Comprehensive Discussion Essay on Suicide and Risk Factors

CLASSMATE 1

What are some risk factors for suicide?

            Sadly, suicide is a serious problem worldwide, with an annual global age-standardized suicide rate of 11.4 per 100 000 population (Choo et al., 2019). Many factors contribute to suicide risk, such as the following: hopelessness, pessimism, previous suicide attempt, history of depression and other mental illnesses, serious illness such as chronic pain, criminal/legal problems, job/financial problems or loss, impulsive or aggressive tendencies, substance misuse, current or prior history of adverse childhood experiences, mental disorders. Most studies agree that suicide is closely linked to mental disorders, previous suicide attempts, personality characteristics, family factors, specific life events-traits, contagion-imitation, and availability of means (Choo et al., 2019).(Comprehensive Discussion Essay on Suicide and Risk Factors)

Protective factors?

            According to Elbogen et al. (2020), mental health services should involve reducing symptoms as well as teaching skills to improve functioning at home, work, and social environments. Clinicians need to focus on an individual’s competence in various domains of basic functioning (financial management, ability for self-care) and well-being (social, psychological, and spiritual) (Elbogen et al., 2020). Major protective factors for suicide include the following: effective mental and behavioral health care, connectedness, problem-solving skills, and contacts with caregivers, connectedness to individuals, family, community, and social institutions, life skills (including problem solving skills and coping skills, ability to adapt to change), self-esteem and a sense of purpose or meaning in life, identify and assist patients at risk, respond effectively to individuals in crisis, ensure access to effective mental health and suicide care and treatment, and support safe care transitions and create organizational linkages (Elbogen et al., 2020).(Comprehensive Discussion Essay on Suicide and Risk Factors)

How will you ask patients and what will your response be?

            Addressing the topic of suicide can be a cumbersome and challenging task that requires a skilled approach. It is important to utilize an approach that is intentional and effective for identifying the risk or intentions of suicide, but the provider also have to be prepared to address the topic appropriately. According to Horowitz et al. (2013), the following questions are appropriate and effective to utilize with patients:  (Comprehensive Discussion Essay on Suicide and Risk Factors)

1.      Have you wished you were dead or wished you could go to sleep and not wake up?(Comprehensive Discussion Essay on Suicide and Risk Factors)

2.      Have you actually had any thoughts about killing yourself? If the loved one answers “yes” to question 2, ask questions 3, 4, 5 and 6. If the person answers “no” to question 2, go directly to question 6.(Comprehensive Discussion Essay on Suicide and Risk Factors)

3.      Have you thought about how you might do this?

4.      Have you had any intention of acting on these thoughts of killing yourself, as opposed to you have the thoughts but you definitely would not act on them?(Comprehensive Discussion Essay on Suicide and Risk Factors)

5.      Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?

6.      Always ask question 6: In the past three months, have you done anything, started to do anything, or prepared to do anything to end your life?(Comprehensive Discussion Essay on Suicide and Risk Factors)

To further probe, following the patient’s confirmed response, I would respond with some of the following examples: have you collected pills; obtained a gun, given away valuables, written a will or suicide note, held a gun but changed your mind, cut yourself, tried to hang yourself.(Comprehensive Discussion Essay on Suicide and Risk Factors)

What are some strategies being implemented at a state level or national level to help reduce suicide attempts?

            Since 1999, Iskander and Crosby (2021) state that the Office of the United States Surgeon General has identified suicide prevention as a national public health priority. In 2021, the Surgeon General’s office released a Call to Action that fully implement a national strategy; which consists of six core types of actions to prevent suicide that include adopting a broad public health approach, addressing upstream factors including social determinants of health, reducing access to multiple forms of lethal means, adopting evidence-based care for persons at risk, enhancing crisis care and care transitions, and improving the quality and use of suicide-related data (Iskander & Crosby, 2021). A multisector and whole government approach, using contemporary evidence-informed approaches and best practices as well as innovative methods including those based on predictive analytics is required (Iskander & Crosby, 2021).(Comprehensive Discussion Essay on Suicide and Risk Factors)

Think about quality improvement programs and some critical thinking skills on your part when assessing these patients.

