SUICIDAL CLIENT

SUICIDAL CLIENT

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  SUICIDAL CLIENT BY:- KAJALCHANDEL
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  INDEX S.R NO CONTENT 1.INTRODUCTION OF SUICIDE 2. HISTORICAL PERSPECTIVE OF SUICIDE 3. DEFINITION OF SUICIDE 4. CONCEPTS OF SUICIDE 5. EPIDEMIOLOGICAL FACTORS 6. INCIDENCE OF SUICIDE 7. RISK FACTORS OF SUICIDE 8. PREDISPOSING FACTORS OF SUICIDE 9. MANAGEMENT OF SUICIDE 10. NURSING DIAGNOSIS OF SUICIDE 11. BASIC LEVEL INTERVENTION
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  INTRODUCTION  Suicide isone of the important psychiatric emergencies which need immediate intervention. It is one of the most common cause of death.
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  HISTORICAL PERSPECTIVE  Approximately95 percent of all person who commit or attempt to suicide have diagnosed as mental disorders. In ancient Greece suicide was an offense against the state and individual who committed suicide were denied burial in community sites. In middle ages, suicide was viewed as a selfish or criminal act. Individual who committed suicide were often denied cementary burial and their property was confiscated and shared by the crown and courts.
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  DEFINITION “ The consciousof self- induced annihilation as a multidimensional malaise in a needful individual who defines an issue for which the act is perceived as the best solution” . Edwish Shncidman, (1985)  “Ultimate act of self destruction”. Clayton, (1985) “ Aggression toward the self following the internalization of frustration or disappointment related to loved one”.
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  CONCEPTS OF SUICIDE SUICIDE: act of intentionally ending one’s own life and opting for nonexistence  SUICIDE ATTEMPT: Includes all willful, self-inflicted life- threatening attempts that have not led to death.  SUICIDE IDEATION: Person is thinking about self-harm
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  EPIDEMIOLOGICAL FACTORS Approximately 30,000persons in the United States end their lives each year by suicide.  Suicide is the  3rd leading cause of death among Americans 15 to 24 years of age  5th leading cause of death for ages 25 to 44 8th leading cause of death for ages 45 to 64
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  INCIDENCE  Worldwide suiciderate have increased by 60% in the past 50 years, mainly in the developing countries. Most suicides in the world occur in Asia, Which is estimated to the world health Organization, China, India and Japan may account for 40% of all world suicides.  Suicide rate in India was 11.2 per 100,000 in 2002. The rate vary across the country with states such as Kerala having the highest suicide rate of 30.8 per lakh in 2002.Suicide rate in Army, Air Force and Naval personal were 0.04, 0.11 and 0.12 per thousand respectively.
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  CONTINUE…… Rate are higherin urban in rural settings. Studies of completed suicides show that 90-94% of the patients are mentally ill while committing the act. Depression accounts for nearly half the number of patients committing suicide followed by alcohol abuse (34%) and Schizophrenia(13%). Highest suicide rate is in the age group of 18-30 years. The ratio of attempted suicide to completed suicide is 10:1.The highest rates of suicide in India –Pondicherry, West Bengal, Kerala, Chennai and Bangalore.
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  GENDER AND SUICIDE In the western world, males die much more often by means of suicide than do female, although females attempts suicide more often. This pattern has held for at least a century. Some medical professionals believe this stems from the fact that males are more likely to end their lives through effective violent means (guns, knives, hanging, etc.), while women primarily use more failure-prone methods such as overdosing on medications.
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  CONTINUE…. AGE AND SUICIDE Inthe USA, males over the age of seventy die by suicide more often than younger males. There is no such trend for females. It is vary from developing countries like India. Adolescence and adulthood more common in suicide.
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  SEASON AND SUICIDE Peopledie by suicide more often during spring and summer. The idea that suicide is more common during Christmas is a common misconception. There is also potential risk of suicide in some people experiencing seasonal affective disorder. Some studies have found that elderly people are more likely to commit suicide around their birthdays.
