Nursing: Suicide, Essay Example

Abstract

This essay establishes critical thinking/evidence emerging from a nursing issue relating a concept to be used in assisting clients coping with the outcomes of the specific nursing issue. Precisely, this clinical issue pertains to suicide attempts and the role of the nurse in applying the hope concept  for resolution of the issue along with integrating Dorothea Orem self-Care theory assumptions to guide interventions. A comprehensive literature review will be undertaken to determine the best nursing practice for suicide and suicide attempts. Current literature of no more than 5 years old will be perused detailing the recommended nursing care for the client problem and accompanying intervention rationale

Introduction

Suicide has been considered a social problem by psychologists; sociologists; social psychologists; psychiatrists; social workers and health care providers alike. Epidemiologists have reported that incidences of suicides or suicides are increasing in America, especially, among adolescents and young adults. During 2008-2009 suicide was rated the 10^th leading cause of death internationally. However, this varies significantly among countries. Studies reveal that an estimated 0.5% to 1.4% commits and die from suicide yearly. This accounts for 800,000 to one million people engaging in the practice annually. Thus, there has been a mortality rate increase of 60% over the past five years accounting for a mortality rate of 11.6 per 100,000 persons per year; a tremendous increase from the 1960s to 2012-2013. Most of these cases occur in developing countries (Meier & Clinard, 2008).

Importantly, statistics reveal that when a suicide death occurs approximately some 10 to 40 attempts have been made and were prevented. While suicide rates differ from one country to the next during various periods of history a review of the world’s 2008 statistics on suicide reveal that in China suicide is the 5^th l Southeast Asia 1.9%; Australia 8.6 per 100,000; India 23.2; United Kingdom 7.6.  Hungary; Lithuania, and Hungary carry the world’s highest suicide rates. United States of America maintained the 10^th suicide death international rating. Rates among men in their 50’s rose by 50% during 1999- 2009. Thirty six thousand people die due to suicide in America every year with approximately 650,000 attempted cases being seen at the emergency departments across the country (Aggarwal, 2009).

Kimberly Van Orden, Tracy K. Witte and Thomas E. Joiner (2010) developed the Interpersonal Theory of Suicide. The researchers posit that appropriate management of attempted suicide is lacking within the science since there are few theories explaining suicide. Consequently, they contend that the most dangerous form of suicidal desire is created by the simultaneous presence of two interpersonal constructs. They are ‘thwarted belongingness and perceived burdensomeness. These states predispose to hopelessness. Further, individuals committing suicide fail to connect their capability of actually engaging in suicidal behavior and their desire to commit the act (Van Orden, Witte & Joiner, 2010).

Theoretically, the capacity for suicidal behavior is created ‘through habituation and opponent processes’ (Van Orden et.al, 2010, p.  575). These sentiments according to the theorists emerge in response to perpetual physical painful exposure accompanied by fear-inducing experiences. They further advance that if these elements are taken into consideration suicides could be addressed from a more scientific basis. World health organization analysts reveal just two interventions have been useful in preventing deaths by suicide and only one form of psychotherapy is effective (Van Orden et.al, 2010) .

Researchers marvel at the inadequacy of evidence based knowledge pertaining to management of suicide in our society. Suicide is a menace just as crime and AIDs, but there are few theories supporting interventions. In this essay, the author will explore contemporary evidence based strategies used to treat both attempted suicide and suicide itself (Van Orden et.al, 2010).

It is my opinion that while theories explaining relevant interventions for suicide are limited from a nursing intervention perspective if hopelessness is responsible for quite a number of suicides and suicide attempts, applications of Dorothea Orem self-Care theory could be valuable in addressing persons who have suicide inclinations by replacing hope in their situation. The major assumption of this theory is that self-care is a primary human need. As such, nurses are expected to design interventions that provide self-care support actions for persons to either recover or maintain health. Consequently, the nurse has a responsibility of replacing hope during self-care interventions (Masters, 2011).

