Suicide risk may increase early in treatment with antidepressants. One possible reason is that as an individual’s energy returns, he or she may have increased ability to act out self-destructive wishes. Assessment: When nurses assess a client’s suicide ideation, it is important to identify and distinguish ideas (thoughts), plans (intentions), and attempts (behavior). -Subjective: Patient statements, verbalization of feelings. (Overt statements and subtle hints) -Objective:Patient behaviors, report from support persons-Risk Assessment Tools:PHQ-9, NGASRSuicidal Ideas of Acts: Individuals may provide both behavioral and verbal clues as to the intent of their act. Examples of behavioral clues may indicate a decision to carry out suicidal intent include:-Giving away prized possessions-Getting finical affairs in order-Writing suicide note-Sudden lift of moodVerbal cues may be both direct and indirect. Examples of direct states can include “I want to die” or “I am going to kill myself.” Examples of indirect states include “This is the last time you’ll see me,” or “I won’t bearound much longer for the doctor to worry about” or “I don’t have anything worth living for anymore”Other assessments include determining whether the individual has a plan and if so, whether he or she has the means to carry out that plan. Nursing Interventions: Primary interventions include support, education, and awareness. Ways to minimize suicide risk on psychiatric units include: -Identify and minimize ligature risks-Shatter resistant/unbreakable glass-Temper resistant screws-Lock all utility areas-Keep electrical cords to a minimum length-Maintain observation policies-Search patients for contraband-Go through personal belongings with patient present remove all harmful objects, belts, shoelaces, metal, razors, perfume, shampoo.-Inform visitors of contraband rules-Search belongings brought in by visitors. Interventions at Discharge: Patients with depressive disorders are at increased risk of suicide as they begin to improve and regain energy to plan and carry out suicide. Discharge interventions include:-Development of a safety plan-Short supply prescription medications-Coordination with support person at discharge time-Appointment for outpatient psychiatric careMilieu ManagementThe goal of the milieu therapy is to manipulate the environment so that all aspects of the client’s hospital experience are considered therapeutic. Within this therapeutic community setting, the client is expected to
learn adaptive coping, interactions, and relationship skills that can be adapted to other aspects of his or her life. Basic Assumptions: 1.The health in each individual is to realize and encouraged to grow: All individuals are considered to have strengths as well as limitations. These healthy aspects of the individual are identified and serve as foundation for personality growth and the ability to function adaptively and productively in all aspects of life.