            Some critical thinking skills and strategies health care providers need to utilize when assessing suicidal patients consist of leaning inward near the patient when starting the conversation, knowing your resources, get comfortable with feeling uncomfortable, create a safe space, practice active listening, ask open-ended questions, and start the conversation with “I’ve noticed….” wrap up the conversation by thanking the patient for taking time to speak with you, and list the observations you’ve made that led you to be concerned (National Alliance on Mental Illness [NAMI], 2019). A quality improvement programs such as the Zero Suicide is a data-driven model to ensure improved patient outcomes and better care for those at risk of suicide or the Translating Initiatives for Depression into Effective Solutions (TIDES) is an evidence-based, quality improvement intervention for depression, with an inclusive component of suicide prevention that is aiding in providing great care to the public (Rubenstein et al,, 2010).(Comprehensive Discussion Essay on Suicide and Risk Factors)

References

Choo, C. C., Harris, K. M., Chew, P., & Ho, R. C. (2019). Clinical assessment of suicide risk and suicide attempters’ self-reported suicide intent: A cross sectional study. PloS One, 14(7), e0217613. https://doi.org/10.1371/journal.pone.0217613Links to an external site.(Comprehensive Discussion Essay on Suicide and Risk Factors)

Elbogen, E. B., Molloy, K., Wagner, H. R., Kimbrel, N. A., Beckham, J. C., Van Male, L., Leinbach, J., & Bradford, D. W. (2020). Psychosocial protective factors and suicidal ideation: Results from a national longitudinal study of veterans. Journal of Affective Disorders, 260, 703–709. https://doi.org/10.1016/j.jad.2019.09.062Links to an external site.(Comprehensive Discussion Essay on Suicide and Risk Factors)

Iskander, J. K., & Crosby, A. E. (2021). Implementing the national suicide prevention strategy: Time for action to flatten the curve. Preventive Medicine, 152(Pt 1), 106734. https://doi.org/10.1016/j.ypmed.2021.106734Links to an external site.

Horowitz, L. M., Snyder, D., Ludi, E., Rosenstein, D. L., Kohn-Godbout, J., Lee, L., Cartledge, T., Farrar, A., & Pao, M. (2013). Ask suicide-screening questions to everyone in medical settings: The asQ’em Quality Improvement Project. Psychosomatics, 54(3), 239–247. https://doi.org/10.1016/j.psym.2013.01.002Links to an external site.(Comprehensive Discussion Essay on Suicide and Risk Factors)

National Alliance on Mental Illness [NAMI]. (2019, September 06). How to ask someone about suicide. https://www.nami.org/Blogs/NAMI-Blog/September-2019/How-to-Ask-Someone-About-SuicideLinks to an external site.

Rubenstein, L. V., Chaney, E. F., Ober, S., Felker, B., Sherman, S. E., Lanto, A., & Vivell, S. (2010). Using evidence-based quality improvement methods for translating depression collaborative care research into practice. Families, Systems & Health: The Journal of Collaborative Family Healthcare, 28(2), 91–113. https://doi.org/10.1037/a0020302(Comprehensive Discussion Essay on Suicide and Risk Factors)

CLASSMATE 2

Suicide rates have increased over the years. Suicide is associated with both risk and protective factors. These factors can be fixed or variable. Risk factors can be thought of as elements that weaken support or make it difficult to access resources, whereas protective elements fortify and safeguard, or function as a buffer against risk factors (Blisen, 2018; cited in Kedar, 2021). Although most individuals that have successfully completed suicide may not have verbalized suicidal thoughts or exhibited any warning signs prior to doing so, they have associated factors that put them at risk. These risk factors can indicate that a person has an increased susceptibility  of being suicidal or have suicidal ideation. Some of these risk factors include substance use or abuse, increased stress levels, physical illness, depression and other mental illnesses, trauma or abuse history, bullying, relationship problems, financial problems, and grief and loss. Suicide can also be a genetic issue, therefore, individuals with a family history of suicide have an increased risk of suicide. Individuals with previous suicide attempts have a higher risk of additional attempts. According to the National Alliance on Mental Illness (NAMI) (2022) research reveals that 46% of individuals that have completed suicide had a diagnosed mental health condition.(Comprehensive Discussion Essay on Suicide and Risk Factors)

Protective factors are those that make bad things less likely to happen or lessen the effects of risk factors and are thought of as being beneficial countering circumstances (Substance Abuse and Mental Health Services Administration, n.d.). When assessing suicide, it is best to ask the patient if they are having thoughts of suicide or suicide intent. A provider’s response is highly dependent on the individual’s answer. If an individual admits that they desire to end their life by suicide, NAMI suggests expressing gratitude, ensuring the person that they are in a partnership and will work together, and offering hope, are important.(Comprehensive Discussion Essay on Suicide and Risk Factors)

