Nursing Care Plan (NCP) for Suicidal Behavior Disorder

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Outline

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, an underlying condition such as depression, bipolar disorder, PTSD, or schizophrenia.

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 before 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

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

Subjective Data:

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

Objective Data:

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

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Perform neurological assessment Determine baseline and if there are other neurological conditions present that may cause symptoms
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) Ensure client safety and remove the opportunity to harm the self. Follow your facility’s specific protocol regarding supervision, restraint, and documentation. 
Create a safe environment by removing potential weapons or objects that may inflict harm (weapons, utensils, sharp objects, belts, ties, etc.) Provide safety and remove items that may be used impulsively during the actively suicidal phase. When possible, remove monitor cables and electrical cables that are not being actively used. 
Encourage the client to discuss feelings, emotions, fears and anxieties and alternative ways to cope with those feelings To determine the cause, if any, of client’s actions or thought processes. Helps the client gain a sense of control over actions and life in general 
Emphasize resiliency with the client to understand that:

The crisis is temporary, but their actions are permanent

Help is available

Pain can be overcome

Help clients see that there are other ways of dealing with circumstances and give them perspective and hope 
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

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 decided 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. 
Obtain history from client and family members Determine if a 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 a job, divorce, etc.) 
Assist client in creating and sign a no-suicide contract Demonstrates an alternative plan for coping when they feel suicidal instead of acting on impulses. Allows the client to feel more in control of actions and promotes accountability  
Discuss and identify things that are important to or have meaning for the client (religious beliefs, family, goals, and dreams) Helps refocus the client’s thinking and priorities, and renews potential for attaining goals. Provides support and encouragement. Gives the client something to hope for. 
Identify situations or triggers and ineffective coping behaviors that may result in suicidal thoughts or actions To determine most appropriate interventions and develop more positive coping techniques  

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

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

Teach positive problem-solving techniques Helps client identify and learn more creative and positive avenues for coping with stress  

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

 

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

Provide resource information for support groups, hotlines and counselors that are available 24/7 Gives client support and more resources to help cope with emotions and underlying conditions such as substance abuse 

Writing a Nursing Care Plan (NCP) for Suicidal Behavior Disorder

A Nursing Care Plan (NCP) for Suicidal Behavior Disorder starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

https://www.mayoclinic.org/diseases-conditions/suicide/symptoms-causes/syc-20378048

https://my.clevelandclinic.org/health/articles/11352-recognizing-suicidal-behavior

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Transcript

Hey everyone. Today, we’re going to be creating a nursing care plan for suicidal behavior disorder. So let’s get started. First, we’re going to go over the pathophysiology. So suicidal behavior disorder describes a client who has attempted suicide in the past two years and includes unsuccessful attempts and completed suicides. Nursing considerations: you want to do a neurological assessment, one to one monitoring, create a safe environment, create a no suicide contract and administer medications. Desired outcomes: the client will not attempt suicide, will remain safe without self-inflicted harm, and will identify alternative activities or support systems to prevent future suicide attempts. 

So we’re going to go ahead and we’re going to start writing in our care plan. We’re going to have our subjective data and our objective data. So what are we going to see with these patients? So, some subjective data you’re going to see that they’re going to have moodiness and excessive sadness. Some objective data you’re going to see is withdrawal, and you’re going to probably see self harm behavior. And, some other ones: feelings of hopelessness, changes in personality, maybe some sleep difficulty, verbal or written threat of suicide, and a history of substance abuse. You’re going to see that they’re going to be giving away personal possessions – that’s a big one for them. Purchasing a firearm or any sort of weapon, changes in their personal appearance, or maybe they had just recently been released from prison. 

So what are some interventions? Well, we want to first perform a neurological assessment. So you want to do a thorough assessment to determine the baseline. If there are any other neurological conditions that are present, that may have caused some symptoms. Another invention that we want to be doing is to make sure we’re initiating one-on-one monitoring. So we want to be one-to-one, and we want to be at arm’s length per the facility protocol. You want to avoid leaving the client unattended for any reason, especially in the bathroom or the shower. We want to make sure that we are ensuring client safety and removing the opportunity to harm themselves; follow your facilities specific protocols regarding the supervision, restraints, and documentation of this. Another invention is that we want to create a safe environment for this patient. So we want to make sure we’re removing any potential weapons or objects that may inflict harm such as utensils, sharp objects, belts, ties, et cetera. We want to make sure that we’re providing safety and removing these items that are able to be used impulsively during the activity of suicidal phase. When possible, remove monitor cables and electrical cables that are not being actively used. We want to emphasize resiliency. We want the client to understand that the crisis is temporary, but their actions are permanent. We want to make sure that they know help is available and that this pain can be overcome. We want to help clients see that there are other ways of dealing with these circumstances, and we want to give them a perspective of holding on for hope. Another intervention we want to do is we want to assess for signs that the client has a plan to commit suicide. So we want to ask this client, do they have a plan? Are they suddenly calm or appear happy or relieved? Are they giving away any sort of personal possessions? So we want to ask specifically, do you have a plan? The client may even state, yeah, I’m going to take that cable and hang myself. This will allow you to remove these objects from their reach clients who have decided to follow through with the 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’s getting better in those circumstances. 

Now, eventually we want to assist the client in creating and signing a no suicide contract. We want to demonstrate an alternative plan for coping when they feel suicidal, instead of acting on impulses. This allows the client to feel more in control of the actions and promotes accountability. We also want to administer medications; this could be antidepressants or anti-anxiety medications that can be given. It can help improve the client’s daily functioning ability and provide any sort of relief during the crisis. 

Alright, so we’re going to go into the key points here. So this would be describing a client who’s attempted suicide within the last two years. It includes unsuccessful attempts and completed suicides. Usually this stems from another underlying condition, such as depression, bipolar disorder, PTSD, or schizophrenia. Some subjective and objective data you’re going to see with these patients. You’re going to see excessive sadness, feelings of hopelessness, sleep difficulty, withdrawal from society, recent trauma or crisis, self harmful behavior, and possible history of substance abuse. We’re going to assess the patient, their neurological assessments, making sure we’re creating a safe environment and initiating that one-to-one monitoring. We’re going to assess for signs of the client having a plan, identify the situation or triggers for this client, and emphasize resiliency with the client to understand that the crisis is temporary And there we have a completed care plan. 

We love you guys. Go out, be your best self today. And, as always, happy nursing.

 

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