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  RISK FACTORS Marital Status The suicide rate for single persons is twice that of married persons. Gender Women attempt suicide more often, but more men succeed. Men commonly choose more lethal methods than women.
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  CONTINUE…. Age Risk of suicideincreases with age, particularly among men. White men older than 80 years are at the greatest risk of all age/gender/race groups. Religion Affiliation with a religious group decreases risk of suicide.
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  CONTINUE….. Socioeconomic status Individuals inthe very highest and lowest social classes have higher suicide rates than those in the middle class. Ethnicity Whites are at highest risk for suicide, followed by Native Americans, African Americans, Hispanic Americans, and Asian Americans.
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  OTHER…. Psychiatric illness –Mood disorders are the most common psychiatric illnesses that precede suicide. Other psychiatric disorders that account for suicidal behavior include • Substance-related disorders • Schizophrenia • Personality disorders • Anxiety disorders • Depressive disorders
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  CONTINUE…. Severe insomnia isassociated with increased risk of suicide. • Use of alcohol and barbiturates • Psychosis with command hallucinations • Affliction with a chronic painful or disabling illness • Family history of suicide other
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  CONTINUE….. Having attempted suicidepreviously increases the risk of a subsequent attempt. About half of those who ultimately commit suicide have a history of a previous attempt.  Loss of a loved one through death or separation is a risk factor. Lack of employment or increased financial burden increases the risk of suicide.
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  PREDISPOSING FACTORS: THEORIESOF SUICIDE Psychological theories  Anger turned inward  Hopelessness  Desperation and guilt  History of aggression and violence  Shame and humiliation  Developmental stressors
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  Sociological theory Durkheim’s foursocial categories of suicide  Egoistic suicide: is the response of the individual who feels separate and apart from the mainstream of society.  Altruistic suicide : opposite of egoistic suicide. Individual is prone to altruistic suicide is excessively integrated into the group.  Anomic suicide : occurs in response to changes that occurs in an individual’s life. (e.g. divorce, loss of job)
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  CONTINUE…. Fatalistic suicide :occurs when individuals are kept under tight regulation. These individuals are placed under extreme rules or high expectations are set upon them, which removes a person’s sense of self or individuality.
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  CONTINUE…. Biological theories Genetics :much higher concordance rate for monozygotic twins than for dizygotic twins. Neurochemical factors : deficiency of serotonin in depressed client who attempted suicide. Some changes in noradrenergic system.
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  SUICIDE WARNING SIGNS
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  CONTINUE….. TALK Direct statements (Iwill end my life). I can’t go on, “ Noting matters anymore,” “I wish I were dead”. Being a burden to others. Experiencing unbearable pain. Having no reason to live.
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  CONTINUE….. BEHAVIOR  Looking fora way to kill themselves.  Isolating from family and friends.  Sleeping too much or too little.  Visiting or calling people to say goodbye.
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  CONTINUE….. MOOD  Depression  Lossof interest  Irritability  Humiliation  Anxiety  Fear
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  MODE OF SUICIDE
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  MODES OF SUICIDE 1.BLEEDING WRIST CUTTING
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  CONTINUE….. 2. DROWNING
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  CONTINUE….. 3. JUMPING FROMHEIGHT
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  CONTINUE….. 4. ELECROCUTION
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  CONTINUE 5. FIREARMS
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  CONTINUE….. 6. POISON
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  CONTINUE….. 7. DRUG OVERDOSE
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  CONTINUE….. 8. HANGING
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  MANAGEMENT  MLC:(MEDICO LEGALCASE) Sec.309 of IPS, states that “ whoever attempts to commit suicide and does any act towards the commission of such offense, shall be punishable with simple imprisonment for a team which may extend to one year and shall also be liable to fine”.
