Nursing Care Plan for Suicidal Behavior Disorder

Pathophysiology

Suicidal Behavior Disorder describes a client who has attempted suicide in the past two years and includes unsuccessful attempts and completed suicides. Nonsuicidal self-injury is when a client inflicts self-injury without the intention to result in death and may also be considered as a precursor to suicidal behavior. While suicide is not a mental illness of itself, it usually stems from another, underlying condition such as depression, bipolar disorder, PTSD or schizophrenia. Studies indicate that clients who typically have completed suicides are primarily men, as men tend to choose more lethal forms of injury (gun, jumping from heights, etc.) and women use less lethal methods such as drug overdose. All suicide threats or attempts should be taken seriously for all people, regardless of age or gender.

Etiology

Diagnostic Criteria:

Current disorder:  the most recent suicide attempt has been within the past 24 months
Disorder in remission:  the most recent suicide attempt was longer than 24 months ago

  • The individual has attempted suicide in the past two years
  • Criteria for “non-suicidal self-injurious behavior” was not met prior to previous suicide attempts
  • The diagnosis does not apply to a person’s preparation for a suicide attempt, or suicidal ideation
  • The suicide attempt was not done during an altered mental state (delirium, confusion, substance use)
  • The attempted suicide was not motivated by religious or political ideas

Desired Outcome

Client will not attempt suicide. Client will remain safe, without self-inflicted harm.  Client will identify alternative activities or support systems to prevent future suicide attempts.

Suicidal Behavior Disorder Nursing Care Plan

Subjective Data:

  • Excessive sadness
  • Sudden calmness following a deep sadness
  • Feelings of hopelessness
  • Changes in personality
  • Sleep difficulty
  • Moodiness
  • Verbal or written threat of suicide
  • Family history of suicide
  • History of substance abuse

Objective Data:

  • Withdrawal from society
  • Self-harmful behavior
  • Recent trauma or crisis
  • Giving away personal possessions
  • Purchase of firearm or poisonous substance
  • Recent release from prison or psychiatric institution
  • Changes in personal appearance (lack of hygiene)
  • High-risk behaviors

Nursing Interventions and Rationales

  1. Perform neurological assessment

  2. Determine baseline and if there are other neurological conditions present that may cause symptoms.

  3. Initiate one-on-one monitoring at arm’s length per facility protocol. Avoid leaving client unattended for any reason (including and especially bathroom or shower time)

  4. Ensure client safety and remove opportunity to harm self.

    Follow your facility’s specific protocol regarding supervision, restraint, and documentation.

  5. Create a safe environment by removing potential weapons or objects that may inflict harm (weapons, utensils, sharp objects, belts, ties, etc.)

  6. Provide safety and remove items that may be used impulsively during actively suicidal phase.

    When possible, remove monitor cables and electrical cables that are not being actively used.

  7. Encourage client to discuss feelings, emotions, fears and anxieties and alternative ways to cope with those feelings

  8. To determine the cause, if any, of client’s actions or thought processes.

    Helps client gain a sense of control over actions and life in general

  9. Emphasize resiliency with client to understand that

    • The crisis is temporary, but their actions are permanent
    • Help is available
    • Pain can be overcome
  10. Help clients see that there are other ways of dealing with circumstances and give them perspective and hope

  11. Assess for signs that the client has a plan to commit suicide

    • Ask if they have a specific plan
    • Suddenly calm or appears happy or relieved
    • Giving away personal possessions
  12. Ask specifically “do you have a plan?”.  The client may even state “yes, I’m going to take that cable and hang myself with it” – this allows you to remove these objects from their reach.

    Clients who have made the decision to follow-through with a planned suicide attempt may suddenly feel calm or relieved.  This can be hard for caregivers or family members – they may perceive it as the client getting better.

  13. Obtain history from client and family members

  14. Determine if client has a personal or family history of suicide that would increase their risk, or any recent catastrophic events that may have prompted such behaviors (death of a loved one, loss of job, divorce, etc.)

  15. Assist client in creating and sign a no-suicide contract

  16. Demonstrates an alternative plan for coping when they feel suicidal instead of acting on impulses.

    Allows client to feel more in-control of actions and promotes accountability

  17. Identify situations or triggers and ineffective coping behaviors that may result in suicidal thoughts or actions

  18. To determine most appropriate interventions and develop more positive coping techniques

  19. Carefully and compassionately make client aware of unrealistic or destructive thinking and offer alternative or more realistic ideas and explanations

  20. Constructive interaction helps client become more open to realistic and satisfying opportunities for the future

  21. Discuss and identify things that are important to or have meaning for the client (religious beliefs, family, goals and dreams)

  22. Helps refocus client’s thinking and priorities, and renews potential for attaining goals. Provides support and encouragement. Gives client something to hope for.

  23. Teach positive problem-solving techniques

  24. Helps client identify and learn more creative and positive avenues for coping with stress

  25. Enlist client’s family members or friends to be available for client to call on in cases of crisis

  26. Gives a sense of value to the client and reminds them that they are not alone. Provides a support system for the client. Helps family and friends understand the struggles that the client is facing.

  27. Administer medications carefully and appropriately

  28. Antidepressants and anti-anxiety medications may be given to improve client’s daily functioning ability and provide relief during crisis situations.

  29. Provide resource information for support groups, hotlines and counselors that are available 24/7

  30. Gives client support and more resources to help cope with emotions and underlying conditions such as substance abuse


References

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