Many state and federal suicide prevention programs have been implemented to decrease suicide rates. According to Iskander and Crosby (2021) safety plans and clinical pathways have been developed for patients screened and determined to have elevated suicide risk, in addition to increasing clinical training, increasing trusted contacts for those experiencing suicidal crises, as well as improving methods to identify at-risk individuals when they receive healthcare services. When suicide occurs, it not only affects that person, but also impacts families and communities. Emphasis should be placed on approaches to avert suicide and create protective tactics that are beneficial for individuals, their families, as well as their communities. Providers must utilize critical thinking skills when performing suicide assessments. Quality improvement is vital as it relates to preventing suicide and assessing patients for suicide. In order to better inform national policy, Joint Commission intends to improve its method for gathering sentinel event data on suicides improvements being made to this persistent safety concern (Williams et al., 2018). Assessments must be geared at asking the right questions to elicit responses. Providers must be able to further explore vague answers to obtain more information. Critical thinking skills are vital when interpreting risk assessments.(Comprehensive Discussion Essay on Suicide and Risk Factors)

References

Iskander, J. K., & Crosby, A. E. (2021). Implementing the national suicide prevention strategy: Time for action to flatten the curve. Preventive Medicine, 152(1), 1-5. https://doi.org/10.1016/j.ypmed.2021.106734(Comprehensive Discussion Essay on Suicide and Risk Factors)

Kedar, T. (2021). Suicide and suicide risk factors: A literature review. Asian Journal of Nursing Education and Research, 11(3), 441-446. https://doi.org/10.52711/2349-2996.2021.00107(Comprehensive Discussion Essay on Suicide and Risk Factors)

National Alliance on Mental Health (2022). Risk of suicide. https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Risk-of-Suicide

Substance Abuse and Mental Health Services Administration. (n.d.). Risk and protective factors. https://www.samhsa.gov/sites/default/files/20190718-samhsa-risk-protective-factors.pdf(Comprehensive Discussion Essay on Suicide and Risk Factors)

Williams, S. C., Schmaltz, S. P., Castro, G. M., & Baker, D. W. (2018). Incidence and method of suicide in hospitals in the united states. The Joint Commission Journal on Quality and Patient Safety, 44(11), 643-650. https://doi.org/10.1016/j.jcjq.2018.08.002

CLASSMATE 3

Even though it was difficult for me over these eight weeks, I managed to finish my DNP Practicum Readiness Form. In the first week, we discovered that a practice gap is a problem or shortcoming in nursing practice that offers room for improvement. I worked on creating a purpose statement and looked at the stakeholders who would be impacted by the practice change I proposed for weight control. The US Preventive Services Task Force (USPSTF) recommendation, which names the 5A’s model and its MI principles as successful behavioral weight loss treatments that primary care practitioners can utilize, is one of the most important clinical guidelines for weight management (Mangione et al., 2022). The 5As is a global model of behavior modification that uses five steps—Ask, Assess, Advise, Agree, and Assist—to encourage healthy behaviors. It begins with the healthcare needs of the patient and moves through several stages before achieving sustained behavior modification (Sturgiss & Van Weel, 2017). I built my PICOT question in weeks two and three and concentrated on the literature’s support for a solution to a practice gap. Week 4 taught me about copyrights and the need for authorization when utilizing an evaluation tool that isn’t in the public domain. The 5As model is an open-access public domain intervention. Therefore, using the framework won’t result in any copyright concerns or need for prior approval. I learned about the Institutional Review Board (IRB) and the need of protecting people throughout weeks 5, 6, and 7. I learned how crucial it is to accurately and honestly enter practicum hours in each Project & Practicum course in order to fulfill the mandatory practicum hours. I obtained a certificate of completion after completing the CITI training. I also learned how essential clinical preceptors are in this process. Clinical preceptors are the cornerstone of NP education since they are crucial to the growth of advanced clinical reasoning skills, which are largely developed and refined during clinical practicums (Todd et al., 2019). Now that we are at week 8, despite the challenges, I can see how much I have learned from this course. Thank you!(Comprehensive Discussion Essay on Suicide and Risk Factors)

References

Mangione, C. M., Barry, M. J., Nicholson, W. K., Cabana, M., Coker, T., Davidson, K. W., Davis, E. M., Donahue, K. E., Jaén, C., Kubik, M., Li, L., Ogedegbe, G., Pbert, L., Ruiz, J. M., Stevermer, J., & Wong, J. B. (2022). Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults without cardiovascular disease risk factors. JAMA, 328(4), 367. https://doi.org/10.1001/jama.2022.10951Links to an external site.(Comprehensive Discussion Essay on Suicide and Risk Factors)

Sturgiss, E., & van Weel, C. (2017). The 5 as framework for obesity management: Do we need a more intricate model? Canadian family physician Medecin de famille canadien, 63(7), 506–508. https://europepmc.org/articles/PMC5507219?pdf=render (Links to an external site.)

