Critical Thinking/ Evidence Based nursing Concept
Abstract
Approximately one million individuals succumb to suicide every year. Suicide is a clinical issue that is caused by interplay of biological/genetic, sociocultural, psychological, pathological and behavioral factors (Boore, and Tsao, 2011). Extensive and thorough assessment is needed in determining the cause individually. According to a number of researches, lack of emotional empowerment among the youth forms one of the contributing factors in suicidal tendencies. Evidence based practice has proven CARE model an effective approach for reducing risk of suicide in the society. The model empowers the victims to develop skills such as; personal control, self-esteem, sense of worth, problem solving and sound decision making skills (Randell, 2007), which are crucial in overcoming suicidal tendencies.
Introduction
Nursing profession is advancing with the need to change from routine management approaches to evidenced based practices. There are ample researches being conducted in the profession with the aim of accentuating the effectiveness of evidence based practices that embrace critical thinking and decisional making approaches. It is in the wake of this shift in practices that several concepts have developed, deemed to help professionals address the cases in the society in an amicable, effective and efficient way. Empowerment is one of the concepts that have elicited profound benefits in alleviating a number of problems in the health care sector. The concept is a component of CARE (Care, Assess, Respond, and Empower) model, which will be forms the focus of the paper. This model will be evaluated for effectiveness in addressing suicide (clinical issue identified). The paper will delineate the model in details and how it can be used to reducing incidences of suicide, especially among the youths. Lastly, recommendation based on the inferred knowledge from the literature review will be offered.
Suicide is a common clinical condition that cuts across all ages in the population. Worldwide, suicide accounts for roughly a million deaths every year, with over ten million cases of attempted suicide. According to statistics from Center for Disease Control and Prevention, reported in a study by Boore and Tsao, 2011, the total number of individuals succumbing from suicide in America is approximated at over 32,800 people. The government incurs a loss of income of over $12 billion. This cost and expenses in preventing and dealing with suicide have attracted interest in devising an appropriate strategy in dealing with this menace. Suicide has been described as a problem that needs to be addressed from the societal setup and not just offering medication to the affected individuals visiting the hospitals. Therefore, nurses have developed a program that maximizes the collaboration among several stakeholders in reducing the incidences of suicide, right from the society level.
CARE model has undergoes rigorous evaluation and has recorded positive and successful outcomes in preventing suicidal tendencies and incidences. The program targets the youth (12 – 25 years) group, which form the largest age group of individuals committing suicide. The program involves a process that start with assessing the individual recruits of the program. The assessment step incorporates counseling the individual to restore hope and help them open up for the causes. Once the problem is defined, the assessor assists the individual to develop the best appropriate coping mechanism to overcome the contributing factor(s) associated with suicidal tendencies. Finally, the individual is assign social support teams in the society level that comprises of a parent (guardian) among others.
Suicide tendencies developed due to affected consciences, and emotional disturbances. Lack of experience in life, poor coping mechanism, and ample physiologic, psychological and social changes taking place during youth stage leave them vulnerable for suicide tendencies. Lack of adequate support among these individuals will, therefore, exacerbate the susceptibility of this group to indulging into suicide. Some of the common factors associated with suicide include low self-esteem, hopelessness, helplessness, worthlessness, conflict of interest, and over expectations from the old people that mounts pressure beyond threshold. These factors are associated to aspects of life including biological/genetic, sociocultural, psychological, pathological and behavioral aspects. The adolescence crises are also a significant contributor of suicide among the youths. According to Center for Substance Abuse Treatment, 2008 report, factor leading to suicidal tendencies among arises due to poor support in the society. The individual lacks avenues to express and share their feeling, grievances and challenges encountered in life. Therefore, managing the condition in the healthcare centers may not address the issue on a broader perspective.
Shain et al, 2007 suggested that empowering the youths to take courage on addressing contributing factor or seeking advice and guidance from the supportive teams is the single most imperative approach in reversing suicide rates. However, the society seemed to have neglected their “brother’s keeper” role and individuals live as single entities in a community; individuals pursuing their duties on isolate bases. Empowering the community seemed as a measure deemed at easing the load of managing the suicidal cases and distributing the responsibilities to a wide range of individuals. Consequently, the youth population will have an extensive source of guidance. Randell, 2007 notes that using CARE model will potentiate sound strategies among all stakeholders in the health sector.
