Suicidal ideation refers to thoughts about, considerations of, or planning for suicide. This nursing diagnosis focuses on identifying risk factors, implementing safety measures, and providing therapeutic interventions to prevent self-harm and support mental health recovery.
Causes (Related to)
Suicidal ideation can develop due to various factors that affect a patient’s mental health and well-being:
- Psychological factors:
- Major depressive disorder
- Bipolar disorder
- Post-traumatic stress disorder (PTSD)
- Anxiety disorders
- Substance use disorders
- Personality disorders
- Social factors:
- Social isolation
- Loss of significant relationships
- Financial difficulties
- Job loss
- Academic pressure
- Bullying or harassment
- Biological factors:
- Family history of suicide
- Chronic pain or illness
- Hormonal imbalances
- Neurochemical disorders
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Expressing thoughts of death or suicide
- Feeling hopeless about the future
- Expressing worthlessness or being a burden
- Verbalizing plans for self-harm
- Reporting feelings of overwhelming emotional pain
- Expressing a lack of reasons for living
- Describing previous suicide attempts
Objective: (Nurse assesses)
- Changes in mood or behavior
- Social withdrawal
- Giving away possessions
- Decreased interest in activities
- Poor self-care
- Sleep disturbances
- Changes in appetite
- Agitation or restlessness
- Writing goodbye notes
- Acquiring means for self-harm
Expected Outcomes
- The patient will maintain safety throughout hospitalization.
- The patient will verbalize decreased suicidal thoughts
- The patient will demonstrate effective coping strategies
- The patient will engage in therapeutic activities
- The patient will establish a safety plan
- The patient will identify support systems
- The patient will show improved mood and affect
Nursing Assessment
Safety Assessment
- Evaluate current suicide risk
- Assess for specific suicide plan
- Document access to lethal means
- Evaluate support systems
- Monitor behavioral changes
Mental Status Evaluation
- Assess mood and affect
- Check thought processes
- Evaluate judgment
- Monitor concentration
- Document orientation
Support System Assessment
- Identify family support
- Document social connections
- Evaluate community resources
- Check spiritual support
- Assess financial resources
Clinical History Review
- Document previous attempts
- Note psychiatric history
- Review medication compliance
- Check substance use
- Evaluate treatment response
Environmental Assessment
- Evaluate home safety
- Check living situation
- Document access to care
- Assess transportation
- Monitor environmental stressors
Nursing Care Plans
Nursing Care Plan 1: Risk for Suicide
Nursing Diagnosis Statement:
Risk for Suicide related to verbalized suicidal ideation and history of previous attempts as evidenced by expressed hopelessness and detailed suicide plan.
Related Factors:
- History of previous attempts
- Current suicidal ideation
- Access to lethal means
- Major depressive disorder
Nursing Interventions and Rationales:
- Implement suicide precautions and 1:1 observation
Rationale: Ensures continuous monitoring and immediate intervention if needed - Remove all potentially harmful objects
Rationale: Creates a safe environment and reduces access to means - Establish therapeutic relationship
Rationale: Builds trust and encourages open communication
Desired Outcomes:
- The patient will remain safe during hospitalization
- The patient will verbalize decreased suicidal thoughts
- The patient will participate in safety planning
Nursing Care Plan 2: Hopelessness
Nursing Diagnosis Statement:
Hopelessness related to chronic depression and perceived lack of control as evidenced by verbal expressions of despair and negative future outlook.
Related Factors:
- Chronic depression
- Social isolation
- Loss of control
- Prolonged stress
Nursing Interventions and Rationales:
- Help identify sources of hope
Rationale: Reframes negative thinking patterns - Encourage participation in goal-setting
Rationale: Provides a sense of control and direction - Facilitate connection with support systems
Rationale: Reduces isolation and increases support
Desired Outcomes:
- The patient will express hope for the future
- The patient will identify personal goals
- The patient will engage with support systems
Nursing Care Plan 3: Ineffective Coping
Nursing Diagnosis Statement:
Ineffective Coping related to inadequate coping mechanisms as evidenced by suicidal ideation and maladaptive behaviors.
Related Factors:
- Limited coping skills
- Overwhelming stressors
- Poor problem-solving
- Limited support system
Nursing Interventions and Rationales:
- Teach healthy coping strategies
Rationale: Provides alternatives to harmful behaviors - Practice stress management techniques
Rationale: Reduces emotional overwhelm - Develop problem-solving skills
Rationale: Enhances ability to manage stressors
Desired Outcomes:
- The patient will demonstrate effective coping strategies.
- The patient will utilize stress management techniques
- The patient will show improved problem-solving skills
Nursing Care Plan 4: Disturbed Thought Processes
Nursing Diagnosis Statement:
Disturbed Thought Processes related to psychological disorder as evidenced by negative self-talk and distorted thinking patterns.
Related Factors:
- Depression
- Anxiety
- Cognitive distortions
- Emotional trauma
Nursing Interventions and Rationales:
- Assist in identifying cognitive distortions
Rationale: Helps recognize unhealthy thought patterns - Practice reality testing
Rationale: Challenges distorted beliefs - Encourage positive self-talk
Rationale: Promotes healthier thought patterns
Desired Outcomes:
- The patient will demonstrate improved thought processes.
- The patient will express more balanced thinking
- The patient will show reduced negative self-talk
Nursing Care Plan 5: Impaired Social Interaction
Nursing Diagnosis Statement:
Impaired Social Interaction related to depression and low self-esteem as evidenced by social withdrawal and isolation.
Related Factors:
- Depression
- Low self-esteem
- Fear of rejection
- Social anxiety
Nursing Interventions and Rationales:
- Encourage participation in group activities
Rationale: Promotes social engagement - Practice social skills
Rationale: Builds confidence in interactions - Facilitate family involvement
Rationale: Strengthens support system
Desired Outcomes:
- The patient will increase social interactions
- The patient will participate in group activities
- The patient will maintain connections with a support system
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Groves S, Lascelles K, Hawton K. Suicide, self-harm, and suicide ideation in nurses and midwives: A systematic review of prevalence, contributory factors, and interventions. J Affect Disord. 2023 Jun 15;331:393-404. doi: 10.1016/j.jad.2023.03.027. Epub 2023 Mar 16. PMID: 36933670.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Mann JJ, Michel CA, Auerbach RP. Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review. Am J Psychiatry. 2021 Jul;178(7):611-624. doi: 10.1176/appi.ajp.2020.20060864. Epub 2021 Feb 18. PMID: 33596680; PMCID: PMC9092896.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Stallman, H. M., & Allen, A. (2021). Acute suicide prevention: A systematic review of the evidence and implications for clinical practice. Journal of Affective Disorders Reports, 5, 100148. https://doi.org/10.1016/j.jadr.2021.100148
