Risk for Suicide Nursing Diagnosis: Comprehensive Care Plan Guide

What is Suicide?

Suicide is defined as the intentional act of taking one’s own life. It is a deliberate action, often stemming from deep distress and ambivalence about living. It’s crucial to use respectful and accurate language; terms like “committed suicide” or “successful suicide” should be avoided. Instead, we say “died by suicide” to emphasize prevention and treatment, not achievement (Soreff & Xiong, 2022). Suicidal thoughts are not uncommon, particularly among individuals struggling with mental health conditions such as depression, schizophrenia, substance use disorders (alcohol and drug abuse), and personality disorders including antisocial, borderline, and paranoid personality disorders. Furthermore, physical health issues like chronic illnesses (HIV, AIDS), recent surgery, persistent pain), and environmental stressors like unemployment, family history of depression, social isolation, and recent loss significantly increase the risk of suicidal behavior.

Suicidal ideation encompasses a spectrum of thoughts, from fleeting thoughts about death to intense preoccupations with suicide. It’s categorized into active and passive ideation. Active suicidal ideation involves current, specific thoughts of self-harm with a conscious desire to die. This signifies a tangible wish to engage in self-destructive behaviors with the intent of ending one’s life. Passive suicidal ideation, on the other hand, represents a generalized wish to die without a concrete plan for self-harm. It can manifest as a feeling of indifference towards living, even to the point of not caring if an accident were to occur (Harmer et al., 2023).

Globally, suicide is a significant public health concern. Suicide rates experienced a concerning rise of 30% in the United States between 2000 and 2018, before slightly declining in 2019 and 2020. Despite these recent declines, suicide remains a leading cause of death in the US, claiming 45,979 lives in 2020 alone. Worldwide, approximately 700,000 individuals die by suicide each year. Alarmingly, a disproportionate 77% of these global suicides occur in low- and middle-income countries, highlighting the urgent need for accessible mental health resources and suicide prevention strategies in these regions (Soreff & Xiong, 2022).

Psychiatric disorders are frequently underlying factors in suicide attempts, with mood disorders, such as major depression and bipolar disorder, being the most prevalent. Schizophrenia and organic brain disorders also elevate suicide risk, particularly when coupled with auditory hallucinations that command self-harm. A complex interplay of factors contributes to suicide risk, encompassing substance misuse, various mental disorders, psychological states like hopelessness and despair, cultural and social contexts, and even genetic predispositions.

The methods of suicide also vary between genders. Men are more likely to use highly lethal methods such as asphyxiation, hanging, firearms, jumping from heights, and sharp objects. Women, while also using some of these methods, tend to employ a broader range, including self-poisoning (overdose), exsanguination (cutting), drowning, hanging, and firearms. Understanding these gender differences can inform targeted prevention strategies.

Nursing Care Plans & Management

Effective nursing care management for patients at risk of suicide is multifaceted and requires a compassionate and systematic approach. Key components include establishing a strong therapeutic relationship, conducting thorough and ongoing risk assessments, implementing robust safety measures, providing comprehensive education and unwavering support, fostering collaborative care within the healthcare team, and actively promoting self-esteem and resilience. These nursing interventions are crucial in creating a safe and supportive environment, addressing immediate crises, and fostering long-term mental well-being for individuals struggling with suicidal ideation.

Nursing Problem Priorities

In caring for patients with suicidal ideation, nurses must prioritize the following critical areas:

