NUR 256
EXAM 3 STUDY GUIDE
Concepts of Mental Health Nursing
Galen College of Nursing
, Review for Exam 3
Chapter 25: Suicide and Non-Suicidal Self-Injury
Suicide
o Intentional act of killing oneself by any means
Tenth leading cause of death
Fourth leading cause of death among children 10 to 14 years of age
Third leading cause of death in 15 to 24 age group
Fourth leading cause of death in 25 to 44 age group
Eighth leading cause of death in 45 to 64 age group
Risk Factors
o Psychiatric disorders
o Alcohol or substance use disorders
o Male gender
o Increasing age
o Race (Caucasian=higher risk)
o Religion
o Marriage
o Profession
o Physical health
Biological Factors
o Suicidal behavior tends to run in families
o Low serotonin levels are related to depressed mood
Depression increases risk
Psychosocial Factors
o Freud—aggression turned inward
o Menninger
Wish to kill
Wish to be killed
Wish to die
o Aaron Beck—central emotional factor is hopelessness
o Recent theories—combination of suicidal fantasies and significant loss
Cultural Factors
o Protective factors
African Americans
Religion, role of the extended family
Hispanic Americans
Roman Catholic religion and importance
of extended family
Asian Americans
, Adherence to religions that tend to emphasize interdependence
between the individual and society
Societal Factors
o Oregon’s Death with Dignity Act of 1994—terminally ill patients allowed
physician-assisted suicide
o Washington state—physicians can prescribe lethal medication
o Netherlands—nonterminal cases of “lasting and unbearable” suffering
o Belgium—nonterminal cases when suffering is “constant and cannot be
alleviated”
o Switzerland—assisted suicide legal since 1918
Terminal illness – prescription for at home to OD, or hospital euthanizing
Application of the Nursing Process
o Assessment
Verbal and nonverbal clues
Overt statements
o “I can’t take it anymore”
o Life isn’t worth living anymore”
o I wish I were dead”
o Everyone would be better off if I died”
Covert statements
o “It’s okay now. Soon everything will be fine”
o “Things will never work out”
o “I won’t be a problem much longer”
o “Nothing feels good to me anymore and probably never
will”
o “How can I give my body to medical science”
ASK: “DO YOU HAVE A PLAN OF HARMING
YOURSELF?” “HAVE YOU EVER FELT THAT LIFE WAS
NOT WORTH LIVING?” “
Lethality of suicide plan
Gun most lethal
Hanging
Cutting
Overdosing on medications
CO2 poisoning
Assessment tools
Previous attempts?
SAD PERSONS scale
o Tells how likely someone is to commit suicide
Self-assessment
Case Study
o You are worried about a close friend who recently broke up with a boyfriend. She
is taking the breakup very hard and seems depressed.
o What are some questions you could ask to assess for suicide ideation?
EXAM 3 STUDY GUIDE
Concepts of Mental Health Nursing
Galen College of Nursing
, Review for Exam 3
Chapter 25: Suicide and Non-Suicidal Self-Injury
Suicide
o Intentional act of killing oneself by any means
Tenth leading cause of death
Fourth leading cause of death among children 10 to 14 years of age
Third leading cause of death in 15 to 24 age group
Fourth leading cause of death in 25 to 44 age group
Eighth leading cause of death in 45 to 64 age group
Risk Factors
o Psychiatric disorders
o Alcohol or substance use disorders
o Male gender
o Increasing age
o Race (Caucasian=higher risk)
o Religion
o Marriage
o Profession
o Physical health
Biological Factors
o Suicidal behavior tends to run in families
o Low serotonin levels are related to depressed mood
Depression increases risk
Psychosocial Factors
o Freud—aggression turned inward
o Menninger
Wish to kill
Wish to be killed
Wish to die
o Aaron Beck—central emotional factor is hopelessness
o Recent theories—combination of suicidal fantasies and significant loss
Cultural Factors
o Protective factors
African Americans
Religion, role of the extended family
Hispanic Americans
Roman Catholic religion and importance
of extended family
Asian Americans
, Adherence to religions that tend to emphasize interdependence
between the individual and society
Societal Factors
o Oregon’s Death with Dignity Act of 1994—terminally ill patients allowed
physician-assisted suicide
o Washington state—physicians can prescribe lethal medication
o Netherlands—nonterminal cases of “lasting and unbearable” suffering
o Belgium—nonterminal cases when suffering is “constant and cannot be
alleviated”
o Switzerland—assisted suicide legal since 1918
Terminal illness – prescription for at home to OD, or hospital euthanizing
Application of the Nursing Process
o Assessment
Verbal and nonverbal clues
Overt statements
o “I can’t take it anymore”
o Life isn’t worth living anymore”
o I wish I were dead”
o Everyone would be better off if I died”
Covert statements
o “It’s okay now. Soon everything will be fine”
o “Things will never work out”
o “I won’t be a problem much longer”
o “Nothing feels good to me anymore and probably never
will”
o “How can I give my body to medical science”
ASK: “DO YOU HAVE A PLAN OF HARMING
YOURSELF?” “HAVE YOU EVER FELT THAT LIFE WAS
NOT WORTH LIVING?” “
Lethality of suicide plan
Gun most lethal
Hanging
Cutting
Overdosing on medications
CO2 poisoning
Assessment tools
Previous attempts?
SAD PERSONS scale
o Tells how likely someone is to commit suicide
Self-assessment
Case Study
o You are worried about a close friend who recently broke up with a boyfriend. She
is taking the breakup very hard and seems depressed.
o What are some questions you could ask to assess for suicide ideation?
