Is a NON-FATAL Deliberate of SELF HARM. Often the individual does not actually want to kill themselves, so it is not always an Attempted Suicide. Sometimes the Para suicide may be a CRY FOR HELP by someone who feels hopeless and desperate. ALL PARAS CIDES MUST BE TREATED SERIOUSLY.
In some countries Para suicide is the commonest reason for medical admission to hospital for women, and the second commonest for men.
METHODS OF SUICIDE, COMMON METHODS ARE:
1. Poisoning : With Drugs or Chemicals
2. Cutting Arteries : Neck or Wrist
3. Hanging/Suffocation : With a rope or Plastic Bag or Gas
4. Burning : With Petrol or Domestic Heating Fuel
5. Jumping : From High Building
6. Drowning : Often Hides the suicide as an Accident
FACTORS LINKED TO AN INCREASE IN THE RISK OF P ARASUICIDE:
1. MARITAL PROBLEMS:
• Divorce
• Husband Taking a Second Wife
2. ECONOMIC PROBLEMS:
• Low Wage
• Unemployment [Especially Men]
3. YOUNG AGE GROUP:
• 75% Under 40 Years of Age;
4. FEMALE SEX
• Twice as Many Women as Men;
5. ALCOHOL & DRUGS
6. MENTAL ILLNESS
• Especially Depression.
WHY DO PEOPLE KILL OR ATTEMPT TO KILL THEMSELVES:
In most of the worlds religions Suicide is a Sin [Haram]. In most societies Suicide brings Shame on the family. So for a person to commit or attempt to commit Suicide that person must be desperate. In some countries including Kuwait attempting suicide is against the law.
FACTORS LINKED TO AN INCREASE IN THE RISK OF SUICIDE ARE:
• Mental illness especially depression;
• Previous attempts at suicide
• Violence of the method used in earlier attempts
• Isolation from family and society
• Economic or family crisis
• Use of alcohol or illegal drugs
• Male sex
• Increasing age
• Occupational groups like doctors, nurses n& bartenders
NURSING CARE OF THE PATIENT WHO HAS ATTEMPTED SUICIDE:
Para suicide is a Psychiatric EMERGENCY and they must ALL be treated SERIOUSLY. You will hear Nurses say that those who attempt Suicide never commit Suicide, That is Wrong. About 1/2 of people who Commit Suicide have had previous attempts.
By the time an individual who has attempted suicide is admitted to the Psychiatric Unit they will be feeling very low in mood. Physically they will probably be very tired and the original problem which caused the Para suicide is still there.
In addition they may feel that they have. brought shame on their family. As attempted suicide is illegal in Kuwait they may also have been questioned by the Police. The patient may be grateful that he has been rescued and is being protected in the hospital or may become even more shamed that he is now Labeled a "Mental Case".
A judgment has to be made, by the Psychiatric Team, between raising the patient's self-esteem and Preventing any further Suicide attempts. It is the Duty of each nurse on a ward to find out what is the Suicide Prevention Policy for that particular ward and patient. Nursing care of the Depressed and/or Psychotic patient is discussed in other sections, this section deals only with suicidal behavior.
MAINTENANCE of PATIENT SAFETY
General Principles:
• ALL Staff, including porters and cleaners, on the ward must be Instructed in the Policy;
• Dangerous Articles such as Knives & Scissors Must be Removed from the Patient for safe keeping, and the patient should be informed in a Positive way about this policy;
• The environment should be Made, and Maintained, Safe. Windows locks act. should be checked.
• Remember that if the cleaner is not informed about the policy he may leave cleaning chemicals where the patient can use them, or buy something for the patient, in a shop outside, without realizing the danger.
• Also visitors Must be instructed to discuss with the staff the dangers of giving articles to the patient.
• When medication is given the nurse Must make sure that it has been swallowed and not kept under the tongue and saved up.
• The Most Important prevention. measures are:
- Assessment of the suicide risk; and
- Observation.
ASSESSMENT:
When deciding on the policy for a particular patient an assessment of the Suicide Risk will be made.
It will include factors such as:
a) What led to the attempt;
b) The Method used;
c) Was the attempt Carefully Planned; d) Is there any Mental Illness [Depression, Delusions, Hallucinations]
e) Does the patient Still want to Die;
1) Has he Planned another attempt.
Depending on the level of risk three levels of observation may be prescribed:
a) Close One to One Observation
b) Continuous Unobtrusive Observation
c) Timed Observation
a) Close One to One Observation
• The patient is under observation 24 hours per day;
• One Nurse is allocated to Special the patient in each shift;
• The nurse allocated to the patient is relieved by another nurse every two hours;
• The nurse with the patient is never more than One Arm's Length away from the patient at any time;
• Even when the patient goes to the toilet the above rule applies and the door to the toilet must remain open;
• When the Specialing nurse is relieved they must write down observation notes;
• The nurse should not just follow and observe the patient. The patient should be engaged in activities such as games, talking and reading.
b) Continuous Unobtrusive Observation
• The patient should be under Observation for 24 Hours Per Day;
• One nurse is allocated to observe the patient;
• This observation does not have to be obvious.
• When the patient goes to the toilet, they can be observed under the door.
• The nurse can observe the patient from across the room or can playa game, such as cards, with them. This is what is meant by Unobtrusive.
• The allocated nurse must write up observation notes at the end of the shift and hand over to the allocated nurse on the incoming shift.
c) Timed Observation
• All staff on the ward are made aware of the risk of suicide with the particular patient;
• One nurse is allocated to check on the patient at specified time intervals:
eg: 10 minutes
15 minutes
30 minutes
• The allocated nurse signs a form each time that they check the patient
Studies have shown that patients have both positive and negative reactions to "Specialing" but the reaction is mostly positive. The negative feelings occur when the nurse acts like a Jailer and doesn't communicate with the patient.
Bassett D. Tsourtos G. Inpatient suicide in a general hospital unit. A consequence of inadequate resources: General Hospital Psychiatry. 15[5]:30 1-6,1993 Sep Green JS. Grindel CG. Supervision of suicidal patients in adult inpatient psychiatric units in general hospitals: Psychiatric Services. 47[8]:859-63, 1996. Aug
Pitula CR. Cardell R. Suicidal Inpatients' experience of constant observation. Psychiatric Services. 47[6]:649¬51,1996 Jun.
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