Suicide as an Ideation, Gestures or Threats - Essay Example

Individual Case Study 1. Suicide whether ideation, gestures or threats is a complex human behavior that is difficult to predict. However, there are risk factors that can be assessed and evaluated to identify individuals at risk for committing suicide. For the purpose of this case study, I have chosen to cluster the risk factors into four domains – psychiatric or psychological, biophysical, social and environmental factors. Psychological/ Psychiatric Risk Factors. Studies have shown that mental health problems are consistently associated with suicide. Some 90% of people who take their own life are believed to have some kind of psychiatric disorder (Hawton, 2009). Accordingly, one of the most common psychiatric disorders associated with suicide is major depression (Gliatto & Ria, 1999) and suicide among the elderly is likely to happen in the context of a depressive episode. Depression is identified as one of the most powerful independent risk factor associated with suicide in old age (Connor et. al., 2011) and is known to increase the risk of suicide by 15 to 20 times (Hawton, 2009). Furthermore, it has been found that depression rates are higher among women than in men, which is congruous with the case study. Other psychiatric conditions associated with suicide are substance abuse, schizophrenia and psychotic disorders. Biophysical Risk Factors. Research suggests that genetic factors are highly related to a particular person's risk for committing suicide. According to Reiss and Dombeck (2007), The offspring of individuals who have attempted and completed suicides have an increased likelihood to commit the same behavior themselves. Therefore, suicide “runs” in the family. In addition, it has been found that dysregulation of the Hypothalamic Pituitary Adrenal (HPA) axis (mechanism responsible for coping with stresses over time) can develop following traumatic events or chronic stress, and has been linked to severe depression and suicidal behavior (Reiss & Dombeck, 2007). This supports the large body of evidence that dysfunctional neurotrophic signaling might be involved in the pathophysiology of suicidal behavior. The prevalence of illnesses later in life contributes to the common assumption that the occurrence of physical ailments plays a significant role in suicide risk later in life. According to Hawton and Heeringen (2009), poor physical health and disabilities are associated with suicides. Sociocultural Risk Factors. Suicide is consistently associated with social factors and age-related life events especially among the elderly. Lack of supportive social network and religious participation as well as family disputes, low level of education, financial difficulties and sense of loneliness greatly increases the risk for suicide (Connor, et. al 2011). The elderly are more likely to experience anxiety, ambivalence and uncertainty facing their future. Eventually, these stressful life events cluster in the weeks and months before suicide attempts in the elderly (Luscomb et al, 1980). Environmental Risk Factors The elderly are typically less physically resilient and physical ailments are fairly common. Consequently, their present infirmity provides them easy access for medications that taken in excess may lead to fatal consequences. According to Carlsten and Waern (2009), antidepressants, antipsychotics, sedatives and hypnotics were associated with increased suicide risk especially among the elderly. This is of much concern since the client from the case at hand was prescribed with an antidepressant. 2. Further data are needed to determine the seriousness of the client’s suicidal intentions. According to the American Association for Suicide Prevention, if the following are present or manifested by the client, it is indicative of a real intent to commit suicide. Precipitating Event. A particularly distressing recent event (e.g. loss of loved one) may lead to a suicide. Intense Affective State in Addition to Depression. Desperation (anguish plus urgency regarding need for relief), rage, psychic pain or inner tension, guilt, hopelessness, acute sense of abandonment may push her to take her own life. According to Sorref (2012), anxiety – the constant sense of dread and tension – in all of its forms proves unbearable for some and leads to a risk for suicide. Changes in Behavior. If the client provides speech such as "my family would be better off without me", it is suggestive that the individual is close to suicide. Such speech may be indirect. Individuals may also pursue a systematic pattern of behavior in which they engage in activities that indicate they are leaving life. This includes saying goodbye to friends, making a will, writing a suicide note, and developing a funeral plan (Sorref, 2012). 