Literature Review: Suicide and Hope Intervention Strategies

Drs. Stephanie Daniel and David B. Goldston (2010) conducted research evaluating ‘Interventions for Suicidal Youth: A Review of the Literature and Developmental Considerations.’ Studies containing treatment in which ‘youth suicidal thoughts, suicide attempts, combined suicidal nonsuicidal self-harm behaviors, or participation in treatment for suicidal behaviors’ (Daniel & Goldston, 2010, p. 252 ) were retrieved from databases inclusive of PSYCHINFO and MEDLINE. Only articles published after July, 2008 were utilized in the review (Daniel & Goldston, 2010).

It was discovered that these studies could have been separated into two categories, especially if they were evaluating interventions that impact suicidal youth decisions. These two broad groups encompassed randomly assigned adolescent suicidal youth along with their families to an intervention under study or a comparison group. The second groups were non-randomly assigned adolescents to experimental or comparison condition, which can be classified a quasi-experimental studies. Researchers located five quasi experimental studies and seven randomized controlled trials (Daniel & Goldston, 2010).

Ultimately, researchers found that even though suicide in the society is a major public health concern, attempt at gathering data from controlled trials which would provide evidence based interventions was lacking. There were no profound recommendations regarding one intervention above another in the treatment of youths, with suicidal tendencies. More importantly most studies offered general interventions, but nonspecific to youths (Daniel & Goldston, 2010).

Inevitably, researchers had to admit in their summary that limited evidence currently exists regarding interventions’ effectiveness in reducing suicide attempts, generally. When the heterogeneity of adolescent suicide attempts is considered, it is anticipated that it is a one size fits all approach towards addressing the problem, which in the context of limited evidence based practice this might be the only solution to date.  In addition, it was recommended that based multiple developmental adolescent experiences, which could predispose to suicidal attempts interventions should focus of addressing developmental challenges (Wyman, Brown, Inman,  Cross, Schmeelk-Cone & Guo, 2008).

John Kasckow, Kandi Felmet, and Sidney Zisook (2011) conducted studies relating interventions Managing Suicide Risk in Patients with Schizophrenia. After conducting their review researchers concluded that in the case of  schizophrenic patients  psychosocial interventions proved beneficial along with pharmacological interventions specific to the disease, However, they contend that while a number of psychosocial approaches available as treatment intervention suicidal schizophrenic patients the degree of their effectiveness has not been researched to provide any profound scientific evidence based practice intervention (Kasckow, Felmet & Zisook, 2011)

From observation trials, it was discovered that an integrated approach applying more than one psychosocial modality has been the standard practice schizophrenic patients’ intervention protocol.  Precisely, they reported a 2-year trial, comparing the effectiveness of an integrated biomedical/psychosocial treatment to standard pharmacotherapy in the management schizophrenic patients expressing suicidal tendencies. The study supported integrated from not only the perspective of reducing suicide attempts or occurrences, but also as a strategy of improving treatment outcomes generally (Kasckow, et.al, 2011).

Alternative approaches cited related employment support, family intervention, education; returning to the community and participating in activities being more community based than institutionalized. Social skills training along with cognitive behavioural treatment were some psychosocial dynamics, which proved beneficial. Importantly, subsequent evaluations revealed that the intervention ultimately improved insight. Consequently, positive symptoms emerge dispelling depressive ones, which influenced suicidal behavior (Kasckow, et.al, 2011)

Drs. Anthony R. Pisani, Wendi, F. Cross, and Madelyn S. Gould (2011) conducted an evaluation pertaining to ‘The Assessment and Management of Suicide Risk: State of Workshop Education.’ The analysts conducted a systematic search for popular and scholarly databases to identify workshops, which focused on clinical competence pertaining to assessment/management of suicide risk in mental health populations. Their aim was to ‘describe the educational objectives and methods of the workshops; characterize the training and qualifications of the trainers who deliver the workshops; and review published studies about the training programs’ outcomes’ (Pisani, Cross & Gould, 2011, p. 255).

It was discovered that theoretically most of the workshops were valid in preparing mental health professionals for accurately assessing and managing suicide risk. However, the majority of clinicians evaluated the workshop programs relating that while valuable it was important to train professional specifically to intervene as suicide prevention strategist. Participants projected urgency in getting this done as soon as possible (Tompkins & Witt, 2009).