Establish a Therapeutic Relationship. The cornerstone of effective care is a trusting and supportive therapeutic relationship. Nurses must cultivate empathy, practice active listening, and maintain a non-judgmental stance. This approach creates a safe space where patients feel comfortable expressing their deepest feelings, fears, and suicidal thoughts. A strong therapeutic alliance is essential for open communication and collaborative care (Therapeutic Relationship).
Conduct a Comprehensive Assessment. A thorough and continuous assessment of the patient’s mental health is paramount. This includes evaluating the presence, intensity, and nature of suicidal ideation, assessing suicidal intent, and determining if a specific suicide plan exists. Nurses must also assess for underlying psychiatric disorders, substance abuse, and psychosocial stressors that may contribute to the patient’s suicide risk.
Implement Safety Measures. Patient safety is the immediate priority. Nurses must take swift and decisive action to ensure the patient’s safety. This may involve removing any potential hazards from the environment, such as sharp objects or medications. Implementing continuous observation, or escalating to suicide precautions according to facility policies, is often necessary to maintain a safe environment.
Collaborate on a Safety Plan. A personalized safety plan, developed in collaboration with the patient, is a crucial tool. This plan outlines specific strategies the patient can use to manage suicidal thoughts or urges. It includes identifying personal triggers, establishing healthy coping mechanisms, and creating a crisis response plan with emergency contact information. This collaborative approach empowers the patient and provides them with concrete steps to take when feeling overwhelmed.
Provide Education and Support. Education and support are ongoing needs. Nurses educate both the patient and their family about suicide risk factors, warning signs of suicidal ideation, and available resources in the community. Psychoeducation on coping skills, stress management techniques, and the importance of medication adherence (if applicable) is vital. Providing consistent emotional support and facilitating involvement of supportive individuals or community resources strengthens the patient’s support network and promotes resilience.

Nursing Assessment

A comprehensive nursing assessment is crucial for identifying and understanding the risk for suicide. This involves gathering both subjective and objective data.

Assess for the following subjective and objective data:

Emotional and Affective Changes:
- Decreased affect, flat or blunted emotional expression
- Loss of interest in life, anhedonia
- Hopelessness and despair
- Increased anxiety and agitation
- Feelings of guilt or shame
- Withdrawal from social activities and relationships
Cognitive and Behavioral Changes:
- Decreased judgment and impaired decision-making
- Decreased problem-solving abilities
- Lack of initiative and motivation
- Passivity and decreased verbalization
- Preoccupation with death or dying
- Suicidal ideation or behavior, verbal or non-verbal cues
- Giving away personal possessions
- Sudden unexplained happiness or calmness after a period of depression
Physical and Non-Verbal Cues:
- Turning away from the speaker, avoiding eye contact
- Neglect of personal hygiene
- Changes in sleep patterns (insomnia or hypersomnia)
- Changes in appetite or weight
- Fatigue or low energy levels

Assess for factors related to the cause of suicidal ideation:

Mental Health History:
- Psychiatric illness (e.g., bipolar disorder, depression, schizophrenia, anxiety disorders)
- History of prior suicide attempt(s)
- Self-destructive behavior
Substance Use:
- Alcohol and substance abuse/use or withdrawal
Psychosocial Factors:
- Childhood abuse (physical, emotional, sexual)
- Family history of suicide or mental illness
- Grief, bereavement/loss of an important relationship
- Poor support system, loneliness, social isolation
- Conflictual interpersonal relationships
- Personal loss or threat of rejection
- Poorly developed social skills
- Employment problems or financial difficulties
- Legal or disciplinary problems
- Situational or maturational crises
Physical Health:
- Physical illness, chronic pain, terminal illness
Demographic and Other Risk Factors:
- Fits demographic at-risk groups (children, adolescents, young adult males, elderly males, Native American, Caucasian)
- Disturbance in the pattern of tension release
- Impulsive use of extreme solutions
- Inadequate coping skills and social support
- Inadequate resources and opportunity to prepare for a stressor
- Anger, hostility

Nursing Diagnosis

Based on the assessment data, common nursing diagnoses related to suicidal ideation include:

Risk for Suicide: This is the primary nursing diagnosis when a patient expresses suicidal thoughts, has a history of attempts, or exhibits risk factors that increase the likelihood of self-harm (Risk for suicide).
Risk for Self-Harm: This diagnosis is used when the patient may engage in self-injurious behaviors that are not necessarily intended to be lethal, but still pose a threat to their well-being.
Hopelessness: When the patient expresses feelings of despair, lack of hope for the future, and a belief that things will not improve (Hopelessness).
Ineffective Coping: If the patient demonstrates an inability to manage stressors effectively and resorts to maladaptive coping mechanisms, increasing suicide risk (ineffective coping).
Powerlessness: When the patient feels a lack of control over their situation and future, contributing to feelings of despair and suicidal ideation (powerlessness).
Social Isolation: If the patient lacks social support and feels disconnected from others, increasing their vulnerability to suicidal thoughts (social isolation).

