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Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions.
The Joint Commission identifies assessment of suicide risk as a Hospital National Patient Safety Goal.6
The Food and Drug Administration issued a black box warning stating that an increased risk of suicide may exist for some children and adolescents who are treated with antidepressant medications. Closely monitor adolescents treated with selective serotonin reuptake inhibitors for worsening of symptoms or suicidal thinking.8
Suicide is a leading cause of death for persons between 10 and 24 years of age.2 Although firearms are used to complete almost half of the suicides, young people also use methods such as suffocation and poisoning.2 Those youths with a prior psychiatric diagnosis, often related to substance use and mood disorders, are at a higher risk for suicide.2,9 Health risk behaviors associated with suicide among adolescents include injection drug use, forced sexual activity, purging and laxative use for weight loss, and methamphetamine use.15
Suicide is a serious public health problem, and many persons between 10 and 24 years of age require medical care for self-inflicted injuries.2 A national survey revealed that many high school students reported seriously considering suicide, although only half of those actually reported a suicide attempt.2 A previous suicide attempt is the strongest predictor for a completed suicide.12 Of reported suicide deaths among 10- to 24-year-olds, the vast majority were males; however, females are more likely to report attempting suicide.2
Establishing therapeutic rapport is important when working with adolescents at risk for suicide.4 Rapport is enhanced with respect, honesty about the limits of confidentiality, reassurance of privacy, and acceptance conveyed through tone and posture.1 The lack of a therapeutic alliance with a patient may increase the risk of suicide.5 The health care team member must also assess the adolescent’s safety and risk of harm and maintain communication with the health care team.
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Rationale: Self-assessment is part of reflective practice that allows the health care team member to gain a better understanding of his or her own feelings when encountering difficulty establishing rapport with a suicidal adolescent.
4 The team member should review personal feelings related to the patient’s suicidal thoughts and death wish.
Rationale: Depending on the patient's age and legal status, parental consent or consent by a guardian may be required in certain jurisdictions.
Rationale: Collateral information from the family is helpful to determine suicide risk; it can be gathered without revealing confidential information about the patient.
Rationale: The patient may be uncomfortable or embarrassed sharing certain information with family. Adolescents tend to cooperate when confidentiality and privacy are assured.
Rationale: A detailed and thorough psychiatric interview is crucial. Monitoring risk within a safe and least-restrictive environment should be balanced with fostering autonomy and respecting the patient’s rights.
Comply with mandated reporting of suspected abuse or neglect.
Rationale: Establishing rapport with the patient and family is important because parental attitudes may influence the adolescent's attitude toward his or her current health care. Privacy is important because adolescents undergo developmental changes that may cause self-consciousness or embarrassment. When efforts are made to help the adolescent feel normal and connected, he or she is more likely to accept treatment.
Rationale: Most suicidal youths attribute suicidal behavior to life stressors, not depression or mental illness.
Do not assume that a patient who denies suicidal ideation will not commit suicide.
Rationale: Suicidal thought processes change. Adolescents may be particularly anxious, or they may have difficulty processing thoughts or feelings like adults.
Rationale: The patient’s person and environment are to be free of anything that may be used for self-harm. The means to commit suicide are commonly found in the patient’s physical environment.
6 Access to drugs that can be used for overdose must be restricted.
Consider that patients may hide items with their clothing.
Rationale: A room close to the nurses’ station makes observation of the patient easier. Having a roommate also enhances safety.
Rationale: Variable random checks impede the patient's ability to plan self-harm.
Rationale: The health care team member should not have other duties to distract him or her from observation of the patient. The team member should be relieved or replaced periodically to ensure that maximum attention is paid to the patient.
Rationale: The assigned health care team member must be able to assess changes in the level of safety or risk and communicate such changes to other team members.
Ensure that other health care team members know that labile, irritable, and impulsive behavior is an indicator of serious risk.13
Rationale: Access to ceiling fixtures is particularly dangerous to the patient who may attempt hanging. Providing a safe environment is an essential component of nursing care for the potentially suicidal patient.
Rationale: The adolescent unaccustomed to being away from home or being an inpatient may require additional contact from the team members. Team members who are aware of the patient’s fears and concerns can provide support, reassurance, and clarification as necessary.
Rationale: Variables contributing to suicide are dynamic and may change. Reassessment helps maintain safety and vigilance.
Rationale: The amount of observation should appropriately respond to the patient's risk and respect the minimal level of restriction needed to ensure his or her safety.
Rationale: Family is an important support system to contribute to the adolescent's safety and well-being.
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