Todd, B. A., Brom, H., Blunt, E., Dillon, P., Doherty, C., Drayton-Brooks, S., Hung, I., Montgomery, K., Peoples, L., Powell, M., Vanacore, D., Whalen, D., & Aiken, L. (2019). Precepting nurse practitioner students in the graduate nurse education demonstration: A cross-sectional analysis of the preceptor experience. Journal of the American Association of Nurse Practitioners, 31(11), 648–656. https://doi.org/10.1097/jxx.0000000000000301(Comprehensive Discussion Essay on Suicide and Risk Factors)

CLASSMATE 4

Analyze and evaluate how your thinking was challenged in this course related to the role of a DNP-prepared nurse in using evidence from the literature to implement practice change and improve practice outcomes.

This course was tremendously helpful in moving from the abstract to the concrete. I continued to further research the practice problem of nurse burnout, and job stress related to the pandemic and possible evidenced based practice (EBP) interventions to address this issue. I narrowed down my intervention to the Stress Management and Resiliency Training (SMART): A Relaxation Response Resiliency Program developed by researchers at the Benson Henry Research Institute out of Massachusetts General Hospital (Benson-Henry Institute, 2022).(Comprehensive Discussion Essay on Suicide and Risk Factors)

I felt the Citi training provided a much better understanding of the IRB process and the responsibilities of the DNP-prepared nurse to implement their EBP intervention into practice. It was interesting to consider the ethics of beneficence and non-maleficence and the possible adverse effects of what I considered a benign practice change with a mindfulness program. I discovered that people with a history of trauma, suicidality, and psychosis are at higher risk of worsening depression and anxiety (Baer et al., 2019), and that will impact my exclusion criteria to ensure the safety of participants while still balancing the possible benefit.(Comprehensive Discussion Essay on Suicide and Risk Factors)

Considering this new knowledge, examine how this learning prepares you to practice as a DNP-prepared nurse.

I feel that I will be better able to mentor and guide nurses on the importance of evidenced-based practice and how to conduct literature searches and implement research into practice. EBP mentorship has proven to be essential in building and promoting a culture of EBP (Schuler et al., 2021). EBP is linked to increased nursing satisfaction and retention (Schuler et al., 2021).(Comprehensive Discussion Essay on Suicide and Risk Factors)

References

Baer, R., Crane, C., Miller, E., & Kuyken, W. (2019, July). Doing no harm in mindfulness-based programs: Conceptual issues and empirical findings. Clinical Psychology Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6575147/Links to an external site.(Comprehensive Discussion Essay on Suicide and Risk Factors)

Benson-Henry Institute. (2022, February 9). Services – Stress Management and Resiliency Training – Benson Henry Institute.  https://bensonhenryinstitute.org/Links to an external site.(Comprehensive Discussion Essay on Suicide and Risk Factors)

Schuler, E., Mott, S., Forbes, P. W., Schmid, A., Atkinson, C., & DeGrazia, M. (2021). Evaluation of an evidence-based practice mentorship programme in a paediatric quaternary care setting. Journal of Research in Nursing, 26(1-2), 149–165. https://doi.org/10.1177/1744987121991417Links to an external site.(Comprehensive Discussion Essay on Suicide and Risk Factors)

Comprehensive Discussion Essay on Suicide and Risk Factors-Responses

Response to Classmate 1

Hello,

Thank you for the great post. I concur that suicide significantly contributes to death worldwide, affecting individuals of all ages, particularly young adults. One of the primary contributing factors to suicide is substance addiction. Alcoholism and other drug addiction have been identified as significant risk factors for suicide over a range of more suicidal actions, from ideation and attempt to actual suicide. Other factors at the individual and socio-contextual levels undoubtedly have a role in the link between substance addiction and suicidality in treatment, even though neglect of suicide risk factors may help to explain some of it (Espinet et al., 2019). Factors contributing to suicide among substance users include past suicidal thoughts, suffering, social loneliness, and hopelessness. I concur that it is vital to inquire about intent and plan when assessing for suicidal behavior. The clinician should ensure high-level sensitivity and a non-judgmental attitude during patient assessment.(Comprehensive Discussion Essay on Suicide and Risk Factors)

