Suicide

The nurse performs comprehensive suicide risk assessment, implements evidence-based safety planning, manages patients during high-risk periods, and coordinates transitions of care to minimize post-discharge suicide risk. Advanced risk stratification moves beyond simple checklists to clinical formulation: integrating static risk factors (demographics, history, diagnosis) with dynamic risk factors (current symptoms, recent stressors, acute intoxication, access to means) and protective factors to determine the overall level of risk. The Three-Step Theory (Klonsky & May) provides a clinically useful framework: Step 1 (pain + hopelessness = ideation), Step 2 (pain + hopelessness + disconnection = strong ideation), Step 3 (strong ideation + capability = attempt). Capability can be dispositional (pain tolerance, fearlessness) or acquired (through prior self-harm, trauma exposure, combat, medical procedures). The nurse uses this framework to identify intervention targets: reduce pain (treat underlying condition), increase hope (therapeutic alliance, treatment plan), increase connectedness (social support, therapeutic relationship), and reduce capability (means restriction). Safety planning (Stanley-Brown model) is more effective than no-suicide contracts: studies show that safety plans reduce suicide attempts by 45% compared to usual care. The nurse also manages the high-risk...