Suicide Prevention within High Security Hospital - Research Paper Example

Suicide Prevention within High Security Hospital Introduction Skill acquisition is whereby one learns connections of events in the course of a long period of time. As a nurse begins to match identical stimuli with specific responses, knowledge representation is developed on appropriate response to certain situations. Suicide is a form of self-induced harm (Andriessen 2006, p. 533). An individual decides to end his or her life. Since human beings are social animals, suicide can indeed be detected and prevented. A person who is at the point of committing suicide exhibits certain behaviours (Althaus & Hegerl 2003, p. 157). In most cases people surrounding a potential victim are unaware or helpless on how to deal with the situation. A person feels ignored, hopeless, not taken seriously or completely worthless. It is common for the victim to withdraw from social life (Barnes, Eisenberg & Resnick 2010, p.890). There are those who show signs and even speak about intention to commit suicide (Szanto et al 2007, p. 154). However, since the family or friends are detached or fail to listen reflectively, the act is finally completed. It is important to realize there are push factors driving a person to commit suicide. These factors exist in the environment. An important step to make is to try and understand feelings of a potential victim. The person must be taken seriously, avoid judgement but express concern (Beautrais 2006, 482). Other people need to be involved. In this case professional help must be sort for immediately. At no time should the individual be left alone. These practices are understood best by mental health nurses who have been exposed to people with mental illness. Developing a therapeutic relationship with the person is vital in the healing process (Borowsky 2010, p. 1064). Through support, care and reflective listening, self-worth will once again be restored. However, there are barriers to development of these skills. Most mentally ill persons do not see the need for medical intervention (Brent 2007, p.989). There are those who are stigmatized to do so. The public is simply not aware of the seriousness of mental illness. The response from public ought to change if professionals are to deal with the problem effectively. Rationale for Suicide Prevention Skill Suicide and self-harm are predominant traits among people suffering from mental illness. In most cases victims feel unworthy, misunderstood and hopeless (Kapur et al 2010, p. 4553). They feel judged, incompetent and out of place. Having worked as a forensic mental health nurse for more than 5 years, it becomes easy to understand the agony experienced by suicide victims before the act is committed. In the modern world people tend to mind their own affairs and forget the predicament of mentally ill persons. There is also stigma on matters regarding mental health. People are ill equipped to deal with mental health patients. The common behaviour is to avoid such people, talk on their back or pretend to care for them. This kind of behaviour makes worsens the problem. It leads to withdrawal and finally suicide is completed. A nurse in a forensic mental health facility is exposed to such people on a daily basis. This exposure enables a nurse interpret on a consistent basis actions, words and behaviour of patients (Department of Health 2006). The training received ensures a patient is assessed, taken care of and appreciated. Self-esteem and self-worth are restored through meaningful interaction, care and understanding. Considering mental health patients are susceptible to suicide, a nurse easily notices behavioural change and tries to alleviate the problem (Szanto et al 2007, p. 155). Once trust and confidence is established between a nurse and patient the two can work on a patient’s concerns. In general forensic mental health workers have the role to defend and protect patients. They have to enlighten a patient about his or her rights, and come up with strategies to ensure patients recover from mental illness. It is due to constant interaction, understanding and cooperation which forensic nurses have with mentally ill patients that justify development of suicide prevention skill (World Health Organization 2006). The two are always free to share and talk about issues affecting the patient. On the other hand the family of the patient is not neglected. They are kept in the picture and made to understand progress made by a patient. Skill Development Human beings can easily mirror themselves in any situation. In sickness it is important for one to be able to identify with the sick. This applies generally to all kinds of sicknesses. However, when it comes to mental illness no other theory can better apply. Apart from sufficient knowledge about mental patients and how to deal with them, humanity must not be abandoned (Kendler, Gardner & Prescott 2006, p. 116). It is important to identify with a patient in all spheres of their live. They must feel loved, cared for and accepted without conditions. The two must share a relationship characterized by trust, confidence, honesty, care and support. The relationship once established must be sustained. A nurse must open up to the patient, acting like a partner in the recovery process (Pennebaker 2006, p. 179). Questions must be asked concerning life, future plans, relationships etc. In the same vein the nurse should shun from withholding information from the patient. Questions paused by a patient must be treated seriously and responded to in an honest and transparent manner. At all times a patient must not be left alone. It is important to realize patients respond to environment with thoughts and feelings. Loneliness must be discouraged as it creates opportunity to brood over negative experiences. It reinforces thoughts of worthlessness. In such moments a patient must be made to reflect on positive side of life. They must participate in group activities, meet friends and socialize (National Institute of Mental Health in England 2006). The nurse must observe carefully how a patient behaves in particular situations. These observations must be well documented for future reference and synthesis. There are times when symptoms begin to show or