Nursing Goals

The overarching goals for nursing care are to ensure patient safety and promote mental well-being. Specific goals and expected outcomes may include:

Safety Planning: The client will actively participate in establishing a personalized safety plan with the nurse, clearly identifying triggers, effective coping strategies, and readily accessible emergency contacts.
Therapeutic Engagement: The client will actively engage in individual or group therapy sessions, demonstrating a commitment to developing and practicing new coping skills and strategies for managing distress.
Professional Support: The client will maintain regular appointments with a crisis counselor or mental health professional, ensuring consistent and ongoing support for their mental health needs.
Future Orientation: The client will identify at least one meaningful personal goal for the future, fostering a renewed sense of purpose, hope, and motivation for recovery and life engagement.
Commitment to Safety: The client will adhere to a no-suicide contract, verbally affirming their commitment to safety and expressing a desire to live and overcome current challenges.
Family Involvement (as appropriate): The client will engage in crisis family counseling sessions to address underlying family dynamics that may contribute to suicidal ideation and promote a more supportive home environment.
Community Support: The client will connect with self-help groups or peer support networks in the community, fostering a sense of belonging, reducing isolation, and accessing additional support systems.
Substance Abstinence: The client will refrain from using substances or engaging in substance abuse as a maladaptive coping mechanism, addressing potential contributing factors to suicidal risk.
Emotional Regulation: The client will demonstrate improved emotional regulation skills and employ at least two healthy and constructive strategies for effectively managing emotional pain.
Self-Worth Recognition: The client will recognize their inherent self-worth and identify personal roles and responsibilities in life, promoting a positive self-concept and sense of value.
Reduced Self-Destructive Behaviors: The client will exhibit a measurable reduction in self-destructive behaviors through the consistent implementation of healthier and more adaptive coping mechanisms.

Nursing Interventions and Actions

Therapeutic nursing interventions and actions for patients with suicidal ideation are crucial for ensuring safety, providing support, and promoting recovery. These interventions are categorized below:

1. Risk Assessment and Establishing Therapeutic Relationship

Understanding the patient’s risk level and building trust are the first critical steps.

1. Perform Screening for Suicidal Ideations. Utilize validated suicide risk assessment scales as per Joint Commission guidelines. These tools should be age-appropriate and setting-specific. Examples include Ask Suicide-Screening Questions (ASQ), Manchester Self-Harm Rule, and Risk of Suicide Questionnaire (Harmer et al., 2023). Screening is essential in emergency departments, primary care, and behavioral health settings.

2. Identify Characteristics or Behaviors Pertaining to Suicidal Ideations. Ask direct, yet empathetic questions to understand the nature and intensity of suicidal thoughts. Differentiate between passive and active suicidal ideation to assess imminent risk. Explore the fluctuation of suicidal thoughts over time, considering both worst-ever and recent experiences. Recognize ambivalence between living and dying as a common experience (Harmer et al., 2023).

3. Assess for Early Signs of Distress or Anxiety and Investigate Possible Causes. Anxiety in its various forms significantly elevates suicide risk. Also, assess for potential for homicide, as aggression turned inward is suicide, and outward is homicide. The link between homicide and suicide is particularly relevant in adolescents (Soreff & Xiong, 2022).

4. Monitor for Suicidal or Homicidal Ideation. These are critical indicators requiring immediate further assessment and intervention. Directly inquire about thoughts of self-harm and also assess for homicidal tendencies. Suicidal ideation is a strong predictor of completed suicide (Soreff & Xiong, 2022).

5. Assess Suicidal Intent on a Scale of 0 to 10. Directly ask if the patient is thinking of killing themselves, and inquire about plans and means. Direct, caring questioning is crucial. This helps determine the urgency of interventions. Millions report suicidal thoughts and plans, with a significant portion attempting suicide (Soreff & Xiong, 2022).

6. Maintain Straightforward Communication and Assist the Client to Learn Assertive Behavior. Avoid manipulative or aggressive behaviors. Clear, consistent communication with boundaries is essential. Reinforce that staff support is available, but manipulation, threats, or abuse are not tolerated.