5. To solidify therapeutic alliance, one intervention that can be utilized is to ask the patient to sign or verbally agree to a “no harm contract.” Although the contract is not legally binding, and can never be imposed coercively, this is used to bind an implied agreement with the client (Soreff, 2012). In the contract, the client agrees not to inflict harm upon herself for a specific period of time and asks the client to contat the physician if the clinical situation changes. On a regular basis, the patient is visited personally or contacted by phone. The patient's family should also be involved in the formation and implementation of the contract (Sorref, 2012). Remove all dangerous objects from client’s environment (e.g., sharp items, belts, ties, straps, breakable items) because client safety is a nursing priority (fadavis.com, 2012). When communicating with teh client, the staff should maintain and convey a calm attitude to client. Anxiety is contagious and can be transmitted from staff members to client (fadavis.com, 2012). Furthermore, always provide autonomy for the client as is possible for the situation as it enhances the client’s feeling of control. 6. The first nursing diagnosis would be “risk for self directed violence”. Safety, first and foremost, is an utmost priority. According to Sorref (2012), suicide means killing oneself. The act constitutes a person willingly, perhaps ambivalently, taking his or her own life. Several forms of suicidal behavior fall within the self-destructive spectrum – suicidal attempt, gesture, ideation or completed. It is for this reason that a risk for self-directed violence has been chosen. Next is “altered thought process”. Although mental illness is generally linked to premature deaths, certain mental illnesses carry with them remarkably high lifetime instances of suicide. In fact, 95% of people who commit suicide have a mental illness (Sorref, 2012). Lastly, a good nursing diagnosis would be “ineffective individual coping”. This diagnosis refers to the inability of the client to form a valid appraisal of the stressors, inadequate choices of practiced responses and initiate responses necessary to adapt to life changes (Schultz & Videbeck, 2008). 7. I personally have biases on depression and suicide. Although some of them are indeed subjective does not carry a scientific rationale, in one way or another, they can influence the way nursing care will be delivered to my patients. Suicidal people will only hurt themselves and not others around them. Consequently, this bias will lead me to become complacent and hence, put myself in harm’s way. Although suicidal people will tend to inflict harm upon themselves, the anger can also be directed towards others in a planned or impulsive manner. Psychotic people may be responding to inner voices that command the individual to kill others before killing the self (Videbeck, 2004). I always believed that the cure for depression is through thinking of positive thoughts. In a way, I have always thought patients will always cure their illness by themselves. However, as experience will tell, depression can be so debilitating for some people that thinking about positive thoughts can be very exhausting. Thus, depression does need professional help to be treated. Lastly, I prefer to believe that once a suicide risk is identified, that person will always be considered a risk. This could affect my care because it would entail me to exert extra vigilance in providing care with that client. However, while it is true that most people who successfully commit suicide have made attempts or at least once before, majority of people who have manifested suicidal ideations can have positive resolutions (Videbeck, 2004). References American Foundation for Suicide Prevention. (2012) Retrieved from http://www.afsp.org/index.cfm?fuseaction=home.viewPage&page_id=05147440-E24E-E376-BDF4BF8BA6444E76 Carlsten, A. & Waern, M. (2009). Are sedatives and hypnotics associated with increased suicide risk of suicide in the elderly? BMC Geriatrics 2009, 9:20  Connor, R., Platt, S., and Gordon, J. (Eds.) (2011). International Handbook of Suicide Prevention - Research, Policy and Practice. West Susssex, United Kingdom: John Wiley & Sons. F. A. Davis Company. (2012) Retrieved from http://davisplus.fadavis.com/townsend-essentials4/Care_Plans/CarePlan12-01.cfm?title=Risk%20for%20Self-Directed%20or%20Other-Directed%20Violence Gliatto, M. & Rai, A. (1999). Evaluation and Treatment of Patients with Suicidal Ideation. American Family Physician. 59(6):1500-1506 Hawton, K. & Heeringen, V. (2009). Suicide. The Lancet. 373: 1372-1381. Luscomb, R.L., Clum, G.A. and Patsiokas, A.T. (1980): Mediating factors in the relationship between life stress and suicide attempting. The Journal of Nervous and Mental Disease 168:644–650 Reiss, N. and Dombeck, M. (2007, October 24). Suicide. Retrieved from http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=13743&cn=9 Sorref, S. (2012, May 15). Suicide. Retrived from http://emedicine.medscape.com/article/286342-overview Videbeck, S. (2004). Psychiatric Mental Health Nursing (2nd Ed..) Philippines: Lippincott William and WIlkins Read More