a patient exhibits similar characteristics with known symptoms. It is not always wise to confront a patient. This is an appropriate time to observe the situation critically and come up with the best response. A nurse must never judge or criticize a patient. The ultimate goal is to be on talking terms with a patient (Glanz, Rimer & Lewis 2002, p 189). Once this is achieved, the two are able to discuss about anything. It is upon the nurse to restore hope and good feeling. A nurse with a good personality, loving people and willing to help patients would easily develop the skill. Good Practice in Suicide Prevention It is important to look at what drives an individual into thoughts of suicide. In most cases such people have little self-worth. They might feel unsuccessful, under achievers, failures or completely lack hope. Sometimes as a result of a painful experience, depression or loneliness, feelings of suicide might come about (Kapur et al 2010, p. 4553). The cause of pain, depression or disappointment must be understood (Lizardi, Thompson & Keyes & Hasin 2010, P. 688). Sometimes careless talk or trying to guide and counsel an individual might actually lead to the act. People react differently to pain and unpleasant feelings (GlaxoSmithKline 2006). Each and every person must therefore be given special treatment. This can be achieved if one develops empathy with the person. At no other time should the individual be left alone without company or something positive to occupy the mind. Great attention must be paid on everything said or done. In some instances a patient will only communicate through body language. Good listening and observation skills help build therapeutic rapport. A relationship of this kind requires enough support from a nurse. For instance one can perform small tasks, give advice thus lighten up the spirit of a patient. Self disclosure on the part of the nurse is a must for sustaining a therapeutic relationship (Reinherz et al 2006, p. 1227). Through actions exhibited and words spoken, a patient will be convinced of one’s feeling. It is therefore important to be consistent. Sometimes an individual might show sudden change in attitude. This is not a sign of recovery and the nurse must be careful on responding to such changes (Fallucco, Hanson & Glowinski 2010, p.954). The patient might have made up his mind to commit the act. Another important skill for a nurse is reflective listening. The nurse should listen to the conversation of a patient and reflect on what is being said. There are lots of implied meanings in words used in conversations. The personality of a person must be kept in consideration before meaning is decided. People are different; to understand an individual one must be patient. In most cases people expect others to be aware of misfortunes that happened in their lives (Sakinofsky 2007, p. 78). Normally, a person expects judgement in regard to such misfortunes. For this reason a nurse must always be non-judgmental. Nevertheless, a nurse should give honest responses to whatever queries or concerns raised by a patient. Clear, sincere and straight forward answers are appreciated by mental patient. Medical jargon and ambiguities must be avoided at all times. The family can furnish a nurse with information that will help understand the patient better (Yip 2008, p. 85). A nurse needs to spend sufficient time with the family. In such sessions general questions can be asked and genuine answers to be expected. Family background and secrets are imperative. It must be realized that not all problems are tagged on family. There are some families which are wonderful and might actually be important in recovery process. Once this is realized, the nurse must ensure a patient spends enough time with loved ones. Culture is an important component in the lives of individuals. Each one of us was brought up in specific backgrounds, customs and traditions (Chen & Yip 2008, p. 1629). The culture of individual patients must be kept into consideration. This is in regard to privacy, confidentiality, matters on family and health. For instance, in some cultures certain ways are observed on disseminating bad news. Only particular people need to be informed. Failure to observe cultural behaviour might lead to loss of trust, support and cooperation from a patient or family members (Letendre, 2007, p. 79). The nurse must not be ashamed to ask for directions. In some cases one ought to research on the internet or inquire from friends just to be sure the right thing is being done. However, it is always important to confirm on dealing with unfamiliar situations. The ability to ask questions shows genuine interest to learn and understand other people’s culture. This helps in a great way to sustain and develop further therapeutic relationship with a patient. Application of Theory and Model of Skill Acquisition Human behaviour is an interaction of the environment, personal factors and behaviour. The theory of social cognition is essential in providing a framework to predict, understand and change the behaviour of humans (Bandura 1986, p.120). According to the one level of the model, thoughts and actions of an individual are primarily an interaction between behaviour and the person. A second level considers a person’s interaction with the environment through beliefs, social structures and influences existing in the environment. The third level is interaction between behaviour and environment. There are aspects of the environment which are determined by a person’s behaviour (Bandura 2001, p.16). Just like a person’s behaviour is influenced and modified by the environment. Different situations bring about difference in human behaviour. However, behaviour is not necessarily a consequent of varied situations. Sometimes the same person responds differently to the same stimuli. Similarly, the same stimuli may provoke diverse responses from a number of people (Bandura 2001, p.13) The theory is therefore important in being able to predict and understand behaviour of individuals. In addition it offers avenues in which behaviour can be altered or modified. A nurse must be critical enough and observe how a patient interacts and responds to the environment. The behaviour exhibited must reflect the immediate environment of