34

The elderly and suicide.

Front 35

What group gives the fewest clues of their thoughts for suicide?

Back 35

The elderly.

Front 36

Their mental illness is not due to patholigical reasons?

Back 36

A patient in crisis.

Front 37

What happens if a person does not adapt in a crisis situation?

Back 37

It becomes detrimental.

Front 38

Crisis nursing focuses on what?

Back 38

The immediate problem.

Front 39

In crisis nursing, the patient can be involved in problem solving if?

Back 39

The patient is in reality.

Front 40

The more confused a crisis patient is, the more what?

Back 40

The more the nurse must be directive.

Front 41

Natural things that occur during life, such as marriage, starting college, the birth of a child, a new job, would be what type of crisis?

Back 41

Maturational (Anticipated, Developmental)

Front 42

Death of a loved one, physical or mental illness, a traumatic or sudden event, is what type of crisis?

Back 42

Situational (Unanticipated)

Front 43

Unanticipated tragedies without warning, not a part of everyday life, acts of God, these are what type of crisis?

Back 43

Adventitious (Social, Unplanned, Accidental)

Front 44

Don't do things for the client that, what?

Back 44

That they can do for themselves.

Front 45

Crisis nursing is, what?

Back 45

Short-termed, problem focused Tx.

Front 46

In most cases, a crisis preceeds, what?

Back 46

The suicide attempt.

Front 47

Suicide is a, what?

Back 47

A cry for help.

Front 48

A suicidal patient has tried everything, is looking for help; this behavior is considered, what?

Back 48

Ambivalence

Front 49

People will frequent their doctor's office and emergeny rooms just before, what?

Back 49

Just before a suicide attempt.

Front 50

Many suicides are covered up as, what?

Back 50

Accidents.

Front 51

Always ask a potential suicide patient what question?

Back 51

Are you thinking of hurting yourself or someone else.

Front 52

In crisis situations, always assess for what?

Back 52

The possiblity for suicide.

Front 53

People who are thinking about suicide, or have attempted suicide, are experiencing what?

Back 53

Extreme anxiety.

Front 54

Who attempts suicide more frequently?

Back 54

Females.

Front 55

What crisis phase is, increased anxiety in response to stressor/trauma. Attempts usual coping skills?

Back 55

Crisis phase 1.

Front 56

What crisis phase is, increased anxiety due to failure of usual coping behaviors?

Back 56

Crisis phase 2.

Front 57

What crisis phase is, anxiety escalates. Usually feels compelled to reach out for help?

Back 57

Crisis phase 3.

Front 58

What crisis phase is, the active state of crisis. Stress and anxiety continue to increase to intolerable level. Short attention span, distressed, behavior impulsive and unproductive. Feel as if "losing their mind", "going crazy". Major disorganization occurs. Tension mounts to a breaking point?

Back 58

Crisis phase 4.

Front 59

Globally, how many die by suicide a year?

Back 59

1 million.

Front 60

Globally, how many exhibit self destructive behavior in a year?

Back 60

10-20 million.

Front 61

How many suicides in the U.S. in a year?

Back 61

>32,000.

Front 62

How many suicides in the U.S. in a day?

Back 62

89

Front 63

What rank is suicide in cause of death in people 15 to 24?

Back 63

Suicide is the 11th leading cause of death in 15 to 24.

Front 64

How many more males die by suicide than females?

Back 64

4 times more men die by suicide than females.

Front 65

What ratio of men die by firearm suicide?

Back 65

2/3

Front 66

What percentage of those who die by suicide have a mental illness, substance abuse or both?

Back 66

>90%

Front 67

What is the predominant mood disorder among suicide behavior?

Back 67

Major Depression (hopelessness)

Front 68

Bipolar d/o; schizophrenia; personality d/o's; anxiety d/o's; somatoform d/o's and eating d/o's?

Back 68

Mood disorders in suicide behavior.

Front 69

What is the most significant predictor of suicide?

Back 69

Hx of previous suicide attempt.

Front 70

What is the key psychological factor in suicide behavior?

Back 70

Unbearable psychological pain.

Front 71

What percentage of people, with a mental illness, do not die by suicide?

Back 71

95%

Front 72

In schizophrenia, it is frequently what that causes them to commit suicide?

Back 72

Inner voices.

Front 73

People with mood disorders have a higher risk for, what?

Back 73

Suicide

Front 74

There is usually a loss or a perceived loss involved in, what?

Back 74

Suicide

Front 75

Most people who have attempted suicide had seen a medical person in the?

Back 75

Last six weeks.

Front 76

The more detailed a suicidal plan?

Back 76

The higher the risk is they will complete it.