APNA 30th Annual Conference Session 2011: October 20, 2016 th Annu - - PDF document

APNA 30th Annual Conference Session 2011: October 20, 2016 Greene 1

AP APNA NA 30 30th

th Annu

Annual al Con Conference ce 2016 2016

Psychi ychiatri atric-Mental c-Mental H Heal alth N th Nursing: g: Inspir spiring ing Le Leader adershi ship Eve Every D y Day

Hart rtford, rd, C Connectic cticut ut

Pamela K. Greene PhD, RN Assistant Professor

Texas A&M University, Corpus Christi College of Nursing & Health Sciences

 Describe the five strategies identified by

research that are effective in the care of suicidal individuals.

 Discuss the underlying rationale for each of

the five strategies

 Provide examples of interventions consistent

with the strategies that can be individualized for implementation.

APNA 30th Annual Conference Session 2011: October 20, 2016 Greene 2

 Difficult to design interventions for complex phenomena with

underlying processes that are not yet completely understood.

 Need increased methodological rigor

• Systematic review processes
• Methodological problems
• Paucity of demographic information and questionable ability to generalize

to minority groups and other specialized populations

• Settings primarily outpatient
• Lack of study replication
• Outcomes not well defined
• Many without detailed psychotherapy manuals
• Longitudinal studies - attrition

Brown, G., K. & Green, K. (2014) Brown, G.K. & Jager-Hyman, S. (2014) Sherry Davis Molock – 2014

 1. What treatment worked?  2. What do the treatments have in common

that could help with understanding why the treatment worked.

 LIMITATIONS

• Follow-up period

Rudd, M.D., Williams, B., Trotter, D. (2011).

• 1. Easy to understand treatment model
• 2. Focus on treatment compliance
• 3. Emphasis on skills building
• 4. (Patient) Taking personal responsibility
• 5. Easy access to treatment and crisis services

Rudd, M.D., Williams, B., Trotter, D. (2011) Stanley, C. 2013

APNA 30th Annual Conference Session 2011: October 20, 2016 Greene 3

 Thoughts (includes core beliefs)  Feelings (physiological & emotional)  Behaviors (focus on adaptive)  Slowed cognition, shame, and

poor problem solving

 Avoidance

• Cognitive
• Behavioral
• Emotional

 Passive-aggressive behavior  Submissive behavior  Aggression

Lin Link to to Dev Development

 Barriers  Use specific interventions/techniques that

target increasing motivation and collaboration (Allen, 2011; Jobes, 2006).

 Clarity about what to do if “non-adherence”

becomes an issue.

APNA 30th Annual Conference Session 2011: October 20, 2016 Greene 4

 Identify skills deficits with the opportunity to

build and practice

• Emotiona

ional R l Regulatio gulation

• Inte

Interpersonal

 Clarification of “what is wrong” and “what to

do about it”

 Relaxation  Mindfulness  Reasons for Living – list  Survival kit (includes reason for living )  Sleep hygiene  Recognize the role of shame/guilt/grief

Effective treatment emphasizes:

• Self-awareness
• Self-control
• Self-reliance

 Commitment to treatment  Crisis management/safety plan

APNA 30th Annual Conference Session 2011: October 20, 2016 Greene 5

 Define a commitment to:

• Living
• Treatment & care

 Incorporates a crisis management or

response plan

 Specifically identify responsibilities:

• Patient/client
• Clinician

 1. Triggers/Warning signs

 2. Personal Coping Strategies: Calming or self-

soothing or Distractions

 3. External Support: Activities that Distract – social

settings/personal contact

 4. Professional Contacts with Phone Numbers  5. Where to go (and when) for emergency help  6. Steps to make environment safe (means

restriction.

 7. Reason for living Sarchiapone, Mandelli, Losue, Andrisano,& Roy, (2011) SAMHSA: National Suicide Prevention Lifeline www.suici.aspxdeprevntionlifeline.org/learn/safety Stanley & Brown (2008)

Counseling on Access to Lethal Means

Prog

• gram

ram D Descript ription

1.5 to 2 hour workshop designed to help providers implement counseling strategies to help clients at risk for suicide and their families reduce access to lethal means, particularly, but not exclusively, firearms. (www.sprc.org)

APNA 30th Annual Conference Session 2011: October 20, 2016 Greene 6

 Clear plan of action for emergencies

• Safety plan (and recognize when to use it)

 Dedication of time to prac

practic ticing skills necessary to identify true crisis, using safety plan, and using external support services

When I find myself making plans to suicide, I agree to:

• 1. Use my survival kit….
• 2. Do things that help me feel better for about 30

minutes, including listening to music, coloring and going for a walk

• 3. Call the emergency number XXX-XXXX if the

thoughts continue to get specific and I find myself preparing to act on the thoughts.

• 4. Go to the emergency room If I still feel suicidal and

find myself unable to control my behavior.

Modify for the treatment setting

 Include items that generate productive,

hopeful thoughts & feelings

 Review items individually  Practice the use of the Survival Kit

• Ask the patient/client to describe
• What are they thinking?
• What are they feeling?

Schrank,B., Bird,V., Rudnick,A. & Slade, (2012)

APNA 30th Annual Conference Session 2011: October 20, 2016 Greene 7

Flexibility

By making:

• the implicit explicit
• the complex simple
• the confusing understandable
• the inaccessible available

Allen, J. (2013) National Action Alliance for Suicide Prevention: Suicide Attempt Survivors Task Force. (2014)