1.A student has committed suicide. Which statement(s) about those left behind after suicide is accurate? a.| A suicide makes survivors more conscious of risk factors and more motivated to reduce risk in themselves and others, leading to a reduced risk of suicide in survivor groups.| b.| The first few weeks after a suicide are the most difficult and are when survivors are at highest risk; the risk then returns quickly to its pre-suicide level as time passes.| c.| All survivors are at increased risk, should be assessed for risk at intervals after their loss, and would benefit from ongoing support primary intervention to reduce their risk.| d.| Speaking of the dead increases the discomfort of surviving loved ones and should generally be avoided in their presence.|
All survivors, both family and peers, are at higher risk of suicide after their loss. Grief, guilt, despair, and modeling all contribute to this risk, as does the isolation that can sometimes follow because of the shame, discomfort, and stigma often associated with suicide. Although consciousness and preventive efforts (e.g., screenings) may increase following a suicide, the overall risk among surviving family members and peers is significantly increased nonetheless. The grief and other factors underlying this increased risk usually lasts for many months or even years, so the risk does not resolve in the weeks after the death. Regular contact to provide support and observe for indicators of risk should be continued for at least a year following the death and for even longer periods around the loved one’s birthday, family events, holidays and the anniversary of the loss, or if the risk has continued or independent risk factors exist. Most survivors feel isolated when their loved one is not mentioned. They usually want their loved one to be remembered, and talking about the loss helps reduce the hurt, stigma, and isolation.
DIF:Cognitive Level: ApplicationREF:Text Pages: 560-562
TOP:Nursing Process: Assessment, Planning, Implementation
MSC:Client Needs: Physiological Integrity: Reduction of Risk Potential; Safe and Effective Care Environment; Psychosocial Integrity
2.An adolescent whose peer committed suicide attempts suicide himself and is admitted to an inpatient mental health unit and assessed as being at high risk for self-harm. Which of the following nursing actions would be most appropriate to assure his safety during his first few days in the hospital? a.| Place him on every-15-minute checks while awake.|
b.| Search the patient and his belongings for dangerous material.| c.| Have him sign a no-suicide contract on arrival to the unit.| d.| Place him on direct one-to-one observation 24 hours a day.|
The most effective way to ensure safety for a person at high risk of self-harm is to observe that person directly at all times. Even when belongings are searched and all dangerous times are kept from the patient, it is still possible to acquire everyday items that can be used as a means for killing oneself, such as blankets, sheets, and the cords from electrical equipment. Checks made every 15 minutes still allow a window of opportunity (the 15 minutes between the checks) that is more than sufficient to permit the completion of suicide, particularly by hanging, the method most often resulting in suicide in inpatient settings. Limiting checks to when the patient is believed to be awake further reduces their effectiveness. The patient need only feign sleep or awaken in the middle of the night to have an opportunity for self-harm without being observed. Research has shown that no-suicide contracts are of limited value; while they may motivate some persons to seek help from staff before acting on suicide ideation, they cannot be counted on to reduce risk....