1
Fall 2017 NURS 660 Exam 1 Study Guide
**Note: I did not include "Interviewing and assessment of the child and the adult" or
"Techniques for interviewing kids" since that is basically the entire book by Cepeda & Gotanco
(2016). It was also the topic of week 6 discussion and week 4 group case study (Craig). Hope
this helps!
Suicide Assessment
DIM - Suicide appears to occur when a mental Disorder is present, Intent develops, and Means
become available
When Should Suicide Assessment be Conducted?
First assessment on any patient with a mental illness or substance abuse diagnosis.
When a patient experiences sadness, low mood, recent loss or hopelessness, and at each
subsequent session as long as the patient remains at risk.
Any time a patient has any other identified potential risk factors.
Dimensions of Assessing Suicide?
- Elicitation of suicidal ideation
- Identification of risk factors for suicide.
- Weighing of risk factors.
Overview of Ideation Assessment.
Be sensitive to the different cultural views regarding suicide
At minimum, ask directly for presence and nature of suicidal thoughts, including
frequency, intensity, circumstances, & characteristics.
Determine if there is current intent or a plan.
Ask for plan details, including rehearsals.
Assess availability and lethality of means.
Determine if there's a history of thoughts, wishes, impulses or attempts.
Assess attitude, beliefs and values about suicide.
Determine if anything is different this time that will raise or lower risk.
Determine if patient shared ideation with anyone.
Identify any support person who might be helpful in reducing the risk.
NB: Available assessment tools, such as the Scale for Suicide
Ideation (SSI) or Beck Scale for Suicide Ideation (BSS)
, 2
The assessment of suicidal ideation proceeds along a gradient, from least to most severe,
with a specific line of inquiry as part of the assessment of mental status.
Beginning with general questions about how patient sees the future, the meaning and
worth of life, and any consideration of self-harm.
The interviewer should ask whether thoughts of death or suicide have occurred; if so,
how often, how persistently and with what intensity?
Are they fleeting, periodic or constant? Are they increasing, decreasing or remaining
constant?
Do they occur under specific circumstances?
Thoughts should be characterized as passive (e.g., “I would be better off dead”) or active
(e.g., “Sometimes, when I am driving my car, I get the impulse to drive into other cars.”)
Any thoughts noted should then be elaborated upon using the patient’s own language.
Specifically, what are the thoughts content?
The patient should be asked whether there is current intent /impulse, and if so, is there a
plan?
Details of the plan (method, time and place) should be reviewed and documented in the
clinical record.
The patient should be asked about whether any rehearsal (mental or through action) has
taken place and whether there have been any attempts made thus far.
Past history of similar thoughts, wishes, impulses, plans or attempts
should be obtained.
The patient with a plan should be asked about the availability of means and/or whether
there is a plan/intent to obtain any means (e.g., plan to purchase a gun).
As part of the evaluation, the interviewer should determine the patient’s attitude toward
suicide, which may range from acceptance of its inevitability or desirability (ego
syntonic) to ambivalence or rejection (ego dystonic).
The patient should be asked about barriers to suicide.
What are the reasons for living and those for dying?
What has prevented the patient from carrying out the act, or
How has s/he managed to evade the act of suicide thus far?
Is there anything different now or anticipated to be different in the near future?
Has the suicidal ideation been shared with anyone else besides the therapist?
Who has been or could be helpful in managing the ideation?
This will allow for the involvement of family and/or significant others who can assist
in obtaining data about the patient and provide containment and feedback during
treatment, as part of the safety plan, but such collaboration should be with the patient’s
permission.
, 3
Suicide Risk Scale
Sex: men kill selves 3x more frequently than women.
Age: greater risk among 19 yrs or younger, and 45 yrs or older.
Depressed: 30x more than non-depressed.
Previous attempters: 64x that of general population.
Ethanol abuser: about 15% of alcoholics commit suicide.
Rational Thinking loss: psychosis, mania, depression or OBS.
Social support lacking: especially a recent loss of support.
Organised plan: either directly or indirectly communicated.
No spouse: single, divorced, widowed or separated.
Sickness: severe, chronic or debilitating illness.
Scoring: 1 point is scored for each factor present.
0-2 allow home with follow up.
3-6 consider hospitalisation depending on confidence in follow-up.
7-10 suggests either hospitalisation or commitment.
Other Identified Risk Factors for Suicide
- Have had psychiatric hospitalization within the past year
- Have had a recent or impending loss
- Have a history of impulsive or self destructive behavior
- Have committed violence in the past year
- Have access to guns
- Have a family history of suicide
- Are socially isolated
- Have a chronic, terminal or painful medical disorder
- Are newly diagnosed with serious medical problems
- Are male age 65 or older
- Have lost a child either to suicide or in early childhood
- Have a history of physical or sexual abuse in childhood.
- Top high risk diagnosis for completed suicides:
Depression, especially with psychic anxiety, agitation and/or significant
insomnia
Bipolar disorder
Alcohol and substance use disorders
Schizophrenia
Borderline personality disorder
Assessment Following an Attempt
After an act of para-suicide, it important to determine the degree of suicidal intent
existing at the time.
What is the explanation for the attempt in terms of likely reason(s) and goal(s)?