Reference

Espinet, S., Corrin, T., Baliunas, D., Quilty, L., Zawertailo, L., Rizvi, S. J., deRuiter, W., Bonato, S., De Luca, V., Kennedy, S., & Selby, P. (2019). Predisposing and protective factors influencing suicide ideation, attempt, and death in patients accessing substance use treatment: a systematic review and meta-analysis protocol. Systematic reviews, 8(1), 115. https://doi.org/10.1186/s13643-019-1028-2

Response to Classmate 2

Hello,

Your discussion is informative. I concur that suicide rates have increased significantly over the years. The leading non-natural cause of death among teenagers and young adults globally is suicide. Additionally, it contributes significantly to years of life-long disability and untimely death. In addition to the evidence on prevalence during this developmental stage, there are other reasons why addressing suicidal behavior in adolescents is essential. Emotional and behavioral challenges, prosocial behavior, subjective well-being, self-esteem, depressive symptomatology, academic performance, socioeconomic position, school participation, bullying, and cyberbullying are all associated with suicide behavior (Fonseca-Pedrero et al., 2022). I agree that quality improvement programs are essential in optimizing the results of suicide prevention. In addition to the many state and federal suicide prevention programs implemented to decrease suicide rates, it is imperative to incorporate contemporary approaches such as social media in suicide prevention. This can be through creating awareness of the link between contributing factors such as substance use or abuse, increased stress levels, physical illness, depression and other mental illnesses, trauma or abuse history, bullying, relationship problems, financial problems, and grief and suicide and how to addresses such life-changing challenges.(Comprehensive Discussion Essay on Suicide and Risk Factors)

Reference

Fonseca-Pedrero, E., Al-Halabí, S., Pérez-Albéniz, A., & Debbané, M. (2022). Risk and Protective Factors in Adolescent Suicidal Behaviour: A Network Analysis. International journal of environmental research and public health, 19(3), 1784. https://doi.org/10.3390/ijerph19031784(Comprehensive Discussion Essay on Suicide and Risk Factors)

Response to Classmate 3

Hello,

The eight weeks have presented multiple challenges, but course completion was successful. The practicum change project offered a significant challenge to adopt course concepts in addressing a healthcare or nursing problem. The first week involved identifying a practice gap or an issue in nursing practice that requires changes or improvement. I also developed the purpose statement in the first week and identified core stakeholders for the project. The following weeks involved identifying, developing, and implementing an intervention to address the practice gap. The first step in a successful intervention is recognizing users and identifying the right interventions based on the patient’s willingness to quit. I agree that the 5 A’s, Ask, Advice, Assess, Assist, and Arrange, are the main processes of an intervention that can promote weight management (Vallis et al., 2016). The course demonstrated the importance of entering practicum hours, CITI training, and clinical preceptors during practicum. What was acquired from this course would be critical in future practice.(Comprehensive Discussion Essay on Suicide and Risk Factors)

Reference

Vallis, M., Piccinini-Vallis, H., Sharma, A. M., & Freedhoff, Y. (2016). Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Canadian family physician Medecin de famille canadien, 59(1), 27–31.(Comprehensive Discussion Essay on Suicide and Risk Factors)

Response to Classmate 4

Thank you for the comprehensive course analysis and evaluation. The course has expanded students’ knowledge base and provided opportunities to practice research skills, particularly identifying nursing or healthcare issues or practice gaps and proposing an intervention to address them. An understanding of the evidence-based process will be helpful in future practice. EBP is associated with better quality care and patient safety (Li et al., 2019). Researching and developing evidence-based interventions to address practice gaps and public health problems is imperative. I managed to access a discussion on your project, which was interesting. Besides, the CITI training offered an opportunity to learn about the IRB process and understand nurses’ role in evidence-based practice. The acquired knowledge will guide future nursing practice.   (Comprehensive Discussion Essay on Suicide and Risk Factors) 

Reference

Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses-systematic review. Medicine, 98(39), e17209. https://doi.org/10.1097/MD.0000000000017209