7. Help the Client Choose Activities to Redirect Emotions. Encourage healthy outlets for emotional energy. Task-focused coping strategies can help clients manage emotions and engage in positive social activities, reducing focus on suicidal thoughts (Addollahi & Carlbring, 2017).

8. Acknowledge Suicide or Homicide as an Option and Discuss Consequences. Address the client’s perception of suicide as the “only” option. Explore alternative solutions and help the client weigh the negative consequences of suicidal actions to encourage change (Substance Abuse and Mental Health Services Administration, 2019).

9. Remain Calm and State Limits on Behavior Firmly. Helplessness and fear often underlie hostile behavior. Set firm limits without giving in to demands or manipulation. Help the client recognize consequences and take accountability.

10. Provide Protection Within the Environment. Structural changes like removing ligature points significantly reduce inpatient suicide rates (Soreff & Xiong, 2022). Assess and remove potential self-harm implements like pills and firearms.

11. Tell the Client to Stop Hostile Actions. A firm “stop” can help clients regain control, especially when they are afraid of their own actions and seeking limits from staff. Verbal interventions combined with de-escalation and active listening are effective.

12. Administer Medications as Indicated. Treat underlying psychiatric illnesses. Antipsychotics are indicated for clients with schizophrenia experiencing command hallucinations for self-harm (Soreff & Xiong, 2022).

13. Prepare the Client for Transcranial Magnetic Stimulation (TMS). TMS shows promise in rapidly reducing suicidal ideation, particularly in crisis situations and for those with comorbid PTSD or traumatic brain injury (Soreff & Xiong, 2022).

14. Talk to the Patient to Evaluate Potential for Self-Injury. Be alert to verbal and behavioral cues indicating suicidal intent.

15. Ask Direct Questions to Assess Suicide Risk:

“Have you ever considered harming yourself?” (Assesses ideation frequency)
“Have you ever attempted suicide?” (Identifies past attempts and risk level)
“Do you currently consider killing yourself?” (Opens discussion about current feelings)
“What are your plans with regard to killing yourself?” (Determines plan and lethality)
“Do you trust yourself to maintain control over your insights, emotions, and motives?” (Assesses sense of control over suicidal thoughts)

16. Observe for Risk Factors that Increase Suicide Attempt Chance. Debunk myths that suicide occurs without warning and that there’s a “typical” suicidal person. Assess for:

Personal or family history of suicide attempts
Suicidal thoughts or statements (verbal cues)
Substance use (alcohol and drugs)
Sleep disturbances (insomnia)
History of mood disorders (depression, bipolar disorder)
Unexplained happiness or drive (sudden behavioral change)
Male gender (higher completion rate)
Giving away possessions (withdrawal from life)

17. Determine Particular Stressors. Identify triggers to develop coping strategies. Suicide often seems like the only solution when other solutions are not apparent.

18. Appraise Possible Coping Methods. Patients with ineffective coping need new resources and strategies.

19. Assess Need for Hospitalization and Safety Precautions. Patient safety is paramount. Direct supervision is necessary for those with suicidal attempts.

20. Assess Support Resources Available. Depression can lead to isolation and inability to see available support systems.

21. Assess Decision-Making and Problem-Solving Energy. Impulsivity is common in mood and bipolar disorder. Supervision in decision-making is needed until mood stabilizes.

22. Render Close Patient Supervision. Maintain constant observation or awareness. Suicide can be impulsive with little warning.

23. Provide a Safe Environment. Remove weapons and pills.

24. Present Opportunities to Express Thoughts and Feelings in a Nonjudgmental Environment. Talking about suicidal thoughts can lessen their intensity and shows staff openness to discussion.

25. Create a Verbal or Written No-Suicide Contract. Establishes permission to talk about suicide and commitment to safety.

26. Stay with the Patient More Often. Provides security and strengthens self-worth.

27. Help with Problem-Solving Constructively. Patients can learn to identify triggers and implement problem-solving before reacting.

28. Arrange for Client to Stay with Family or Friends or Hospitalize if Necessary. Relieves isolation and ensures safety.

29. Educate on Appropriate Medication Use. Drug therapy can help manage underlying conditions like depression.

30. Contact Family and Arrange Crisis Counseling and Self-Help Groups. Re-establishes social ties and reduces isolation.

31. Educate on Cognitive-Behavioral Self-Management for Suicidal Thoughts. Patients learn to identify and challenge negative thoughts.

