1. The client/caregiver can list general facts about suicide.
   1. It is the eighth leading cause of death.
   2. The suicide rate is increasing rapidly among adolescents.
2. The client/caregiver can list people at greater risk for suicide.
   1. There is a history of previous attempts.
   2. Men are four times more likely to die from suicide.
   3. There is a family history of suicide.
   4. There is a history of mistreatment as a child.
   5. There are feelings of hopelessness.
   6. There is a plan for committing suicide.
   7. The person is widowed, separated, divorced, or single.
   8. There is a job loss or failure.
   9. The person has physical health problems.
   10. There is drug or alcohol abuse.
   11. The person is living alone.
   12. There is a recent loss of a spouse, child, or pet.
   13. The person has a lack of social support system.
   14. There is a history of mental disorders, especially depression.
3. The caregiver can list signs and symptoms of impending suicide.
   1. Giving things away
   2. Refusing food
   3. Suddenly improving mood or attitude
   4. Feeling depressed and tearful
   5. Getting affairs in order
   6. Verbalizing death wish
   7. Collecting medications (hoarding medications)
4. The client/caregiver can list measures to identify or decrease the risk of suicide.
   1. Ask the client whether he or she has a plan for suicide.
   2. Remove any dangerous objects (i.e., guns, knives, and razors). Check supply of medication. Do they have more than a 1-week supply and/or hoarding medication?
   3. Discuss coping methods that have helped in the past.
   4. Discuss other possible coping methods. Help plan for alternative ways to handle anger or frustration.
   5. Identify two people to contact when feeling self-destructive.
   6. Implement a written no-suicide contract if needed.
   7. Encourage the client to take medications as ordered.
   8. Encourage the client to keep follow-up appointments.
   9. Contact family or friends. Arrange for crisis counseling.
   10. Arrange for hospitalization if the client is threatening suicide.
   11. Stay with the client who is at risk until in a safe environment.
   12. Activate contact with self-help groups. Encourage participation in support or therapy groups where others have similar experiences or thoughts.
   13. Develop skills in problem-solving, conflict resolution, and nonviolent handling of disputes.
   14. Discuss cultural and religious beliefs that discourage suicide.

Resource

National Center for Disease Control and Prevention Fact Sheet on Suicide
www.cdc.gov/ncipc/factsheets/suifacts.htm

Suicide Awareness Voices of Education
www.save.org/

Clergy

Mental health professional

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.
Hitchcock, J. E., Schubert, P. E., & Thomas, S. A. (2003). Community health nursing: Caring in action. Clifton Park, NY: Thomson Delmar Learning.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.
Varcarolis, E. M. (2006). Manual of psychiatric nursing care plans. St. Louis: Saunders Elsevier.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com