CARE model empowers the youths through the development of skills that strengthen self-esteem and decision making approaches. Such individuals will develop personal control and improve on interpersonal communication skills (Randell, 2007). Consequently, the individual will appreciate their life overcoming the suicide contributing factors such as hopelessness, helplessness, and worthlessness among others. Boore and Tsao, 2011 noted that involving school, family and society at large in addressing suicide enables the youth to focus on positive aspects of life due to the feeling of care and concerns surrounding them. The assessment team comprises of professionals who determine the exact needs of the client, thereby strategies devised in the coping and social support ameliorates the client’s needs effectively.
Hooven, Jerald and Karen, 2010 emphasized that an effective program in reducing suicide should address the problem from the public health perspective rather than curative approach. They noted that CARE model reflects a well evidenced based design whose success lies on critical thinking platform. The program moves the focus from general practice to evidenced based approach. Every person in the program is assessed and addressed depending with their associated problem rather than on a general program. Involving clients (suicide victims) reduce the monopoly or the passive involvement of patients in the treatment strategy witnessed in the hospitals. Nurses using CARE model will also be in a position to collaborate maximally with the other health care provide synergizing the achievement of the program. Nurses interact with other health professionals quantified by CARE protocol at the counseling level. These professionals include psychologies, psychiatrist, social workers and to some extent the physicians.
According to Shain et al, 2007, suicide victims recorded three times difficulties in accessing the medical care compared to individuals dying from other medical conditions. Seventy percent of the individuals, who accessed medical care in the help centers, failed to get the necessary medical attention which could help them overcome the overwhelming suicidal tendencies. The core factor contributing to the poor scale of individuals accessing these services was poor hospital strategies. Mostly, hospitals offer curative services while preventive services are less accorded the needed attention. Randell, 2007 estimated that 50 percent of individuals succumbing in suicide can be reached in time. What was lacking was a prompt and effective intervention formula for helping these individuals.
The hospital sector is designed in a way that the suicide cases victims seek help in mental health clinics. The society has a negative perception towards being psychiatric assessment. Therefore, the nurses and other healthcare providers in the metal health clinic may be incapacitated to render services to victims. Stigmatization of mental conditions in the society widens the gap between the victims and the nurses, specialized to offer the necessary services and help. In this respect, CARE model seems appropriate in reaching out for the victims in the institution and using the trusted people to assist the victim overcome the problem.
The broad causes of suicide tendencies offer challenges in clinical intervention; thus, adopting a program that focusses on the broader dimension or holistic assessment of the victim has seen the success recorded by CARE model. In a study conducted by Randell, 2007, 85 percent of the participants (suicidal associated victims) recorded a reduction in the risk of committing suicide. However, he noted that the interplay of factors associated to suicide tendencies among victims affected the positivity of CARE model in reducing the risk of suicide.
Summary and recommendation
In summary, suicide is a common problem among the youth. The organization of the hospital set up leaves the victims of this problem with not straight answer of where to seek help for their problems. Involving the society and other social institutions in managing suicide using the CARE model has recorded profound success in empowering the youth and the community on strategies for overcoming the problem. Empowering as a concept forms a critical approach in evidenced based strategies in preventing suicide. Empowering enables the victims to develop imperative skills crucial in overcoming the feelings that drive the victim to commit suicide. Such skills include personal control, self-esteem, sense of worth, problem solving and sound decision making skills. The recommendation suggested in promoting CARE model and concept of empowering is intermarrying and integrating the concepts in the nursing process when it comes to addressing suicide cases. In addition, campaign to reduce stigmatization of the society on suicide should be staged. This will enable the victims to come out and seek for help before it is too late. This will allow the nurses to dispense their knowledge effectively, thus resulting accentuated results.
References
Boore, J. and Tsao, L. (2011), Theory and concepts for the nursing care of patients at risk of suicide. Journal of Advanced Nursing, 53: 680–690.
Center for Substance Abuse Treatment. (2008). Substance Abuse and Suicide Prevention: Evidence and Implications—A White Paper. DHHS Pub. No. SMA-08-4352. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Hooven, C,. Jerald, R., and Karen, A. (2010). Long-Term Outcomes for the Promoting CARE Suicide Prevention Program. American Journal of Health Behavior 34:721–36.
Randell, B. (2007). Promoting CARE (Care, Assess, Respond, Empower): Counselors and parents prevent youth suicide risk. Manuscript in preparation, University of Washington School of Nursing.
Shain, B. et al (2007). Suicide and suicide attempts in adolescents. Pediatrics, 120(3) 669-676.