Nursing intervention hope strategies and self-care theoretical applications

Self-care theory comprises three divisions, which must be considered when being applied to a nursing issue. They are Theory of Self-Care; Theory of Self-Care Deficit and Theory of Nursing Systems. Further research embraces four concept- paradigms, which must be address when planning hope interventions for suicidal clients. They are first acknowledging the person; next the environment; health status of the patient/client and nursing capabilities of the interventionists.

Hope Intervention suicide strategy applying self-care theory

John Kasckow, Kandi Felmet, and Sidney Zisook (2011) discovered that an integrated approach was beneficial in restoring hope among schizophrenic suicide patents. Nurses could guide clients/patients into identifying aspects of health care deficits in their personality and body. Subsequently, referral to a specialist or agencies, which could address the issues identified, would be a very useful intervention. These strategies researchers revealed ultimately improved insight and hope was restored (Kasckow et. al, 2011).

In this particular case these clients’ health was challenged due to schizophrenic episodes. Nursing interventions had to be more from a specialist approach in restoring hope through self-care techniques. The environments, which are available facilities, must be recruited into supporting hope restoration through the nursing systems approach in self-care management. Drs. Anthony R. Pisani, Wendi, F. Cross, and Madelyn S. Gould (2011) confirmed that health care professionals especially nurses yearn for specialist training in suicide management separate from a psychiatric approach which is currently available (Pisani et.al, 2011).

Conclusion

In this essay, it was the author‘s intention to explore contemporary evidence based strategies used to treat both attempted suicide and suicide itself from a nursing intervention perspective. There is limited literature related to specific strategies which nurses ought to employ when faced with this dilemma. More importantly, Kimberly Van Orden, Tracy K. Witte and Thomas E. Joiner’s (2010)  attempt at developing the Interpersonal Theory of Suicide was evidence that there is currently no scientific basis relating nursing intervention for attempted suicide within the discipline (Van Orden et.al, 2010).

In the literature review there has been no single intervention for management of suicide among adolescents; schizophrenic and the general population of mental health clients across the country. Mental health clinicians are advocating development of education and ultimately certification towards training specialists in suicide attempts management. With the increasing suicide rates among adolescents, it is time public health goes beyond just classifying suicide a problem towards developing resources that can intervene effectively. Ultimately, an approach whereby  self-care nursing theory in attempts of restoring hope was highlighted as a valuable intervention from a nursing perspective.

References

Aggarwal, N (2009). Rethinking suicide bombing. Crisis 30 (2): 94–7

Daniel, S., & Goldston, D. (2009). Interventions for Suicidal Youth: A Review of the Literature and Developmental Considerations. Suicide Life Threat Behavior, 39(3); 252

Kasckow, J. Felmet, K., &  Zisook, S. (2011). Managing Suicide Risk in Patients with Schizophrenia. CNS Drugs,25(2);129-143

Masters, K. (2011). Nursing Theories: A Framework for Professional Practice. Sudbury, MA: Jones and Bartlett Learning, LLC.

Meier, B., & Clinard, F. (2008). Sociology of deviant behavior (14th edition). Belmont, CA: Wadsworth Cengage Learning

Sitzman,  L., & Eichelberger, L.  (2011). Understanding the Works of Nurse Theorists: A Creative Beginning (2nd ed.). Sudbury, MA: Jones and Barlett Learning, LLC.

Tompkins, T., & Witt, J.(2009)The short-term effectiveness of a suicide prevention gatekeeper training program in a college setting with residence life advisers. The Journal of Primary Prevention.  30:131–149.

Van Orden, K. Witte, T & Joiner, T. (2010). The Interpersonal Theory of Suicide. Psychology Review, 11(2); 575-600

Wyman, P. Brown, C. Inman, J. Cross, W. Schmeelk-Cone, K., & Guo, J. (2008).Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. Journal of Consulting and Clinical Psychology. 76:104–115