Fall 2017 NURS 660 Exam 1 Study Guide
**Note: I did not include "Interviewing and assessment of the child and the adult" or
"Techniques for interviewing kids" since that is basically the entire book by Cepeda & Gotanco
(2016). It was also the topic of week 6 discussion and week 4 group case study (Craig). Hope
this helps!
Suicide Assessment
DIM - Suicide appears to occur when a mental Disorder is present, Intent develops, and Means
become available
When Should Suicide Assessment be Conducted?
First assessment on any patient with a mental illness or substance abuse diagnosis.
When a patient experiences sadness, low mood, recent loss or hopelessness, and at each
subsequent session as long as the patient remains at risk.
Any time a patient has any other identified potential risk factors.
Dimensions of Assessing Suicide?
- Elicitation of suicidal ideation
- Identification of risk factors for suicide.
- Weighing of risk factors.
Overview of Ideation Assessment.
Be sensitive to the different cultural views regarding suicide
At minimum, ask directly for presence and nature of suicidal thoughts, including
frequency, intensity, circumstances, & characteristics.
Determine if there is current intent or a plan.
Ask for plan details, including rehearsals.
Assess availability and lethality of means.
Determine if there's a history of thoughts, wishes, impulses or attempts.
Assess attitude, beliefs and values about suicide.
Determine if anything is different this time that will raise or lower risk.
Determine if patient shared ideation with anyone.
Identify any support person who might be helpful in reducing the risk.
NB: Available assessment tools, such as the Scale for Suicide
Ideation (SSI) or Beck Scale for Suicide Ideation (BSS)
, 2
The assessment of suicidal ideation proceeds along a gradient, from least to most severe,
with a specific line of inquiry as part of the assessment of mental status.
Beginning with general questions about how patient sees the future, the meaning and
worth of life, and any consideration of self-harm.
The interviewer should ask whether thoughts of death or suicide have occurred; if so,
how often, how persistently and with what intensity?
Are they fleeting, periodic or constant? Are they increasing, decreasing or remaining
constant?
Do they occur under specific circumstances?
Thoughts should be characterized as passive (e.g., “I would be better off dead”) or active
(e.g., “Sometimes, when I am driving my car, I get the impulse to drive into other cars.”)
Any thoughts noted should then be elaborated upon using the patient’s own language.
Specifically, what are the thoughts content?
The patient should be asked whether there is current intent /impulse, and if so, is there a
plan?
Details of the plan (method, time and place) should be reviewed and documented in the
clinical record.
The patient should be asked about whether any rehearsal (mental or through action) has
taken place and whether there have been any attempts made thus far.
Past history of similar thoughts, wishes, impulses, plans or attempts
should be obtained.
The patient with a plan should be asked about the availability of means and/or whether
there is a plan/intent to obtain any means (e.g., plan to purchase a gun).
As part of the evaluation, the interviewer should determine the patient’s attitude toward
suicide, which may range from acceptance of its inevitability or desirability (ego
syntonic) to ambivalence or rejection (ego dystonic).
The patient should be asked about barriers to suicide.
What are the reasons for living and those for dying?
What has prevented the patient from carrying out the act, or
How has s/he managed to evade the act of suicide thus far?
Is there anything different now or anticipated to be different in the near future?
Has the suicidal ideation been shared with anyone else besides the therapist?
Who has been or could be helpful in managing the ideation?
This will allow for the involvement of family and/or significant others who can assist
in obtaining data about the patient and provide containment and feedback during
treatment, as part of the safety plan, but such collaboration should be with the patient’s
permission.
, 3
Suicide Risk Scale
Sex: men kill selves 3x more frequently than women.
Age: greater risk among 19 yrs or younger, and 45 yrs or older.
Depressed: 30x more than non-depressed.
Previous attempters: 64x that of general population.
Ethanol abuser: about 15% of alcoholics commit suicide.
Rational Thinking loss: psychosis, mania, depression or OBS.
Social support lacking: especially a recent loss of support.
Organised plan: either directly or indirectly communicated.
No spouse: single, divorced, widowed or separated.
Sickness: severe, chronic or debilitating illness.
Scoring: 1 point is scored for each factor present.
0-2 allow home with follow up.
3-6 consider hospitalisation depending on confidence in follow-up.
7-10 suggests either hospitalisation or commitment.
Other Identified Risk Factors for Suicide
- Have had psychiatric hospitalization within the past year
- Have had a recent or impending loss
- Have a history of impulsive or self destructive behavior
- Have committed violence in the past year
- Have access to guns
- Have a family history of suicide
- Are socially isolated
- Have a chronic, terminal or painful medical disorder
- Are newly diagnosed with serious medical problems
- Are male age 65 or older
- Have lost a child either to suicide or in early childhood
- Have a history of physical or sexual abuse in childhood.
- Top high risk diagnosis for completed suicides:
Depression, especially with psychic anxiety, agitation and/or significant
insomnia
Bipolar disorder
Alcohol and substance use disorders
Schizophrenia
Borderline personality disorder
Assessment Following an Attempt
After an act of para-suicide, it important to determine the degree of suicidal intent
existing at the time.
What is the explanation for the attempt in terms of likely reason(s) and goal(s)?