32. Introduce Self-Expression Methods. Journals and hotlines can help manage suicidal feelings safely.

2. Establishing Safety Measures

Preventing repeat self-harm, especially after a prior attempt with violent methods, is critical.

1. Arrange for Client to Stay with Family/Friends or Hospitalization. Inpatient care is often medically necessary for acute suicide risk (Soreff & Xiong, 2022). Family and friends can provide immediate support while treatment is arranged.

2. Encourage Client to Avoid Decisions During Crisis. Impaired decision-making is linked to suicidal behavior (Soreff & Xiong, 2022). Encourage delaying major decisions until crisis passes.

3. Encourage Talking About Feelings and Plan Alternative Coping. Therapeutic communication skills are vital for suicide prevention (Türkles et al., 2018). Help patients develop healthy ways to manage disappointment, anger, and frustration.

4. Remove Weapons and Pills. Create a safe environment free of potential harm. Secure medications and dangerous objects away from the client. Be mindful of stockpiled medications (Soreff & Xiong, 2022).

5. Administer Tranquilizers if Anxiety is High and Sleep Deprived (Short-Term). Relief of anxiety and sleep restoration can help clients think more clearly. However, psychotropic drugs can also be used for suicide attempts, so monitor closely and provide limited supplies (Soreff & Xiong, 2022).

6. Contact Family, Arrange Counseling, and Activate Self-Help Groups. Re-establish social ties and reduce isolation. Educate family and provide resources.

7. Provide Information About Technological Advances. Internet-based safety planning and integration of safety plans into electronic medical records show promise (Harmer et al., 2023).

3. Providing Crisis Intervention

During a suicidal crisis, reinforce key messages and implement immediate safety protocols.

1. Emphasize Four Key Points During Crisis: “The crisis is temporary, unbearable pain can be survived, help is available, and you are not alone.” Clients in crisis often experience “tunnel vision”. Affection, valuing the individual, and ensuring they feel cared for are crucial (Türkles et al., 2018).

2. Prepare the Client for Electroconvulsive Therapy (ECT). ECT is effective for severe depression and suicidal ideation when rapid treatment is needed or other treatments have failed (Harmer et al., 2023).

3. Administer Clozapine as Prescribed. Clozapine is FDA-approved to reduce suicidality in schizophrenia (Harmer et al., 2023).

4. Follow Unit Protocol for Suicide Precautions. Create a safe environment by removing potential weapons. The VA’s environmental risk assessments and removal of ligature points significantly reduced suicide rates (Harmer et al., 2023).

5. Keep Accurate and Thorough Records. Documentation may be court evidence. Document all behaviors and nursing/physician actions. Cooperate fully with root cause analysis (RCA) after suicide attempts or deaths (Wilson et al., 2022).

6. Implement Suicide Precautions or Observation. Use one-on-one monitoring or 15-minute checks depending on risk level. Prioritize client safety and follow unit protocol. Increased staff and reduced client numbers can improve safety (Türkles et al., 2018).

7. Maintain Accurate and Timely Records (Every 15 Minutes). Document client activity, mood, and verbatim statements. Charting is a legal document. Document any actions not taken and reasons why (Wilson et al., 2022).

8. Encourage Talking About Feelings and Problem-Solve Alternatives. Talking and exploring alternatives minimizes suicidal acting out. Therapeutic relationship and active listening are key tools (Clua-Garcia et al., 2021).

9. Construct a No-Suicide Contract or Crisis Safety Plan. Safety plans are personalized, collaborative, and help clients identify triggers and coping strategies (Harmer et al., 2023).

4. Emotional Support and Building Self-Esteem

Promote self-worth and resilience through supportive interventions.

1. Assess for Feelings of Apathy, Hopelessness, and Depression. These can indicate powerlessness.

2. Determine Patient’s Power Needs or Need for Control. Identify areas of self-governance that are most important to the patient.

3. Distinguish Patient’s Locus of Control. Internal vs. external locus of control influences feelings of powerlessness. External locus of control may increase powerlessness.