the patient. In this case the environment integrates positive attitude and circumstances created by a practitioner. The behaviour of a patient must be closely monitored. It is however not the work a nurse to directly try to control the response of a patient to the environment. Of course there are those who are sceptical of any kind of help given to them. They believe a nurse tries to conspire and disorganise set plans. As always a nurse must show understanding in order to avert any kind of suspicion. This can be achieved with understanding of individuals, their environment and mental illness. In order to judge the progress of a patient, assessments must be carried out on a consistent basis. These assessments must show how an individual responds to different environments. A record of assessments from the day a patient is admitted in a health facility must be kept for future reference. This will help to come up with an evaluation of the overall performance. Barriers to Skill Development In the acquisition and development of any skill there are challenges to be experienced. These challenges act like barriers to mastery or achievement of goals set in the mind of a practitioner. In mental health nursing there are lots of material and research regarding suicide and ways of prevention. Most victims of suicide exhibit mental illnesses such as depression. The characteristics are in many ways similar. As much as a nurse might have had some experience dealing with people susceptible to suicide; this experience cannot be applied wholly on another individual (Paterson 2009). People are unique and should be handled with caution. An earlier experience is vital to classify certain problem cases. However, on dealing with individuals accurate observation is required in order to understand the problem. Not all prevention measures that worked for one patient are successful with another. The nurse must realize that being able to understand individuals is a skill on its own right. One must be patient, flexible, non-judgmental and sociable. Once a nurse appears to open up on patients it becomes easy for them to do the same (Cholbi 2007, p. 155). Clinical care sometimes can prove difficult due to institutional rigidities. There are not always sufficient personnel and facilities to guarantee maximum care for a patient. Due to staff shortage, a nurse might not have enough time to develop a therapeutic relationship that would see to a meaningful cooperation with a patient. Once the mind is divided on a number of tasks; the likelihood to lose focus and purpose of a therapeutic relationship is high. Considering the patient relies on support and care of a nurse, a lapse on the part of the nurse jeopardizes an entire program. It is therefore important that the nurse maintains focus on a patient (Pennebaker 2006, p 162). There must be clear and well documented records for each patient. In case of any changes to the program, the patient must be informed well in advance. It is unfortunate not all persons with mental illness accept they are ill. The common behaviour among individuals and their families is to live in denial (Cholbi 2007, p. 156). Alarm bells will ring after an attempt of suicide. Nevertheless, even after it is not completed the family would imagine the problem solved. Delay in seeking professional help is one of the main barriers to development of the skill. Unlike other diseases whereby one contacts a physician immediately signs show; few people will do so with mental illness (Jorm, Christensen & Griffiths 2006, p. 37). It is a challenge for practitioners to ascertain when a problem begun. This is trickier if a patient proves to be uncooperative. However, there are ways to turn the situation round. One way is by creating awareness of the problem among the population. Signs and symptoms of mental illness must be known and documented (Gutierrez, Brenner & Huggins 2008, p. 336). In addition once a patient arrives at the hospital, a practitioner must be able to establish and sustain therapeutic rapport. The ability to gain trust and confidence of a mentally ill person is a major step towards recovery. Through questioning practitioners learn more about the person. Sometimes it becomes difficult to determine whether or not a patient has fully recovered from a mental illness. In most cases one might be discharged from a health facility when in actual sense the problem still exists. The patient might sound normal or in a stable mental state when in actual sense the individual has made up his mind to commit an act (Life Is For Everyone (LIFE), 2007). It is challenging for a nurse to know the progress on a patient once out of hospital. In a number of cases the home environment contributes greatly to creation of the problem. The decision to discharge a patient back to the same environment becomes complicated. A patient might relapse thus end up committing suicide. Most people suffering from metal illness are still living freely in society. The majority are stigmatized to seek medical attention. In the public domain people easily gain access to lethal means. It is unfortunate the media will sometimes publicize drugs, sites, weapons, poisons and similar substances and warn of apparent danger (Bennewith, Nowers & Gunnell 2007, p. 266). Exposure to such environments hinders skill development. For instance if some news or information is being conveyed through the media, it becomes difficult for a nurse to intervene. The way people receive and respond to information is dissimilar and difficult to predict or control. Suicides occur at home and even in public. However, not all victims are perceived to be at risk. It becomes difficult to convince people to be admitted in hospital with an intention to avert suicide. The majority would dismiss the idea. They feel the problem to be temporary and will soon be solved (Reinherz et al 2006, p. 1228). The stigma associated with mental diseases and suicide is a major barrier to nurses in the field. In most communities few people are willing to talk about signs of mental illness or suicide attempts for that matter. Even victims are ashamed to reveal vital information thus denying a practitioner a chance to fully diagnose the disease (Isacsson & Rich 2008, p. 25). One might be tempted to assume the