Suicide: Teaching Families and Consumers
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Transcript Suicide: Teaching Families and Consumers
1998 Biennial Convention
“Uniting Nurses: One Strong Voice”
June 27, 1998 Session 003
“Suicide Prevention Strategies for
Families and Consumers”
American Psychiatric Nurses Association
Phyllis M. Connolly PhD, RN, CS
President
http://www.apna.org
Overview
Quality mental health care consist of four
main elements: prevention, early detection,
treatment and education. This session,
including a mini teaching activity, will
provide you with an increased
understanding of the content, skills and
methods of suicide prevention teaching for
families and consumers with psychiatric
disorders.
Objectives
Discuss the statistics of suicide in persons with psychiatric
disorders.
Describe the myths related to suicide.
Identify the relevant theoretical frameworks which guide
the teaching of families and consumers.
Examine the components and methods of teaching and the
specific content for teaching.
Analyze culturally sensitive approaches to teaching
ethnically diverse families and consumers.
Participate in teaching simulation exercises.
Compare a family fire/disaster and emergency medical
plan with a plan for possible suicide prevention.
Suicide: 8th leading cause of
death in US
90%
associated with mental & addictive
behaviors
Highest rates for elderly white males
Firearms account for 60% of all suicides
across all ages
Substance abuse found in most
Family violence and physical & sexual
abuse increase risk
Persons with schizophrenia
10%
-13% commit suicide
Leading
18%
cause of premature death
- 55% will make a suicide attempt
Depressive Disorders
Up
to 15% requiring hospitalization
eventually die by suicide
10%
- 15% of untreated persons with
bipolar I commit suicide
Risk Factors
History
of suicide attempts
Hopelessness
Physical illnesses
Family history of substance abuse
Caucasian race
Male gender
Risk Factors Continued
Advanced
age
Presence of psychotic symptoms
Living alone
Unemployment
Depression
Substance abuse
Relapse
Having a positive supportive
and helpful relationship with a
mental health provider may
reduce the risk of suicide.
Suicide Myths
People
who think about suicide must be
crazy
Talking about suicide may give a person the
idea
If a person really wants to kill themselves
there is nothing you can do
People who talk about suicide never follow
through
Identifying Triggers
Alcohol
and/or drugs
Stopping psychotropic medications
Lack of sleep
Increased stress: losses, changes,
interpersonal relationships
Increased anxiety
Reactions to prescription /over the counter
drugs
Nutritional imbalances
Medical conditions
Interventions: Step 1
Check out your concerns--ask the person
If
the person says “YES,” stay calm--take a
deep breath
Ask the person what their thoughts are like--are
they hearing voices
If, Yes, get the person to a suicide or crisis
center immediately
Interventions: Step 2
Determine
if they have a plan
What exactly do they intend to do
How will they do it
When will they do it
If the plan is lethal, concrete, specific, and
available, get them to a suicide or crisis
center immediately
Interventions: Step 3
If
no plan, ask about medications taken
within the last 24 hours
ask
about any over the counter medication
ask about alcohol/street drugs
Interventions: Step 4
The
person should be seen by a mental
health professional as soon as possible
Call the primary therapist or case manager
If unable to contact the therapist, call the
crisis help line for a referral
Suicidal gestures
Get
the person to the nearest hospital or
emergency service as soon as possible
You may need to call 911
Stay calm
Stay with the person, unless you have been
the targeted person who may have failed to
meet the person’s expectations
Assessment at Crisis Center
Hospitalization
may be needed
Medications
Identifying
precipitating factors
Assessing for medical problems
Facilitating feelings of hope
Facilitating sense of competency & efficacy
Someone needs to stay with
the person at all times
The person is
experiencing strong
feelings of
abandonment,
loneliness, guilt and
hopelessness
Adaptive Problem Solving
Assist with basics
Living
arrangements
Food availability
Identify
past coping
mechanisms
Identify person(s)
available in the
support system
Competency & Efficacy
Set achievable short
term goals
Encourage & give
positive feedback
Family & support
persons are critical in
providing positive
feedback
In Home Support
Family can be instrumental providing basic
critical components in reestablishing the
person’s equilibrium.
If the person is not hospitalized they should
not be left alone
Establish support system: Family, friends,
church members, roommates
Psychiatric home care may be provided
Facilitating Hope
Provide
a supportive climate
Facilitate a hopeful perception
Help the person to restructure the situation
Assist the person in making plans
Assist the person in taking action, and
establishing goals for living
Concept of Newness
Discovery
Resources
Insight
Creativity
Plans
Facilitating Hope
Outcomes
Stress Management
Crisis Intervention
Deep
breathing
Self talk
Time out
Visualization
Leaving the situation
Talking to someone
Music
Prevention
Diet
& nutrition
Exercise & physical
activity
Self-help groups
Having fun
Playing
Massage
Progressive relaxation
Assertiveness training
Care for Support Person
Stay
calm
Get support for yourself
Utilize formal mental health professionals
or spiritual guides
Utilize the Alliance for the Mentally Ill
800-
Once
950-6264
the person is stable and restored,
debrief the incident with them
You should have an emergency
plan for handling a suicide
gesture or ideation.