4. Evaluate Decision-Making Competence. Powerlessness is the feeling of lost control over one’s interests.

5. Know Situations/Interactions that Increase Powerlessness. Respect patient’s right to refuse procedures. Avoid routines done without consent.

6. Assess Role of Illness in Powerlessness. Illness, prognosis, and dependence can contribute to powerlessness.

7. Note Need for Information About Illness, Treatment, and Procedures. Differentiate powerlessness from knowledge deficit.

8. Evaluate Results of Information Given. Powerless patients may overlook or be overwhelmed by information. Information can strengthen independence.

9. Encourage Verbalization of Feelings and Concerns About Decisions. Create a supportive and caring environment.

10. Encourage Client to Identify Strengths. Recognize inner strengths and capabilities.

11. Appraise Impact of Powerlessness on Physical Condition. Assess appearance, oral intake, hygiene, and sleep habits.

12. Discuss Care with Patient. Include patient in decisions about treatment, visits, and ADLs to increase autonomy.

13. Encourage Increased Responsibility for Self. Support systems and resources may be needed to achieve self-care goals.

14. Help Reexamine Negative Perceptions. Challenge unrealistic perceptions of the situation.

15. Eliminate Unpredictability. Prepare patient for tests and procedures to increase control.

16. Give Patient Control Over Environment. Enhance independence and autonomy within the care setting.

17. Aid in Recognizing Cultural, Religious, Gender, and Age Influences on Powerlessness. Hospital environments can exacerbate powerlessness due to language barriers, unfamiliar food, and customs.

18. Support Planning and Timetabling for Increased Responsibility. Set realistic short-term goals for self-care to build confidence.

19. Avoid Coercive Power. Increases powerlessness and reduces self-esteem.

20. Render Positive Feedback for Decisions and Self-Care. Success and positive reinforcement promote confidence and self-governance.

5. Promoting Positive Coping Mechanisms

Develop and reinforce healthy coping strategies to replace maladaptive ones.

1. Assess Client’s Strengths and Positive Coping Skills. Identify past successes and build upon them. Ask about past coping strategies: “How did you get from where you were to where you are now?” (Substance Abuse and Mental Health Services Administration, 2019).

2. Assess Ineffective Coping Behaviors. Identify negative coping mechanisms like anger, denial, substance use, withdrawal. Nurses observe isolation, disconnection, and mismatches in communication before suicide attempts (Clua-Garcia et al., 2021).

3. Assess Need for Assertiveness Training. Assertiveness helps balance control and meet needs respectfully (Association for Behavioral and Cognitive Therapies, 2023).

4. Assess Client’s Social Support. Encourage engagement with support systems. Family support and religious belief can prevent suicide (Türkles et al., 2018).

5. Identify Situations that Trigger Suicidal Thoughts. Questioning shows concern and helps identify targets for adaptive coping skill learning (Soreff & Xiong, 2022).

6. Assess for Defining Characteristics of Ineffective Coping. Observe behavioral and physiological responses to stress.

7. Assess Cultural Influences on Coping. Cultural beliefs shape perceptions of effective coping.

8. Observe for Causes of Ineffective Coping. Consider poor self-concept, grief, lack of skills or support, and life changes.

9. Assess Intergenerational Family Problems. Family issues can overwhelm coping abilities.

10. Identify Specific Stressors. Accurate appraisal helps develop coping strategies. Persistent stressors can exhaust coping abilities.

11. Observe for Strengths. Praise and build on strengths, especially in families coping with critical injuries.

12. Determine Patient’s Understanding of Stressful Situation. Patient’s perception of threat vs. resources influences coping.

13. Analyze Past Coping Mechanisms. Past coping success influences current adjustment. Maladaptive coping requires additional resources.

14. Monitor Risk of Self-Harm and Intervene Appropriately. Hopelessness and problem-solving deficits increase suicide risk.

15. Evaluate Resources and Support Systems. Assess support availability at home and in various settings.

16. Clarify Things Not Under Personal Control. Recognize limitations in controlling others’ actions and health status. Acceptance of limitations can be empowering (Türkles et al., 2018).

17. Encourage Expressing Feelings, Active Listening, and Empathy. Validate emotions, build trust, and promote communication (Substance Abuse and Mental Health Services Administration, 2019).