magnitude of a problem basing on false information. This situation is problematic since family members might not be willing to share certain information with a practitioner. Again, to deal with stigma a therapeutic relationship must be cultivated with the family and the patient. Furthermore, awareness must be created through the media. The public must be educated about prevalence, ways of control and treatment of mental diseases. Just like any other diseases those affected must seek medical intervention on time. Development and Maintenance of the Skill The most important feature in development of any skill is continued exposure to relevant tasks. After acquiring enough experience one is able to see trends, characterize, diagnose and apply necessary treatment. Since most of patients do not show up for help voluntarily, they must be sought after. In the military for instance there are many cases of depression and trauma (Gutierrez, Brenner & Huggins 2008, p. 339). It is important for all service men to be observed critically such that any abnormality in behaviour is addressed sooner than later. The ability to detect such problems is a sign of development of the skill. The initial stage in developing of the skill is to ensure the environment of a patient has been changed. A change of environment might include people surrounding a patient, response given to a patient in terms of support and attitude. As the environment is changed, a nurse has to observe carefully whether or not a patient’s behaviour changes as well (Sakinofsky 2007, p. 74). Normally, behaviour comes in response to environment. If situations are changed yet a patient does not change behaviour then a nurse will be forced to try creating other situations. This might be in the form of performing tasks for a patient, involving the patient in conversations etc. In the course of a therapeutic relationship one tries to ask questions that may hint on the mood and attitude of a patient. Studies on individual patients can be demanding but it is an important step towards mastery of the illness. Records of individual patients must be kept and their every action, words or behaviour correctly documented. This should be encouraged in mental hospitals and with patients who have shown signs of suicide (World Health Organization 2006). Whether or not a patient recovers, records have to be studied and analyzed in view of final results. Similarities and differences between behaviour and actions by individuals must also be closely studied. These studies are encouraged in a number of settings including institutions of learning, work environments, homes and hospitals. Findings can be compared to those in other countries, institutions’ etc. Creating awareness and reducing stigma is another way to develop the skill. There must be openness when it comes to discussing individual cases and going on campaigns to educate the public. The family of a victim must not be left alone. In fact coping skills and dealing with the aftermath of death of a family member is important to the nurse. A mental health problem normally is not the concern of an individual. Sometimes the problem is actually a family problem (Life Is For Everyone 2007). It is therefore vital for the family to be kept under close observation after death of a loved one. This helps in a great way to avoid reoccurrence of the same. A follow up also helps document feelings of family members. The way a practitioner helps a family cope with loss of a loved one will in a greater way augment knowledge on the same. In addition a nurse gains confidence, insight and determination in dealing with similar concerns. Knowledge must be shared and passed on. In as much as institutions of learning exist to accomplish this goal, much ought to be done practically. A nurse must endeavour to pass knowledge to students through sharing notes and observing a patient together. Since people have unique ways of observation and appreciation; differences and similarities must be highlighted (Satherley & Lawes 2008, p. 198). Conclusion In order for anyone to prevent something from happening one must be well prepared. One must have accumulated enough knowledge on situations or circumstances that may lead to the problem. This is no different from prevention of suicide. It can be noted that most of the completed suicides were in some way or another detected. However, due to other commitments or not taking the individual seriously the action was carried out. A nurse who has worked in a forensic mental hospital; defending, supporting and assessing mental patients is in a good position to prevent suicide. The reason being suicide arises from mental instability. An individual fails to function properly due to poor perception, bad feelings and loneliness. Since those around the person fail to realize or respond to the problem, it leads to action. On the other hand a nurse can deal with the situation by establishing a therapeutic rapport with a patient. It is through this relationship that the patient will be made whole again. The skill of preventing suicide develops as a nurse is exposed to different patients and varied experiences. It becomes easy to notice similarities, trend and respond accordingly. However, this process is not always smooth. There are barriers towards achievement of this goal. Many people are stigmatized about seeking help from mental hospitals. There are those who feel the problem can be dealt with without medical intervention. Due to assumptions and false information regarding mental sickness majority people belittle the illness. It is important to enlighten the public on the seriousness of the disease. Again, mental patients must show willingness to cooperate fully with health practitioners. References Althaus, D & Hegerl U 2003, The evaluation of suicide prevention activities: state of the art. World Journal of Biological Psychiatry, Vol. 4, pp. 156-165 Andriessen, K 2006, On “intention” in the definition of suicide. Suicide Life Threat Behaviour, Vol. 36, No. 5, pp. 533-538 Bandura A, 1986, Social Foundation of Thought and Action: A Social Cognitive Theory. Englewood Cliff, New Jersey: Prentice Hall Bandura, A 2001, Social cognitive theory: An agentive perspective. 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