Theoretical Frameworks
Crisis
Intervention
Orem’s Self-care
Knowles, Adult Learning
Yalom, Group Theory
Carl Rodgers, student-centered
Knowles Assumptions:
Adult Learners
Desire
and enact toward self-directedness as
they mature
Experiences are rich resource for learning
Awareness of specific learning needs
generated by real life
Competency based and wish to apply
knowledge to immediate circumstances
Teaching Families & Consumers:
Suicide prevention
Assessing
the learners including culture
Identifying specific content
Developing teaching objectives
Developing learner outcomes
Instructional planning
Implementation
Evaluation
Belief Systems: Health & Illness
MagicoReligious
Fate of world
World under
View
supernatural
forces
Cause of illness,
Illness/
disease mystical
Gift or reward
Health
Ethnic
group
Hispanic Americans
Black Americans
Scientific/
Biomedical
Holistic
Control by
physical &
biochemical
Harmony,
natural balance
Cause/effect
relationship,
pathogens
Illness
prevention,
meds, treatments
Disease
imbalance, laws
disturbed
Environment,
sociocultural
factors
White Americans
Native Americans
Asian Americans
Teaching Designs
Learner-Development
Topic
Centered
Distance
Education Telecommunication
Instructional Techniques
Discussion
Lecture
Role Play
Questioning
Skits
Simulations
Audiovisual
CAI
Web Resources
APNA & links
http:www.apna.org
Suicide
Helpline
http:www.grohol.com/helpme.htm
KEN
http:www.mentalhealth.org
NDMDA
http://www.ndmda.org
Selected Bibliography
Aguilera, D. C. (1994 ). Crisis intervention: Theory
and methodology (7th ed.).St. Louis: Mosby-Year Book.
Babcock, D., & Miller, M. (1994). Client education:
Theory and practice. St. Louis: MO..
Campinha-Bacote, J. (1994). Cultural competence in
psychiatric mental health nursing: A conceptual model.
Nursing Clinics of North America, 29(1), 1 - 9.
Cowan, C. F., & Bowie-Guillory, J. A. (1995).
Teaching patients with low literacy skills In B. Fuszard,
Innovative teaching strategies in nursing 2nd ed.) (pp. 231
- 241). Gaithersbrg, MD: Aspen.
Selected Bibliography
Depression Guideline Panel (1993). Depression in
primary care: Volume 1, Diagnosis and detection. Clinical
practice guideline, Number 5. Rockville, MD. U. S.
Department of Health and Human Services, Public Health
Service, Agency for Health Care Policy and Research.
AHCPR Publication No. 93-0550.
Depression Guideline Panel (1993). Depression in
primary care: Volume 2, Treatment of Major Depression.
Clinical practice guideline, Number 5. Rockville, MD. U.
S. Department of Health and Human Services, Public
Health Service, Agency for Health Care Policy and
Research. AHCPR Publication No. 93-0551.
Selected Bibliography
Falvo, D. (1994). Effective patient education (2nd ed.).
Gaithersburg, MD: Aspen.
Hoff, L. (1995). People in crisis: Understanding and
helping (4th ed.). San Francisco: Jossey-Bass Publishing.
Jack, R. (1992). Women and attempted suicide.
Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers.
Knowles, M. S. (1980). The modern practice of adult
education: From pedagogy to andragogy (2nd ed.). New
York: Cambridge University Press.
Moller, M., & Murphy, M. (1997). The three R’s
rehabilitation Program: A prevention approach for the
management of relapse symptoms associated with
psychiatric diagnoses. Psychiatric Rehabilitation Journal,
20(3), 42 – 48.
Selected Bibliography
Palmer-Erbs, V., & Anthony, W. (1995). Incorporating
psychiatric rehabilitation principles into mental health
nursing. Journal of Psychosocial Nursing, 33(3), 36 – 44.
Palmer-Erbs, V., & Manos, E. (1997). New thoughts
on promoting collaborative partnerships with consumers,
survivors, and family members. Journal of Psychosocial
Nursing, 35(1), 3-5.
Silverman, M., & Maris, R. (Eds.). (1995). Suicide
prevention toward the year 2000. New York: Guilford
Press.