18. Assist in Identifying and Addressing Negative Thoughts and Cognitive Distortions. Develop realistic and positive thinking patterns to improve coping (Soreff & Xiong, 2022).

19. Encourage Activities Promoting Purpose and Accomplishment. Exercise, learning, volunteering, and classes can restore control and meaning (Stanley et al., 2021).

20. Promote Use of Multiple Coping Strategies. Enhance ability to cope with suicidal thoughts before acting (Stanley et al., 2021).

21. Prepare for Psychotherapy. Interpersonal psychotherapy can improve social support, while CBT and DBT build coping skills (Stanley et al., 2021).

22. Provide Information About Coping Styles. Task-focused coping (direct problem-solving), emotion-focused coping (managing emotions), and avoidance coping (Addollahi & Carlbring, 2017). Emotion-focused coping can elevate suicidal ideation.

23. Set a Working Relationship Through Continuity of Care. Builds trust and reduces isolation.

24. Assist Setting Realistic Goals and Identifying Skills. Involve patients in decision-making to promote independence.

25. Provide Chances to Express Concerns, Fears, and Expectations. Verbalization reduces anxiety and opens communication.

26. Use Empathetic Communication. Acknowledging and empathizing creates a supportive environment.

27. Convey Acceptance and Understanding. Avoid False Reassurances. Honesty facilitates problem-solving.

28. Encourage Choices and Participation in Care Planning. Increases control and self-esteem.

29. Encourage Recognizing Strengths and Abilities. Foster awareness of inner resources.

30. Consider Mental and Physical Activities. Reading, exercise, outings, crafts, games, social gatherings improve well-being. Exercise, nutrition, and relaxation can reduce anxiety and depression.

31. Assist in Evaluating Situation and Accomplishments. Help patients realistically assess their skills and resources.

32. Encourage Moderate Aerobic Exercise. Improves coping with acute stress.

33. Provide Information About Wants and Needs (Manageable Amounts). Ineffective copers may need guidance and less information initially.

34. Provide Touch Therapy (with Permission). Back massage with slow, rhythmic strokes can induce relaxation and reduce physiological stress responses (decreased heart rate, blood pressure).

35. Assist with Constructive Problem-Solving. Promotes independence and autonomy.

36. Provide Information and Explanation Before Care. Prepares patient and family for understanding the situation and outcomes.

37. Eliminate Threatening Stimuli. Reduce environmental noise to minimize anxiety.

38. Discuss Changes Before Making Them. Open communication with staff enhances understanding.

39. Provide Outlets for Achievement and Self-Esteem. Role-playing and rehearsal can build confidence.

40. Point Out Signs of Positive Progress. Ineffective copers may not recognize their own progress.

41. Encourage Cognitive Behavioral Relaxation. Music therapy and guided imagery can aid coping and reduce anxiety.

42. Be Supportive of Coping Behaviors. Allow time for relaxation and rest.

43. Discuss Previous Stressors and Coping Mechanisms. Strengthen effective coping strategies.

44. Use Distraction During Fearful Procedures. Directs attention away from anxiety-provoking stimuli.

45. Apply Systematic Desensitization. Gradual exposure to new situations can reduce fear and improve coping.

46. Refer for Counseling. Connect patients with mental health professionals for specialized support.

47. Evaluate for Suicidal Tendencies and Refer for Mental Health Care Immediately. Ensure emergency plan is in place for suicidal patients.

48. Refer to Medical Social Services. Social services can provide evaluation and counseling to promote effective coping.

49. Engage in Mental Health Team Planning. Home care nurses can advocate for patients based on their home environment knowledge.

6. Managing Hopelessness

Address feelings of despair and foster hope through targeted interventions.

1. Assess Client’s Emotional State. Evaluate for symptoms of depression, anxiety, and hopelessness. Hopelessness and helplessness dominate suicidal thoughts (Soreff & Xiong, 2022).

2. Assess Social Support Level. Lack of support contributes to despair. Involve supportive individuals in treatment (Substance Abuse and Mental Health Services Administration, 2019).

3. Assess Physical Appearance. Observe grooming, posture, and hygiene. Hopelessness affects self-care.

4. Ascertain Role of Illness in Hopelessness. Illness can significantly impact perception. Cancer can intensify feelings of hopelessness.

