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Nursing Care Plan for Suicidal Behavior Disorder

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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. 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 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.

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
  • The 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
  • The recent release from prison or psychiatric institution
  • Changes in personal appearance (lack of hygiene)
  • High-risk behaviors

Nursing Interventions and Rationales

  • 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  
  • 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  
  • 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.  
  • 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.  
  • Administer medications carefully and appropriately
  Antidepressants and anti-anxiety medications may be given to improve the client’s daily functioning ability and provide relief during crises.  
  • 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  

References

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  • Question 1 of 5

A 45-year-old client with schizophrenia has been brought to the hospital after trying to commit suicide. The client tells the nurse that the voices he hears told him to do it. He is extremely anxious and upset. Which assessment question would most likely help the nurse to assess the client’s perception of this event?

  • Question 2 of 5

Common symptoms of impending suicide include which of the following? Select all that apply.

  • Question 3 of 5

The nurse caring for a 16-year-old male knows that which of the following is a warning sign of suicide? Select all that apply.

  • Question 4 of 5

Which of the following situations are risk factors for suicide? Select all that apply.

  • Question 5 of 5

A client with a history of severe depression and anxiety is in the hospital after attempting suicide. Which evidence would most likely be seen that indicates a crisis in a person with a mental illness? Select all that apply.

Module 0 – Nursing Care Plans Course Introduction
Module Obstetrics (OB) & Pediatrics (Peds) Care Plans

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