Youth at Risk - Suicide and Self-Harm

[traumaRUs, MSN, APRN]

Suicidal and suicide attempt survivors require special care. This is even truer in a pediatric ICU (PICU). Feri Kiani, MSN, PHN, CCRN, RRT, NPS and Sandra Lee, MSN, RN, CCRN recently presented the topic: Youth at risk for Self-Harm and Suicide.

Tools for the Bedside Nurse

allnurses.com's Content and Community Director, Mary Watts, BSN, RN interviewed the two presenters. She asked what was the impetus for this presentation? They answered that this was initiated by bedside nurses concerned about their suicidal and suicide attempt patients. This was the first project the education dept wanted them to tackle. Of course, medical needs need to be met first, but once they are met, patients need to have further psychiatric care. However, there was often a delay with transferring them. The goal was to give the bedside nurse tools to deal with the post-acute suicide attempt patient. They looked at numbers and suicide is the second leading cause of death for children. The goal was to provide a therapeutic environment for these children post-suicide attempt while they await placement.

Risk Factors

They identified some risk factors for youth suicide attempts:

• Previous suicide attempts
• Previous mental health issues
• Family history of suicide
• Stressful family situations
• Knowledge of close friends, family or classmates that have attempted suicide
• Access to weapons
• Peer pressure

Protective Measures

And they also identified protective measures that fight against risk for suicide:

• Involved in school
• Good coping skills
• Connected with school/community
• Feel valued in their environment
• Engaged in activities

Family engagement was also very important, they stated and said that the families can refocus and emphasize the positives in the patient's life. In pediatric nursing, the family is also cared for and is an extension of the patient.

Staff Education

Another issue they discussed was the staff nurses perception of these patients and how to provide education to deal with these situations? Some of the solutions included role-playing, suggestions for therapeutic communication and tools for dealing with these patients.

They integrated this education into the annual competencies. Role-playing occurred in the skills fair which is held once/year. The unit psychiatrist and social workers facilitated this station. The number of patients that fall into the self-harm or suicide attempt diagnoses is fortunately rare but very stressful for the PICU staff. The nurses felt awkward and were fearful they would say the wrong thing and further stress the patient. However, the skills fair role-playing provided a safe outlet to verbalize and practice these communication skills.

There was also a survey and found that nurses can be judgemental and unfortunately their behavior can reflect this. However, once they learn more, they develop more compassion and better-coping skills to deal with this patient subset.

[NotReady4PrimeTime, RN]

For me, caring for the family was harder than caring for the patient. Especially when the suicide attempt was *almost* successful. Over the years I was assigned to care for several teenagers who'd attempted suicide by hanging. All of them were left with significant anoxic brain injuries, meaning full-time, ongoing personal care would be required. In some ways, the death of their child would have been the most merciful outcome. Watching as each tiny glimmer of hope was snuffed out and the enormity of the changes the family faced began to sink in was very difficult emotionally and psychologically.

Taking part in family conferences took a lot of effort, because I knew none of what was said was truly understood. One such meeting stands out in my memory: there were no signs of brain activity but it was still too early to consider assessing for brain death. The mom was ready to let go, the dad very close to being there, but the physician insisted we wait until 72 hours had elapsed. And in that brief interval, the window slammed shut... spontaneous respiratory effort returned. But that was ALL that returned. This poor family was dragged through 10 years of waiting for the inevitable. They were never able to take their child home and weren't equipped to provide that necessary care and when death finally came, it was within the walls of a long-term care facility. It's heartbreaking.

My experience with the child and adolescent mental health system has left me quite jaded. Too many of these young people are returned fairly quickly to the exact situations they were trying to escape, with few real tools to effect change in their coping. Another memory from years past reminds me of a young man so unhappy with his life at the age of 12 that he hanged himself; he was found before he lost his pulse and was revived. A year later, he stole a truck and crashed it into a tree; this time he was left paralyzed from the waist down. His subsequent attempts all involved drug overdoses. The shrink-du-jour would come talk to him, they'd hold him for a few days, then send him home. By the time he aged out of pediatrics he'd made SEVEN attempts to die. I'm not sure that he hasn't succeeded. At what point does the "system" take responsibility for this parade of horror?

[traumaRUs, MSN, APRN]

These patients take such a toll on themselves and their caregivers.

A close friend lost her adult child to suicide and she never recovered - neither has her family.

In the ED, we cared for many "near misses" and some "successful" suicides - agree with above poster, the families were so much harder to care for then the pt.