The History And Background Of Suicide Nursing Essay

The History And Background Of Suicide Nursing EssaySuicide is the third leading cause of death among childlike people however the incidence of assay felo-de-se is much to a great extent than. It has been observed that aft(prenominal) puberty, roll of suicide increases with age until it stabilizes in young adulthood. This increase in suicide whitethorn be associated with the onset and increase in depressive and other disorders during adolescents as compared to childhood.Suicide ideation, gestures and attempts are frequently but not always associated with depressive disorders, reports target that as many as half of unsafe individuals express egotism-destructive intention to a friend or a relative within 24 hours before en diligent dangerous doings.It is a time proven fact that all the breathing organisms on this earth beseech for survival and existence. What then makes the man to attempt his own life? The tr patriarchaly of self inflicted death has always attracted the attention of the medical as well as the legal fraternity. People who conduct perpetrate suicide or have been thinking about committing suicide probably feel overwhelmed by their enigmas. They might not be able to handle that good-natured of pressure and feel that death would be the only way to escape it.( Alonso J,2008).Although suicide was condemned in the Dharmashastras, yet, there is also a chapter on allowed suicides. But the foregoing scriptures, of Manus and Kautilyas were against suicide. These sentiments were echoed for ages in India. Even though to sidereal day, attempted suicide is also a crime in India under the Indian Penal Code arrangement. The neighbouring nation Sri Lanka has removed attempted suicide as a punishable offence. In India, even the assisting and abetting suicide is also a punishable offence.The striking aspect of Indian entropy is the large variation in different subprograms of India in relation to attempted/committed suicide. The states and c ities with rapid fond change are associated with high suicide rates in the year 2010, much(prenominal) as the states of Tamilnadu (5470) and Andhra Pradesh (5675),Maharashtra (6289), West Bengal (5302).(NCRBI 2007).Adolescence is a stressful give voice intellectual period filled with major changes body changes, changes in thoughts, and changes in feelings. Strong feelings of stress, confusion, fear, and uncertainty, as well as pressure to succeed, and the ability to think about things in new ways influence a teenagers enigma solving and decision making abilities.For some teenagers, normal developmental changes, when compounded by other events or changes in their families such as enate break up or moving to a new community, changes in friendships, difficulties in school, or other losses can be very upsetting and become overwhelming. Problems may appear too difficult or embarrassing to overcome. For some, suicide may seem like a perfect solution.The adolescent suicide rate ha s greatly increased in recent years. Suicides in those ages 15 to 24 years erstwhile accounted for 5% of all suicides but now it is increased to 14%. This makes suicide the third leading cause of death among adolescents. Suicide rates for males within the age group of 10 14 years have tripled, whereas rates for males patriarchal 15 to 19 years have quadrupled. Rates for females have doubled. Males aged 15 to 19 years are some 5 times more than likely to kill themselves than females in the same age group. Although female adolescents attempt suicide 2 to 3 times more often than their male counterparts. save suicide attempts peak between the ages of 15 and 19years.(WHO 2008).1.1 NEED FOR STUDY The numbers of suicides are increasing in India. India accounts for 10% of worlds suicides. According to the latest national crime record bureau report, there are over 1.2 lakh suicides in 2006 and 1.3 lakh in 2007. It also states that Bangalore has the highest rate of suicides in India. Ti ll June 2007 there have been around 900 cases of suicide reported from Bangalore city alone. In 2005, 1,480 persons have committed suicide, while in the year 2006, the number was over 2,000, and among all states, Karnataka stands second later Kerala, followed by Maharashtra and West Bengal (Gururaj G.2008).According to WHOs estimation, in the year 2004, approximately one million people died from suicide, and 10 20 times more people attempted suicide worldwide. This represents one death every 40 seconds and one attempt every 3 seconds, on average (WHO,2004).The adolescent suicide rate has greatly increased in recent years. Suicides in those ages 15 to 24 years once accounted for 5% of all suicides but now it is increased to 14%. This makes suicide the third leading cause of death among adolescents. Suicide rates for males within the age group of 10 14 years have tripled, whereas rates for males aged 15 to 19 years have quadrupled. Rates for females have doubled. Males aged 15 to 1 9 years are n wee 5 times more likely to kill themselves than females in the same age group. Although female adolescents attempt suicide 2 to 3 times more often than their male counterparts. put down suicide attempts peak between the ages of 15 and 19years(Marlow,2002).1.2 STATEMENT OF PROBLEMSTRUCTURED TEACHING PROGRAMME ON THE PREVENTIVE MEASURES OF SUICIDAL IDEATION AMONG ADOLESCENTS IN PRIYADARSHINI SCHOOL,PITHAPURAM,ANDHRA PRADESH.1.3 OBJECTIVES1.3.1 To pass judgment the friendship regarding preventive measures of unsafe ideation among adolescents.To evaluate the effectiveness of incorporate teach political platform on Preventive measures of Suicidal ideation among adolescents.1.3.3 To associate the preventive measures for suicidal ideation among adolescents with the various demographic variables.1.4 ASSUMPTIONSThe adolescents are prone for suicidal thoughts.1.5 HYPOTHESISThere will be a significant difference between the preventive measures for suicidal ideation befor e and after administration of unified teaching programme.There will be a significant association between the preventive measures for suicidal ideation with various demographic variables1.6 operable Definition1.6.1 Suicide is the act of intentionally taking ones own life in a culturallyno endorsed manner.1.6.2. Preventive measures refer to the risk factors, pattern signs, suicidal behavior, misconceptions of suicide, how to communicate and monitoring safety withdraws in the environment.1.7 Conceptual Framework Modified general systems theory of learning General systems theory is useable in breaking process into sequential operations or tasks to ensure goal realization. Purpose, goal or aim is necessary for any process or system. The aim of the translate is to increase the association of