5. Assess Understanding of Situation, Belief in Self, and Abilities. Hopeless patients may perceive threats as insurmountable.

6. Assess for and Point Out Reasons for Living. Interventions that highlight reasons to live can reduce hopelessness.

7. Assess Eating, Sleeping Patterns, and Daily Activities. Changes in these patterns indicate hopelessness.

8. Evaluate Ability to Set Goals, Make Decisions, and Solve Problems. Hopeless patients feel unable to achieve goals or make decisions.

9. Determine Social Support System and Hope Sources. Social isolation hinders improvement.

10. Ascertain Future Expectations. Dependence and uncertainty contribute to hopelessness.

11. Encourage Reframing Negative Thinking. Cognitive reframing helps shift to neutral or objective perspectives (Substance Abuse and Mental Health Services Administration, 2019).

12. Work to Identify Strengths. Emphasize strengths and abilities to counter feelings of being overwhelmed (Substance Abuse and Mental Health Services Administration, 2019).

13. Point Out Unrealistic and Perfectionistic Thinking. Perfectionism increases suicide risk (Addollahi & Carlbring, 2017).

14. Identify Past Sources of Meaning and Joy. Reincorporate religious/spiritual beliefs, group activities, or creative endeavors to rekindle joy and purpose. Task-focused coping and creative activities are beneficial (Addollahi & Carlbring, 2017).

15. Discuss Dreams and Wishes for the Future. Set short-term goals to renew hope and purpose (Substance Abuse and Mental Health Services Administration, 2019).

16. Encourage Contact with Religious/Spiritual Groups. Religious affiliation and service attendance are protective against suicide (Lawrence et al., 2016).

17. Teach Problem-Solving Steps. Empower patients to actively improve their situation and reduce helplessness (Schoenmakers et al., 2015).

18. Encourage Effective Coping Styles. Task-focused coping reduces suicidal ideation by managing emotions and promoting resilience (Addollahi & Carlbring, 2017).

19. Develop Trusting Relationship. Build rapport for open dialogue (Substance Abuse and Mental Health Services Administration, 2019).

20. Listen to Verbalizations of Hopelessness and Lack of Self-Worth. Acknowledge and validate feelings.

21. Learn Perception of Failures vs. Accomplishments. Hopelessness can stem from seeing failures as defining.

22. Encourage Positive Mental Perspective and Discourage Negative Thoughts. Prepare for potential negative results realistically.

23. Provide Openings to Verbalize Hopelessness. Create a supportive, nonjudgmental environment.

24. Maintain Staff Consistency. Builds trust and promotes coping.

25. Identify Previous Coping Strategies. Past experiences influence coping effectiveness.

26. Assist with Options and Relevant Goals. Mutual goal setting restores hope.

27. Encourage Recognizing Strengths and Abilities. Foster awareness of inner resources.

28. Work to Set Small, Attainable Goals. Incremental goals build hope and confidence.

29. Render Physical Care and Respect Abilities. Overcome weakness, guilt, and negative perceptions.

30. Spend Time with Patient and Use Empathy. Warmth, empathy, and positive regard reduce hopelessness.

31. Assist in Developing Realistic Appraisal of Situation. Connect patients with resources and support groups.

32. Promote Realistic Hope. Emphasize intrinsic worth and manageable problems. Avoid unrealistic reassurances.

33. Send Acceptance and Understanding. Honesty promotes problem-solving. Avoid false reassurances.

34. Provide Time for Patient to Initiate Interactions. Hopeless patients need time to initiate relationships.

35. Strengthen Relationships with Significant Others. Enhance connectedness and reduce isolation.

36. Encourage Family to Display Care, Hope, and Love. Family support can shift hope state.

37. Practice Touch (with Authority and Permission). Provides comfort and fosters hope.

38. Present Opportunities to Manage Care Setting. Choices can reduce hopelessness.

39. Promote Spiritual Resources. Religious practices can provide strength.

40. Provide Plant or Pet Therapy. Fosters a sense of purpose and being needed.

41. Refer to Self-Help Groups. Groups like “I Can Cope” and “Make Today Count” foster belonging and support.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care

We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)

Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales

Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care

Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health

Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.