How do you know if your patient, your resident or your client is in pain? Are they struggling to breath? Running a high fever? Clutching their stomach?
Not all kinds of pain are easy to detect or measure. You are a healthcare worker, on the front lines, and your user could be at risk of suicide. Do you know the signs?
“Healthcare professionals are obligated to intervene appropriately for all health matters—and that includes mental health,” says Tung Tran, Associate Director of the Mental Health and Addiction program for CIUSSS West-Central Montreal.
Corporate campaigns raised public awareness about mental health during Suicide Prevention Week at the beginning of February, in Quebec and across the nation. More rigorous, professional training is called for, however, on the front lines of health care. To reach the greatest number of staff in the CIUSSS, a multidisciplinary team specializing in mental health has created a bilingual E-learning course on suicide intervention.
“When new practitioners come out of school, they don’t always have experience in dealing with someone in distress or contemplating suicide,” says Clinical Nurse Specialist in Mental Health, Dominique Boudreau, the primary author of the course. “Oftentimes even seasoned clinicians can miss more subtle behavioural or emotional cues of a person who is suicidal. There’s also uncertainty about what steps to take once they have identified someone at risk. We developed this tool to help staff throughout our network to respond skillfully, resourcefully and confidently to help identify keep an at-risk user safe.”
E-learning course teaches best practices in suicide prevention
Whether you’re a social worker at a long-term care site, an occupational therapist who is part of a home care team, or a nurse in a hospital triage, the online course provides you all with the same training to familiarize you with best practices in suicide prevention.
“It’s important to be aware that there are certain groups that are generally at higher risk, such as men, who tend to confide less in others and isolate themselves,” explains Jennifer Clarke, a Clinical Nurse Specialist in Geriatrics. “Other vulnerable individuals include those with a history of mental illness such as clinical depression, people suffering from chronic health problems, or with an illness that causes a loss of autonomy. When it comes to performing a suicide risk assessment, however, there is no discrimination—it must be performed on all adult and elderly users, regardless of supposed risk level.”
Screening should systematically take place during five key moments:
- At the ED triage
- Prior to admission
- Prior to a transfer to an inpatient unit or another service/health centre
- Prior to discharge from the ED or an inpatient unit
- Any time a user shows warning signs
Unfamiliar with the warning signs? You’ll learn how to detect them in the course. A healthcare user may reveal suicidal thoughts obliquely, saying for instance, “There’s no point to living, I am a burden on my loved ones, they would be better off without me.” They may also communicate their state of mind with non-verbal cues, such as by giving away their personal possessions, no longer taking their medication, withdrawing from social interaction, or exhibiting apathy toward life and loved ones.
A risk assessment must be carried out in these circumstances, which involves communicating with the user. “Many practitioners remain uncomfortable talking with the user about their mental state,” says Ms. Boudreau, the clinical lead on the project. “We know, though, that most people are receptive and relieved that a healthcare professional is sensitive to their distress, and engages with them in a calm, respectful, empathetic and non-judgmental manner.” To help open up that conversation, the course provides a list of key questions that are instrumental in evaluating risk.
If a healthcare provider determines that a user is at risk, then a timely and appropriate intervention must follow, to ensure their safety. Staff are urged not to intervene independently, however, says Annick Simard, a Management Consultant, Professional Practice in Multidisciplinary Services (with a background in Social Work) who collaborated in developing the online course. Evidence-based practice and suicide prevention guidelines recommend an interdisciplinary approach. “If you do not have the experience or competency to help, refer to a healthcare professional who can provide support,” says Ms. Simard.
Different options in seeking help include consulting a nurse manager, psychiatric consultation liaison team or psychiatric nurse on the units, or reaching out to mental health teams in CLSCs.
A user who is assessed as posing a moderate to high risk of suicide should be placed in a secure environment that has adequate monitoring. A physician must be notified, and an evaluation performed. If the person leaves before seeing a physician, place a Code Yellow call, as the person might represent a danger to themselves, and securing their safety is a priority.
“Once the immediate threat has subsided, an important next step is to create a safety plan along with the user and their family,” recommends Ms. Boudreau. “The plan should identify warning signs, coping strategies, social settings that can serve as distractions, people who can be relied upon to help and professionals who can be contacted during crisis. It’s all about creating a safe environment and dependable support system.”
The course was made interactive for the CIUSSS intranet by e-learning technology specialist Chantal Bastien with input from Geneviève Beaudoin, both Clinical Nurse Specialists. It concludes with a 10-question accredited quiz. Both training and quiz can be completed within one hour.