Establishing rapport Establishing rapport with the at-risk individual may be the most challenging part of the assessment process. Being skilled and focused is an essential factor for the evaluator. It is important that the assessor gives the individual privacy, shows them concern, and makes them aware that they want to know what is currently happening. The act of asking about suicide can be therapeutic and can make a person feel understood, accepted, and connected to their clinician. 5 The evaluator should use active listening and make eye contact with the individual (Table 5). Active listening is an important skill that requires time and practice. It is an essential component of a productive discussion because it allows for the respectful exchange of ideas. 46 Here are some recommendations to improve active listening skills 46 : • Listen to fully understand what is being said to you. • Rephrase what you heard the person say so you can be sure you heard correctly. • Ask questions that help you get more information (e.g., “What did you mean when you said ...?”)
• Offer encouragement and support. • Ask how the person feels. Be careful not to assume that you know how the person feels. Structuring the assessment interview If significant risk factors are present or any suicide warning signs are evident, the healthcare worker must conduct a suicide assessment. It is important to ask patients directly about suicide and obtain additional information from family members, friends, other clinicians, EMS personnel, and appropriate others. When conducting a suicidal inquiry, healthcare professionals must use a non- judgmental, non-condescending, matter-of-fact approach. Individuals at elevated risk for suicide may be guarded during an interview or may respond with vague language prompting the interviewer to probe and inquire further. See Table 6 for examples of these statements as well as possible responses.
BEFORE MOVING ONTO THE NEXT SECTION, PLEASE COMPLETE CASE STUDY 3 ON THE NEXT PAGE. Understanding Levels of Suicide Risk It is estimated that in 2019, 12 million Americans seriously thought about suicide (CDC, 2021d). Unfortunately, there is no specific way to predict who will attempt suicide, although we try and identify prognostic factors. According to the American Psychological Association (APA) , while the elderly makes up only 13% of the population, they account for 20% of individuals who die by suicide. In addition, 75% of older adults who die by suicide have seen their physician within the last month. 19 Healthcare Professional Consideration: When assessing a patient for suicide, healthcare professionals need to demonstrate self-awareness of their emotional reactions, attitudes, and beliefs related to suicide.
Table 5. Active Listening Techniques 47
Communication Blockers Blaming and attacking.
Communication Enhancers
Asking for more information and problem solving together.
Being distracted or using other body language that is not-attentive.
Making eye contact, leaning toward the other person, giving full attention.
Dismissing or making light of someone’s problems.
Showing empathy, validating the other person’s feelings. Staying silent until the person is finished speaking.
Interrupting.
Lecturing / memorializing. “Yes…but” statements.
Withholding judgment.
“Yes…and” statements. Note. Adapted from Tutu and Franklin: A Journey Toward Peace. (2000). PBS. https://www.pbs.org/journeytopeace/meethope/index.html 47
Table 6. Common Individual Statements and Appropriate Responses 48
The Individual’s Statement
Possible Responses
Everyone will be better off without me.
Who would be better off? What would be better for those people? Where are you planning to go? What is so hard to bear? What would make your life better? When did you begin to feel this way?
I just can’t bear it anymore.
I just want to go to sleep and not deal with anything again.
What do you mean by “sleep?” What is it that you don’t want to deal with anymore?
I want it to be over.
What is it that you want to be over? How can you make it be over?
I won’t be a problem much longer.
How are you a problem? What is going to change in your life so that you won’t be a problem any longer? When will you no longer be a problem?
Things will never work out.
What can you do to change that? What, then, do you propose to do?
It is all so meaningless.
What would make life more meaningful? What are some aspects of your life that make it worth living? What is happening in your life that makes it so meaningless?
Note. Adapted from Videbeck, S. L. (2017). Psychiatric-mental health nursing (7 th ed.). Philadelphia, PA: Wolters Kluwer. 48
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