Identifying Patients Safety Risk for Suicide

The Joint Commission requires hospitals to follow certain standards for patient safety and positive outcomes. One of the safety issues that hospitals are required to promote is a safety risk for suicide, as described in the National Patient Safety Goals (NPSG) for suicide prevention. The NPSG was established to assist in identifying areas of concern with patient safety and enhance the quality and safety of care for any patient being treated for behavioral health conciliations and those identified as high risk for suicide (Canady, 2018). According to King, Horwitz,  Czyz, & Lindsay (2017), suicide often cuts short the lives of persons and leaves the survivors and those left behind struggling with grieving and efforts to understand the predicaments. In the US, suicide accounted for more than 42, 000 deaths in 2014 and is currently the 10th leading cause of death in the country. Globally, approximately 1 million people die from suicide (King et al., 2017). 

Research indicates that although suicide tragedy cuts across all groups regardless of age, sex, ethnicity or race, and geographical locations, males are four times likely to commit suicide than females. For many health care workers such as nurses, suicide presents the most feared outcome of a patient’s mental illness, thus making management of suicide vital to their everyday clinical practice. Additionally, more than 50 percent of psychiatrists have witnessed the death of their patients by suicide. As the prevalence of suicide increases every year, screening for suicide risk has become a crucial role of nurses in any healthcare setting. This paper intends to present the role of nurses in identifying patient’s risk factors for suicide, ethical concerns, and developing intervention strategies for suicide prevention.

The Importance of Screening for Suicide Risk

Statistics show that about 70% of all suicide cases reported are by hanging in healthcare facilities (King et al., 2017). Therefore, addressing ligature risks is the most crucial role played by nurses in hospitals. Nurses are responsible for identifying and removing risk or looping hazards from psychiatric units and the room of a patient on safety observation (Cherry & Jacob, 2019). These risks include loose linens, plastic garbage bags, belts, clothing ties, stretchers with open side rails, door handles, shower curtain rods, iv poles, lines, tubing, where they are not necessary for patient care (Canady, 2018). These facts show that healthcare nurses have a significant responsibility to play when it comes to the prevention of suicide via suicide risk screening with an accurate follow-up of positive screens. Research also indicates that healthcare facilities have little ability to predict suicide incidences because risk factors of suicide rating scales have produced no consistent definitive techniques to determine who will and who will not attempt to commit suicide (King et al., 2017). Therefore, the purpose of suicide screening is not to predict suicide but to assist healthcare workers to comprehend the sources of a patient’s suicidal behaviors and establish an informed intervention strategy for preventing suicide. 

Similarly, research indicates that there is no single factor or a combination of risk factors that can help predict or preclude incidences of suicide. However, attempting to assess a person’s risk by asking about suicidal thoughts, reviewing the risk factors, or utilizing clinical rating scales may help healthcare professionals to determine the next appropriate action such as discharge, medication, psychiatric referral, consultations, or hospitalization (Canady, 2018). In the process of talking to the patient and assessing the patient’s risk for suicide, one may begin to comprehend the patient’s sufferings, which is described as the most common denominator in suicide and maybe, an essential clue to heightened suicide risk. This exploration allows one to identify the potential risk factors for suicide that can be modified and the preventive factors for suicide that can be promoted. The factors range from socio-demographic and environmental factors, mental disorders, and physical illness. Therefore, nurses have the responsibility of identifying these factors and prevent the patient from being affected by the risk factors from committing suicide (Cherry & Jacob, 2019). Moreover, even though asking about suicidal thoughts is a necessity in identifying the factors, it is not enough to comprehend an individual’s potential risk for suicide. However, healthcare professionals still need to ask patients about suicide because some patients who deny suicidal thoughts or plans may still be at risk of committing suicide (Flynn et al., 2017). 

Ethical Principles Supporting Suicide Prevention

According to a moral perspective, suicide is wrong and should be prevented at all costs. As healthcare providers, nurses have a moral obligation and duty to protect life and prevent individuals from self-harm, such as committing suicide (Hom, Podlogar, Stanley, & Joiner, 2016). The protection of life entails an overriding value and takes precedence in decision-making. Even though suicide is criminalized in many countries, some countries have laws that oblige citizens to intervene and save persons at risk of losing their lives to suicide.  These laws may be invoked to justify the need to stop suicides by active interventions. According to the moralistic perspective, if a man who suffers a terminally painful illness is deemed to be at risk of self-harm, it is the legal right and ethical responsibility of healthcare workers to limit autonomy and hold protective custody to hold that individual for screening (Hom et al., 2016). 

