Note: This article was translated from Japanese using translation software. Please use at your own risk, as there may be unnatural points in the content or differences in content due to cultural differences.
Area 11 “Safety/Defense”
Category 3 Violence Use of excessive force or ability that results in injury or abuse
Risk for suicidal behavior
Nursing Diagnosis: Risk for suicidal behavior
Definition: Susceptibility to self-harm with some degree of intent to die
1. cause of suicide
Before formulating a plan, consider the causes of suicide.
Depending on where you live, the causes of suicide may differ, so please do your own research.
Here are the 2020 suicide trends in Japan.
(1) Annual changes in the number of suicides
・In 2003, the number was the highest at 34,000, and has been gradually declining since then.
・The number of male suicides is more than double that of females (2.3 times).
(2) Number of suicides by age
・There are many people in their 40s and 60s (around 3000).
・There are about 500 to 600 suicides among teenagers every year.
・Other generations are trending at the 2000 level.
(3) Number of suicides by occupation
・There are overwhelmingly many unemployed people, accounting for half of all suicides.
・ There are about twice as many suicides among unemployed people as there are employees.
・There are more than 800 suicides among students every year.
(4)Motives and causes of suicide
・Health problems are the most common, accounting for about half of all suicides.
· In descending order, health problems → financial problems → family problems → work problems.
It is imaginable that when one motive or cause occurs, it can develop into other problems in succession.
For example, let’s say you get sick. If you are unable to work, you will have the option of quitting your job. If you take a leave of absence or retire, you will not get a salary, so you will have financial problems. If you are single, you may be able to manage on your own, but if you have a family, your family will suffer. This can lead to family discord. You can also see that if these things hit you at once, you will corner yourself saying “I want to die already”.
But let’s support the surroundings so that it won’t be hasty.
2. Nursing Diagnosis ” Risk for suicidal behavior ” Indications:
The content overlaps with “Self-violence risk status”. The definition of self-violence risk state is “a state in which a person is likely to take actions that may harm themselves physically, emotionally, or sexually”.
・Interpersonal relationships (parents and children, family, friends, workplace)
・Economic reasons (debt, single parent, gambling addiction, financial hardship)
・Employment problems (unemployment, relegation, lack of results, failure at work)
Health problems (end of life, long-term chronic illness, mental illness)
・Managers (Executives, Senior Officials, Managers, Business Owners, Professionals)
・Actions suggestive of suicidal ideation: Posting on social media, remarks, withdrawal, writing a will, changing a will, giving up property or belongings, attempted suicide, impulsive, dejected behavior, purchasing a lethal weapon, hoard drugs,
・Acute phase and chronic phase of depression
・Domestic violence, broken family life, social isolation
・Isolation due to environmental changes (transfer, relocation)
・Change or loss of role (retirement, independence of child), helplessness
・Loss of important relationships, death of important others
・Experience of child abuse, suffering from gender identity disorder, suffering from homosexuality
・Young people living in different environments (juvenile training schools, prisons, rehabilitative training centers)
3. setting a goal
Goal setting by linkage (listed in the second half of the NOC)
* “Linkage” has the role of connecting “NANDA”, “NIC” and “NOC” (link means “connection”)
1) Linkage achievements
・Abstinence from suicide attempts (1408)
(Definition: Suicidal Attempts and Personal Actions to Deter Suicide Attempts)
・Self-harm restraint (1406)
(Definition: Behavior of an individual to refrain from intentional self-harm (non-fatal)
・Identity (self-identity) (1202)
(Definition: Distinguishing between self and others and understanding self’s essence)
・Personal health status (2006)
(Definition: General physical, psychological, social and spiritual health status of adults 18 years and older)
・Motivation to live (1206)
(Definition: desire, determination, effort to live)
・Family functions (2602)
(Definition: The ability of the family to meet their needs during the period of change associated with the attached rabbit)
The goal is to make the patient the subject.
Instead of saying “Nurses can do ○○”,
For example, “The patient will be able to do ○○.”
・Continuing counseling and treatment.
・You can find a new role and purpose in life.
• Describe what abuse is. If you have been abused, you can talk to someone you trust.
・Able to make a living using local social resources.
*Nurse goals include:
・Encourage the patient to accept the change in role (retirement or independence of the child) and gain a new sense of purpose in life.
・Help the patient to understand the disease, accept her condition and future course, and find a way to spend the rest of her life with no regrets. It also encourages the family to understand and help them acquire the means to support them.
• Patients with low self-efficacy and unidentified identity (eg, because of abuse) should be encouraged to seek counseling and help with identity acquisition.
・According to the treatment policy of doctors and counselors for children who are underage and self-harm.
・To help prevent recurrence in the environment surrounding the patient (system and human environment) by family and social resources, and to help each related organization cooperate and acquire knowledge.
