For Nurses: Tips for Documenting Suicidal Ideation

When facing these types of serious situations, try to reduce all risks by documenting appropriately. It’s important to remember the saying, “If you don’t chart it, you didn’t do it,” especially to prevent possible legal action.

Try to follow these tips:

• Complete the assessment as soon as you can while being thorough.
• If you have to take any actions, document your reasons why.
• If you don’t feel specific actions are appropriate, document why.
• Understand the laws of your state regarding breaching confidentiality.

Another important step is fully cooperating with a root cause analysis (RCA) and debriefings after an attempted suicide or death.

According to single-site studies of the Veteran Affairs (VA) health facilities, RCA identified that a person’s chance of suicide increased when discharged from the hospital against medical advice or other unplanned discharges.

This RCA shows that your participation can make a difference in suicide prevention interventions moving forward.

Nurses may encounter persons with suicidal ideation in a hospital setting or a clinic.

Research from 2017 shows that up to 80% of those who died by suicide contacted their primary care doctor in the year before suicide, 54% contacted them six months prior, and 44% in the last month of their life.

So, taking their feelings and thoughts seriously in a primary care setting is required to help keep them safe.

A person may be asking for help without voicing their concerns, so knowing what signs to watch out for is critical. These can include:

• changes in behavior such as increased substance use
• expressing feelings of hopelessness
• changes in sleep patterns
• expressing feelings of extreme sadness
• having experienced self-harm or injury

As a nurse, the goal is to prevent a suicidal event and provide needed care. Consider the following actions to prepare for this responsibility.

Understand suicide

There are basic terms in suicidality that are vital to understanding how to provide care for your patient. For example, there’s a difference between having thoughts of suicide and planning the action.

According to research from 2021, some key definitions are:

• Suicide attempt: nonfatal self-directed injury or behaviors with an intent to die as a result
• Self-harm: acting with a nonfatal outcome to harm one’s self without intervention from others
• Suicidal ideation: thoughts of wanting to die without detailed plans to carry it out (passive) or thoughts with an intent to commit the action and plans on how to do it (active)
• Suicide: death caused by self-directed behavior to injury with any intent to die

Additionally, it’s crucial to understand the impact of suicide and who it affects. Suicide is a leading cause of death in the United States.

According to the Centers for Disease Control and Prevention (CDC), an estimated 12.2 million adults in the U.S. had serious thoughts of suicide in 2020, 3.2 million had a plan to commit the action, and 1.2 million attempted to carry the action out.

Certain groups of people have a higher chance for suicide, according to the Suicide Prevention Resource Center. This includes:

• people ages 10-14 and 25-34
• males
• veterans
• people who live in rural communities
• people in particular industries, such as mining and construction workers
• young people in the LGBTQIA+ community

Manage personal reactions, attitudes, and beliefs

No matter your thoughts about suicide or whether you’ve personally been affected by it, remember to try not to judge, shame, or impart your personal feelings or beliefs on that person.

Maintaining a level of professionalism while remaining compassionate and empathetic at the same time is crucial. Any emotional reaction or expression of personal belief can negatively impact that person’s health and safety.

Besides remaining nonjudgmental and supportive, the person you’re providing care for also needs reassurance that you know what you’re doing, you can help, and that you want to help.

Ask the patient if they’re considering suicide. If yes, ask them if they have a plan to carry out the action.

Try to educate them about suicidality, the symptoms of their condition, and treatment options if needed. Speaking words of hope and trying your best to connect with them will help the person feel emotionally safe and supported.

Recognize conflict

It’s not uncommon to experience conflict. For example, they may be having thoughts of hurting themselves, and you want to prevent them from doing so.

Consider these strategies to try to manage some of that conflict.

• Explain motivations for suicidal thoughts and behaviors: Talking with the person and helping them identify the reason behind their thoughts of suicide can be helpful.
• Understand and validate their feelings: It’s important that they feel valid in their emotions. Try to remain empathetic to those feelings and thoughts.
• Use effective and therapeutic communication: Some who have thoughts of suicide may feel a loss of self-respect or shame. So, try to make them feel accepted for who they are and how they think.

You’ll assess your patient at first encounter, as needed with a change of condition or event, and then per your facility’s protocol. Each time you evaluate them, you’ll want to make sure it’s thorough and accurate.

Adequately documenting and communicating the following to all people involved in your patient’s care is crucial:

• risk factors
• mental status exam
• history and physical, including physical and psychological trauma
• triggers of distress
• how patient reports symptoms
• personal sources used, such as loved ones
• warning signs
• if the patient has made a plan for suicide, document what that plan is
• history of self-harm

You’ll likely encounter a patient with suicidal ideation or a history of attempted suicide throughout your career. Treating them is challenging, and despite best efforts, some may still try or commit the action.

But nurses are in one of the most critical positions for suicide prevention since they have long and close contact with the patient. They depend on your rapport to obtain the support they need to live a happy and healthier life.

Sharing suicide prevention resources with your patients can be helpful. We can all help prevent suicide and ensure our patients get their much-needed support.