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  PREVENTABLE This management liesin preventing the act. This can be done at suicide prevention centers. Crisis intervention centers, Psychiatric emergency services, medical emergency services, social welfare centers, even at home. Important steps for preventing suicide are:-  Take all suicidal threats; gestures to attempts seriously and notify a psychiatrist.  Inspect physical surrounding and remove all means of committing suicide, like sharp objects, ropes, drugs, etc.
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  CONTINUE….  Acute psychiatricemergency interview. Counseling and Guidance. Treatment of psychiatric disorder with medication of ECT. Follow up care- is very important to prevent future suicidal attempts or suicide.
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  WORLD SUICIDE PREVENTIONDAY 10 SEPTEMBER BY WHO World suicide prevention day is an opportunity for people worldwide to unite in commitment and action to ensure that suicides and prevented, that people living with mental illness receive adequate treatment, that community-based care and close follow-up are available to people who attempts suicide, that access to common methods of suicides is restricted, and that media reports of suicides are more measured. Every 40 seconds, the loss of a person who killed themselves shatters the lives of family and friends. For every person who completes a suicide, 20 or more may attempts suicide. For family and friends affected by suicides or attempted suicide, the emotional impact can last for many years.
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  CONTINUE…. World Suicide PreventionDay not only offers an opportunity to ensure that suicides are prevented , but also that people living with mental illness, in particular depression and alcohol use disorders, receive adequate treatment, that community-based care and close follow-up are available to people who attempt suicide, that access to common methods of suicides is restricted, and that media reports of suicides are more measured.
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  CHALLENGES AND OBSTACLES Worldwidethe prevention of suicide has not been adequately addressed due to basically a lack of awareness of suicide as a major problem and the taboo in many societies to discuss openly about it. In fact, only a few countries have included prevention of suicide among their priorities. Reliability of suicide certification and reporting is an issue in great need of improvement. It is clear that suicide prevention requires intervention also from outside the health sector and calls for an innovative, comprehensive multi-sectoral approach, including both health and non-health sectors, e.g. education, labour, police, justice, religion, low, politics, the media. The 2013 international theme for would suicide prevention day is stigma: A major barrier to suicide prevention.
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  ASSESSMENT The following itemsshould be considered when conducting a suicidal assessment. It include  Demographic assessment • Age • Gender • Ethnicity • Marital status • Occupation • Religion • Family history
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  CONTINUE….  Presenting symptoms/ medical –psychiatric diagnosis • What are the major physical or psychological symptoms and treat the symptoms.  Suicidal act or ideas • How serious the intent and plan, means, is the first time or second  Interpersonal support system
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   Analysis ofthe suicidal crisis likes • Precipitating events • Relevant history • Life stage issues Psychiatric/ medical/ Family history The individual should be assessed with regards previous psychiatric treatment SAD person scale is a simple, clear cut, and practical guide for gauging suicide potential. Ten categories are described in the assessment tool, and the person being evaluated is assigned on point for each applicable characteristics
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  NURSING DIAGNOSIS  Riskfor suicide related to prior suicidal attempts. Ineffective coping mechanism related to disease condition as evidenced by poor problem solving skills. Disabled family coping mechanism related to changing family environment as evidenced by poor problem solving skills.  Poor self-esteem related to depressive thoughts as evidenced by hopelessness.
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  PLANNING INTERVENTION Level of intervention Nursinginterventions for suicide takes place in three levels  Primary intervention It includes activities that provide support, information an education to prevent suicide  Secondary intervention It is the treatment of actual suicidal crisis  Tertiary intervention It refers to the intervention with the family and friends of aperson who committed suicide to reduce the traumatic after effects.
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  NURSING INTERVENTION 1. Riskfor suicide related to prior suicidal attempts. Intervention:- ◦ Closely supervise the patient by sustaining observation or awareness of the patient at all times. ◦ Provide a safe environment to the patient. ◦ Give opportunities to the patient to express thoughts, and feelings in a nonjudgmental environment. ◦ Stay with the patient more often.