Another example is where a nurse is taking care of an end-stage aggressive prostate cancer patient who expresses the suicide thoughts to the nurse and asks that the nurse to keep it a secret for him, the nurse can break the principle of confidentiality by following the principle of Non-maleficence which dictates that nurses have a duty to prevent harm to their patients (Jie, 2015). In this and cases, prevention of suicide is a clinical priority and legal protection even if intervention is technically unlawful because it limits the patient’s confidentiality. The nurse can break the principle of confidentiality and inform other healthcare workers of the patient’s suicidal ideation (Hom et al., 2016). The healthcare personnel can, therefore, limit the individual’s autonomy through involuntarily hospitalizing and enforcing treatment to the individual in an attempt to assess or prevent self-harm. According to Jie (2015), non-maleficence gives support to the beneficence principle, which supports treatment aimed at restoring a patient’s autonomy by dictating that nurses have a duty to provide benefits to the interest of the patient under consideration.  

Nursing Intervention and Prevention

Suicide can be prevented via different interventions. The prevention interventions include identification of risk factors, stressors, and acute triggers for suicide and comprehending protective factors and developing interventions as per the socio-demographic conditions of the patient (King et al., 2017). Notably, the risk factors for suicide are universal; however, their importance and nature differ across countries and cultures. In this case, the nursing intervention is to place the patient at risk for suicide on Suicide or Homicide observation (Flynn et al., 2017). In this prevention intervention, if the patient has attempted suicide in the past but has no current plan or ideation to do so again, it is crucial to notify the healthcare facility to determine if any level of observation is required. Moreover, any patient admitted due to a suicide attempt must have a psychiatric consult ordered and completed within 24 hours of admission. 

In this intervention, the RN performs the initial risk assessment and reports to the MD. The MD is responsible for further evaluating patients who are identified to be at risk and orders psychiatric consult as required. Unlicensed Assistive Personnel is responsible for direct observation of patients and notifying RN of potentially threatening or unsafe behaviors (Cherry & Jacob, 2019). Therefore, nurses in psychiatric hospitals and psychiatric units in general hospitals must perform an environmental risk assessment that identifies various aspects of the physical environment that could be utilized to attempt suicide. Nurses need to take necessary actions to minimize the risks such as removing anchor points, door hinges, and hooks that can be utilized for hanging. However, many other types of hazards exist, so it is vital to conduct a thorough assessment of the environment to reduce all potential suicide risk factors. 

Overall, nurses have a duty to ensure that NPSG regulations concerning suicides are strictly followed to prevent the rising incidences of suicides in psychiatric mental hospitals. Suicide risk assessment is a key responsibility of nurses in the management of suicide cases. Through risk safety assessment, nurses can identify the risk factors that need to be eliminated around the patient and those that need to be promoted. However, in the process of safety risk prevention, nurses encounter ethical dilemmas that must be addressed. Nurses need to consider ethical principles that support suicide prevention. Lastly, developing appropriate intervention prevention strategies is crucial in the prevention of incidences of suicides.

References

Canady, V. A. (2018). Joint Commission announces new National Patient Safety Goal. Mental Health Weekly, 28(46), 5-5.

Cherry, B., & Jacob, S. R. (2019). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.

Flynn, S., Nyathi, T., Tham, S. G., Williams, A., Windfuhr, K., Kapur, N., ... & Shaw, J. (2017). Suicide by mental health in-patients under observation. Psychological medicine, 47(13), 2238-2245.

Hom, M. A., Podlogar, M. C., Stanley, I. H., & Joiner Jr, T. E. (2016). Ethical issues and practical challenges in suicide research. Crisis.

Jie, L. (2015). The patient suicide attempt–An ethical dilemma case study. International Journal of Nursing Sciences, 2(4), 408-413.

King, C. A., Horwitz, A., Czyz, E., & Lindsay, R. (2017). Suicide Risk Screening in Healthcare Settings: Identifying Males and Females at Risk. Journal of clinical psychology in medical settings, 24(1), 8–20. https://doi.org/10.1007/s10880-017-9486-y