4. nursing plan
1) Observation Plan 《OP》
We will draft an observation plan (OP) for each outcome of the linkage.
Suicide attempt self-restraint (symptoms of suicide attempt) 1408> Self-harm restraint 1406>
・ Expression of emotion ・ Expression of hope
・Isolation (lack of human relationships), environment where help is sought, personality
・Remarks about suicidal thoughts・Are you able to control yourself without supervision
・Disclose suicide plans ・Gather information on suicide methods ・Give personal belongings to others ・Inflict serious bodily injury
・ Accumulating oral medications ・ Intake status of oral medications (Are you taking them as prescribed?) ・ Using over-the-counter medications that cause mood swings
・ Mental instability due to substance abuse (drugs, alcohol, tobacco)
・Progress of treatment for depression ・Whether or not mental health services are being used
Identity: Identity 1202>
・Can you express yourself as such a person (do you have an established identity)
・ Do you show consistent language and non-verbal about yourself
・Are you able to express your own values in words?
・Have you established personal boundaries
・Are you fulfilling your social role?
Individual Health (Mental and Physical Health) 2006>
・Name of disease ・Painful treatment ・Stage of disease and stage of healing process ・Life expectancy ・Pain ・Symptoms
・ ADL (lower ADL due to illness → need someone’s help → feeling sorry) ・ Anxiety about the future ・ Burden on family ・ Things left unfinished
・ Emotional stability ・ Coping ability ・ Family cooperation
・Are you expressing your determination to live?・Are you expressing your hopes?・Are you constantly making pessimistic remarks?
・The other world of a close and important person
・ Changes in the environment (transfer/relocation)
・Loss of role (independence of child/retirement) ・Feeling of helplessness
・ Human relationships at school
・ Personality that can’t be said to be unpleasant ・ Feeling mental pain from being bullied
Family functions 2602>
・Understanding of the family’s medical condition (understanding of future progress and things that will be needed after returning home)
・Relationship with family (whether there is any discord)
・The patient’s behavior toward the family (whether the family was distressed by being violent, intimidating, or being hostile to the hostess)
・Family attachment to the patient
・Is the family knowledgeable about social resources?
・Whether there is a willingness to cooperate with the family to support recuperation life
・Whether family members have acquired nursing care skills to support recuperative life
2) Action plan 《TP》
・If your self-efficacy is low and you are pessimistic, saying, “I shouldn’t be here,” I will listen and accept it. Understand the background of such cases and act as a bridge to doctors and counselors.
・Tell them that no one is better off without them.
・For patients who are worried about the future due to illness, think together with their families about what they can do with the rest of their lives.
・If self-care is difficult due to lethargy, help with self-care. Take care of cleanliness.
・Improve the environment and do not leave weapons or chemicals within reach.
・If you have distressing symptoms such as pain, hallucinations, delirium, or dyspnea, report them to your doctor. In addition, efforts should be made to provide palliative care.
• If there is self-injury due to substance abuse (drugs, alcohol, tobacco), keep the subject substance away from the patient to avoid abuse.
3) Education plan 《EP》
・Encourage participation in self-help groups if substance abuse leads to mental instability and self-harm.
・Tell the patient that he or she will continue to receive medical care after being discharged from the hospital, and that he or she can consult experts such as “Ministry of Health, Labor and Welfare: Heart Dial 0570-064-556” when in trouble. Tell them that they don’t have to worry alone.
・Explain to the family the circumstances leading up to the self-injury and how they can be involved in preventing the recurrence of the self-injury, according to the doctor’s treatment plan. (Check if the doctor or counselor’s explanation is understood, and if they do not understand it correctly, encourage them to understand it correctly.)
・If you have lost your motivation to live due to an illness, etc., talk about the various options you have for the rest of your life, such as giving examples of people who are still living with purpose even after being notified, and increase their motivation to live. Involved so that you can have it.
Please refer to the diagnosis below.
T. Heather Hardman Shigemi Kamitsuru. (2016). NANDA-I Nursing Diagnosis Definition and Classification 2015-2017. Igaku Shoin.
Okaniwa, Yutaka. (2012). Review book for nurses and nursing students. Medic Media Co., Ltd.
Yutaka Okaniwa. (2019.3). Year Note 2020. Medic Media Co., Ltd.
Yuko Kuroda (Translation). (2015). Nursing Outcome Classification (NOC) Original 5th Edition Indicators and Measurement Scales for Measuring Outcomes. Elsevier Japan K.K.
Yamaguchi Toru, Kitahara Mitsuo, Fukui Tsuguya. (2012). Today’s treatment guidelines.
Yumiko Ohashi, Hajime Yoshino, Naoki Aikawa, Sumi Sugawara. (2008). Nursing Learning Dictionary (3rd Edition). Gakken Co., Ltd. (Gakken).
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