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  CONTINUE….. 2. Ineffective copingmechanism related to disease condition as evidenced by poor problem solving skills. Intervention:- ◦ Assist patient set realistic goals and identify personal skills and knowledge. ◦ Provide chances to express concerns, fears, feeling, and expectations. ◦ Use empathetic communication. ◦ Encourage the patient to recognize his or her strengths and abilities.
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  CONTINUE….. 3. Disabled familycoping mechanism related to changing family environment as evidenced by poor problem solving skills. Intervention:- ◦ To assess the causative and contributing factors: ascertain preillness behavior/ interaction of the family ◦ Established rapport with family members who are available and promotes therapeutic relationship and support for problem solving solutions. ◦ Allow free expression of feelings, including frustration, anger, hostility and hopelessness. ◦ Provide time for private interaction between client/family.
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  CONTINUE….. 4. Poor self-esteemrelated to depressive thoughts as evidenced by hopelessness. Intervention:- ◦ Develop a trust relationship with patient. ◦ Encourage the patient to participate in self-care activities. ◦ Enhance sense of self by being attentive through - Listening - Validating your interpretation of what is being said or experienced. - Helping the patient verbalize what he/she is experiencing non- verbally.
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  BASIC LEVEL INTERVENTION In the hospital or community setting the basic level registered nurse utilizes counseling, health teaching, case management, and psychobiological interventions.
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  MILIEU THERAPY WITHSUICIDAL PRECAUTIONS  In accordance with the unit policies and procedures, client in continuously observed by nursing staff. Monitoring flow sheets for suicide precautions are more clinically useful if they include a description of affect as well as behavior. Nurse should monitor the environment for safety hazards.
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  COUNSELLING  Counselling skillincluding interviewing, crisis care, and problem solving techniques are used in both the inpatient and outpatient setting.  The key element is establishing a working alliance to encourage the client to engage in more realistic problem solving. One particular aspect of counselling. One particular aspect of counselling is the use of no-suicidal contract.
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  HEALTH TEACHING  Thenurse teaches the client about any psychiatric diagnosis present and about medications, age related crisis, community resources, coping skills and communication skills especially the expansion of anger.
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  CASE MANAGEMENT  Casemanagement is an important aspect of nursing care of suicidal client. The clients perception of being alone without support after blinds the person to the real support figure who are present.
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  PSYCHOBIOLOGICAL INTERVENTIONS  Asignificant nursing intervention to assist the suicidal client in regaining self control is the careful administration of medication. All medication should give to high risk clients are monitored carefully.
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  EVALUATION  Evaluation ofsuicidal clients is an ongoing part of assessment. The nurse must be constantly alert to the changes in the suicidal patients mood, thinking, and behavior. In evaluation the nurse also look for indications that the client is communicating thoughts and feelings more readily and that the clients social network is widening.
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  SUMMARIZATION Suicide is thetaking of one's own life. It is a death that happens when someone harms themselves because they want to end their life. A suicide attempt is when someone harms themselves to try to end their life, but they do not die. Suicide is a major public health problem and a leading cause of death. The effects of suicide go beyond the person who acts to take his or her life. It can also have a lasting effect on family, friends, and communities.
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  CONCLUSION Youth suicide constitutesa major public mental health problem. Young people and especially adolescents are by nature a vulnerable group for mental health problems. While suicide is relatively rare in children, its prevalence increases significantly throughout adolescence.
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  BIBLIOGRAPHY BOOK REFRENCES  RajBhaskara Elakkuvana D., Debr’s Mental Health (Psychiatric Nursing), EMMESS, edition 2, Pp- 315-322. INTERNET REFRENCES  https://pt.slideshare.net. Net. Suicidal client (viewed on March 5, 2022).  https://www.Wikipedia.com-suicide (viewed on March 10,2022).