Ask patient directly, “Have you thought about killing yourself?” If so, ask, “What do you plan to do?” Suicide risk increases if patient has a definite plan.
Initiate appropriate safety protocols by removing from patient's environment anything that could be used to inflict further self-injury (razor blades, belts, glass objects, pills) to help ensure patient's safety. - Make a short-term contract with patient on not harming self during a specific period. Continue negotiating until no evidence of suicidal ideation exists. A contract gets the subject of suicide out in the open, places some responsibility for safety on patient, and conveys acceptance of patient as a worthwhile person.
- Supervise the administration of prescribed medications. Medications may be appropriate alternative to verbal interventions. Be aware of drug actions and adverse effects. Make sure that patient doesn't hoard medications.
- Provide supervision (one-on-one observation when possible) for patient based on facility policy to ensure compliance with legal requirements to protect patient and to reassure patient of staff concern.
- Use a warm, caring, nonjudgmental manner to show unconditional positive regard.
- Listen carefully to patient and don't challenge patient to communicate care and support.
- Demonstrate understanding, but don't reinforce denial of the current situation because denial can mask the roots of suicidal feelings.
Make appropriate referrals to mental health professionals to help patient work through suicidal feelings and develop healthier alternatives.- Help patient set a goal for obtaining long-term psychiatric care. Ambivalence about psychiatric care or refusal to consult with a therapist marks the suicidal patient's lack of insight and use of denial.
- Provide patient with telephone numbers and other information about crisis centers, hot lines, and counselors. Alternatives may ease anxiety about the perceived threat of long-term psychotherapy.
Suggested NIC Interventions
Behavior Management: Self-Harm; Environmental Management: Violence Prevention; Impulse Control Training; Suicide Prevention |