According to the American Foundation for Suicide Prevention, 44,193 Americans die by suicide annually, making suicide the 10th-leading cause of death in the United States. Thankfully, modern mental health research is allowing psychiatric nurse practitioners, among other mental health care professionals, increasing access to evidence-based knowledge of suicide risk factors, suicide risk assessment techniques, and effective preventive care practices for patients who are at risk of suicide. By educating themselves on the following skills and competencies, practicing or prospective psychiatric nurse practitioners can become more effective in their efforts to assess, evaluate, and treat suicidal patients.
Develop communicative, therapeutic relationships with patients
The last thing anyone suffering from mental distress wants is to be judged, cast out, or neglected. By providing their patients with an emotionally safe and supportive environment, psychiatric nurses can build trusting relationships that may improve the effectiveness of interventions, as patients may be more open to evidence-based discussions regarding their suicidal motivations, thoughts, and beliefs. Through these discussions, the psychiatric nurse can demonstrate the validity of the patient’s psychological pain and better convey hope that the patient has the power to eliminate that pain through treatment.
Understand the patient by utilizing all applicable risk assessment techniques
One critical step toward preventing death by suicide is promoting and performing thorough suicide risk assessments that fully evaluate the likelihood of a patient committing acts of self-harm or suicide by using any of the following tools and techniques:
● Performing the Mental Status Examination (MSE), which describes the mental state of a patient through objective observations of the patient’s responses.
● Identifying any history of physical or psychological trauma that may diminish the patient’s mental well-being.
● Acknowledging all apparent risk factors, protective factors, and triggers that may cause feelings of distress.
● Assessing whether patient exaggeration or minimization of symptoms/factors is affecting outcomes.
Understand suicide risk factors at every level
Suicide risk factors are generally defined as any factors within an individual’s life that are likely to increase the chances that the person in question may consider or actually attempt suicide. At the individual level, a dysfunctional family environment or a history of suicide within the family could be considered a suicide risk factor, while in group analysis, psychiatric health care professionals examine factors that put the entire community at greater risk, such as the lack of a local mental health service or a community-wide substance abuse epidemic. For a psychiatric nurse practitioner, understanding risk factors means saving lives, as recognizing that risk factors exist within individuals, communities, and even entire societies is often the first step to formulating a preventive plan of action.
Develop an adaptable, long-term plan of care for patients
Following the assessment of suicide risks, the psychiatric nurse must construct a plan of care that combines continuous assessment with collaborative problem-solving to safely prevent suicidal thoughts and actions. This requires working alongside interprofessional mental health care providers, as well as the patient’s family/support network, to provide the patient with realistic interventions that can be used to address immediate, acute, and ongoing suicidal behaviors, such as a specific safety plan for limiting the potential risk of suicide or the coordination of a rescue process if a suicide attempt is made. Beyond planning, nurses must also routinely review and amend their treatment plans during inpatient hospitalizations while also ensuring that all outpatient providers have access to updated treatment plans and are completely informed on any relevant knowledge that may aid them in providing sufficient care.
Manage personal reactions to patients who express suicidal thoughts and attempts
When patients make attempts to take their own lives, the psychiatric nurses who were treating them are likely to experience some level of emotional reaction, but it is imperative that nurses learn to regulate these emotions through experience. An insufficiency in their own emotional security and personal well-being due to a previous experience with patient suicide could reduce the quality of care that nurses are capable of providing, damaging their ability to build strong relationships with future patients.
Understand legal and ethical issues regarding suicide
Suicide is a sensitive subject, legally and ethically. Therefore, psychiatric nurses must uphold the privacy and confidentiality of patients as regulated by HIPAA standards and avoid unlawful practice through compliance with laws such as lawful civil commitment (detaining a mentally ill person to prevent harm to himself or others), patient rights (the right to accept or refuse treatment), and lawful use of restraints or seclusion-based mental health interventions.
At-risk groups are the most in need of intervention from informed psychiatric mental health nurse practitioners, as the Centers for Disease Control and Prevention estimates that between 18 and 22 veterans die from suicide daily, and the Cincinnati Children’s Hospital Medical Center found that 30 percent of transgender youth reported at least one suicide attempt. In these and many other US populations, suicide is endemic. Therefore, nurses are encouraged to contribute to developing innovative means of addressing suicide, which is most easily accomplished following the receipt of guided training on suicide assessment and prevention through completion of a doctor of nursing practice program.
Health care is seeing an industry-wide demand for advanced practice nurses trained at the doctoral level due to the changing landscape, drive for improved patient outcomes, and a shortage of qualified nurses. If you’re an RN with a bachelor’s degree in nursing and ready to take your career to a higher level, the Regis College’s BSN to Doctor of Nursing Practice online program can prepare you for advanced nursing practice.
1. American Psychiatric Nurses Association
2. American Psychiatric Nurses Association
3. Department of Veterans Affairs
4. Nursing Theory
5. American Foundation for Suicide Prevention
6. Suicide Prevention Resource Center
7. Science Daily