Practice Tip of the Week | Suicide Prevention: A Case Scenario

By Denise McNulty

Hope is a necessity for normal life and the major weapon against suicide.

- Karl A. Menninger

According to the Center for Disease Control and Prevention (CDC, 2022), approximately 46,000 Americans died from suicide in 2020, representing a 30% increase since 2000 and equating to 1 death every 11 minutes. The rate in the healthcare workforce and nurses, in particular, is even higher. Let’s consider the following case scenario (names and facts have been changed to protect Olivia’s identity):

From the outside, it appeared that Olivia was living an exciting and glamorous life—a statuesque, South American, successful model in New York, with more work and designer shoes than she could handle. Yet not everyone can survive the lifestyle that accompanies such success and the competitive nature of the industry.

For Olivia, the competition and her success led to loneliness and excessive partying complete with substance abuse. One night the hollowness of her life led to her brush with suicide. It wasn’t that she didn’t see an out or that she didn’t believe she could be happy again—she felt that it wasn’t worth the work. Realizing that many women who use drugs to end their lives fail, Olivia planned a double-barreled approach to ensure death.

She did, however, leave herself an out. As Olivia entered the bathtub to prevent a mess for her roommate to clean, she had a list of phone numbers to call. If anyone picked up the phone, she would abort her well-thought-out plan. Did anyone pick up the phone? More on that later.

Clinicians cannot wait to take action until someone’s life is in danger. To combat burnout, depression, and suicide, Melnyk suggests moving away from crisis intervention toward prevention and early intervention, using screening and counseling, and decreasing the stigma associated with asking for mental and behavioral help. Awareness of suicide risk factors on the individual, relationship, community, and societal levels help as well. Based on that information, prevention can take many forms:

• Individual
  • Teach practical coping and problem-solving skills
  • Cultivate a reason for living or purpose in life
  • Promote strong cultural identity
• Relationship
  • Cultivate supportive relationships with partners, friends, and family
  • Promote connectedness
• Community
  • Connect with schools, community, and other social institutions
  • Enhance availability and access to physical and mental healthcare
• Societal
  • Decrease access to lethal means to suicide to people at risk
  • Acknowledge cultural, religious, and moral objections to suicide

Nurses can help decrease the stigma of asking for help by openly discussing suicide risks and prevention and using the correct language. For example, using the phrase “death by suicide” instead of “committed suicide.” Additionally, to prevent suicide in healthcare, the literature supports routine screenings and referrals, minimizing work stressors, enhancing substance-use disorder detection and non-punitive treatment, routinely offering preventative measures, and self-care.

Back to Olivia: No one answered her calls, so she began to finalize her preparation to take the overdose of medications and slit her wrists. As she was about to take the pills, the phone rang. No, it wasn’t one of the people she reached out to. Her savior was a gentleman she gave her phone when she met him a year before. He introduced himself, said he was in town with his wife, and invited her to join them for a late dinner. Olivia, an extraordinary person, aborted her plans, started a life-long friendship, and left modeling to become an exceptional nurse.

One person reaching out created hope. Hope builds resilience to safeguard against the impact of hopelessness that can lead to suicide; choose to be a source of hope.

References

Center for Disease Control and Prevention. (2022). Suicide Prevention. https://www.cdc.gov/suicide/index.html

Davidson, J. E., Mendis, J., Stuck, A. R., DeMichele, G., and Zisook, S. (2018). Nurse suicide: Breaking the silence. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC.https://doi.org/10.31478/201801a

Davidson, J. E., Proudfoot, J., Lee, K., Terterian, G., and Zisook, S. (2020). A longitudinal analysis of nurse suicide in the United States (2005–2016) with recommendations for action. Worldviews on Evidence-Based Nursing, 2020; 17:1, 6–15. https://doi.org/10.1111/wvn.12419

Huen, J. M., Ip, B. Y., Ho, S. M., & Yip, P. S. (2015). Hope and Hopelessness: The Role of Hope in Buffering the Impact of Hopelessness on Suicidal Ideation. PloS one, 10(6), e0130073. https://doi.org/10.1371/journal.pone.0130073

Melnyk, B. M. burnout, depression and suicide in nurses/ clinicians and learners: an urgent call for action to enhance professional well-being and healthcare safety Worldview on Evidence-Based Nursing, 2018. https://doi.org/10.1111/wnv124916

TNA Suicide Prevention Resource Guide https://cdn.ymaws.com/www.texasnurses.org/resource/resmgr/toolkits/Suicide_Prevention_Resource_.pdf