preventive measures for suicidal ideation.Input The first function is the input which is the information, energy or matter that enters the system. For a system to work well the input should con centrate in achieving the purpose of the system. In the present study the information, energy or matter which enters the system is the introduction of organize teaching programme regarding the preventive measures for suicidal ideation. In the present study input is the existing experience regarding preventive measures for suicidal ideation.Throughput According to the theorist, doneput refers to the process use by the system to convert raw material or energy into products that are usable by the system itself or by the environment. In this active phase, teacher converts the information from structured teaching programme regarding preventive measures for suicidal ideation.Output According to theorist, it refers to the product or service which proceedss from the systems finished put. Output in this study refers to the end product of the system. This is evidenced by adolescents gaining knowledge regarding the preventive measures for suicidal ideation.Evaluation Evaluation is the inf ormation about some aspects of selective information or energy processing that can be utilise, to evaluate and monitor the system and to guide it to more effective performance. In the present study, evaluation measures the success or failure of output. I t is done by measuring the performance and it is graded as adequate knowledge (75% scores), moderately adequate knowledge (50%-75% scores) and curt knowledge (Feedback The final function is feedback which is the process of communicating what is found in evaluation of the system. It is the information given back to the system to determine whether or not the purpose or end result of the system has been achieved. The final part of feed back communicates what is found in the evaluation and it tells whether the structured teaching programme was effective in enhancing the knowledge of adolescents regarding the preventive measures for suicidal ideation.1.8 Projected Outcome Structured teaching program attends to improve the knowledge on preventive measures for suicidal ideation among adolescents.Fig 1.1 MODIFIED SYSTEM MODEL TO ASSESS THE KNOWLEDGE OF ADOLESCENTS REGARDING PREVENTIVE MEASURES OF SUICIDAL IDEATIONOUTPUTTHROUGH PUTINPUTAssessment of demographic variables of adolescents such as age, sex, family income, religion, parents education.Pre assessment of knowledge of adolescents regarding preventive measures of suicidal ideationPost assessment of knowledge of adolescents regarding preventive measures of suicidal ideationAdequateInadequateStructured teaching design on Preventive measures of suicidal ideationInadequateModerately adequateREASSESSMENTCHAPTER IIREVIEW OF LITERATUREReview of Literature is a key stair in research process. Nursing research may be considered as a continuing process in which knowledge gained from earlier studies is an integral part of research in general. In review of books a researcher analyses existing knowledge before delving into a new study and when making shrewdness about a pplication of new knowledge in nursing practice. The literature review is an extensive, systematic, and critical review of the most important published scholarly literature on a particular topic.2.1 Literatures related to Suicide risk factors2.2 Literatures related to Prevention of suicidal ideation2.1 Literatures related to Suicide risk factorsA case learn study was conducted to identify and quantify risk factors for realised suicides in Bangalore, India. The study was conducted with the families of 269 accomplished suicides and 269 living controls within the broader population of the city victimization psychological necropsy methods. The results deputeed that, the significant risk factors for completed suicides were the presence of previous suicidal attempt in self odds ratio (OR) = 42.62, interpersonal conflicts and marital disharmony with spouse OR = 27.98, drink OR = 23.38, presence of mental affection OR = 11.07, sudden economic bankruptcy OR =7.1, domestic violence OR = 6.82, and unemployment OR = 6.15. Individuals completing suicides did not have a positive outlook towards life, problem solving approaches and coping skills. The study concluded that, the discourse strategies should include prioritized macro and micro level efforts aimed at individual, family and society. (Gururaj G 2007)A study conducted involving 1205 adolescent students of 2 schools from New Delhi reported, one year suicidal ideation was 11.7%. they also found that physical abuse by parents, feelings neglected by parents, annals of running away from school, history of suicide by a friend and death wish were found to be associated with non-fatal suicidal behavior. (Siddhartha and Jena,2006).A study conducted on ruffleing and risk of suicidal behaviour among adolescents in New York. Total 2341 adolescents aged 13-19 years who were enrolled in grades 9 through 12 in suburban school was selected for study. Researchers used Beck printing Inventory to assess depression and suic ide Ideation Questionnaire. Suicide attempt history included any attempt, regardless extend of injury. With regard bullying behaviour, students were asked how often they had been bullied or had bullied others in and out of school during the past 4 weeks. Being bullied was defined as having the student say or do unpleasant thing or being teased repeatedly in a way the person does not like. lead shows about 20% student reported that they were victims of bullying in school and about 10% reported that they were victims of bullying outside the school. With regard to bullying behavior, about 25% students reported that they bullied other students in school and 15% reported that they were bullied others outside school .The risk of depression, suicidal ideation and suicidal attempt was significantly higher for students who were considered either a victim or a bully compared with students who were not. The more frequent the bullying behaviour the greater risk of depression, suicidal ideation or suicidal attempt. (Wagnar KD,2007).A study conducted on rates and factors associated with suicide in Kaniymbadi block, Tamil Nadu, South India. The setting for the study was a comprehensive community health programme in a development block in cracker-barrel South India. The main outcome measure was death by suicide diagnosed by detailed verbal autopsy and census and birth and death selective information to identify population base. Result shows the average suicide rate was 92.1 per 1,00.000. The ratio of male to female suicide was 10.66. The age specific suicide rate for women showed two peaks 15-24 year and over 65 years of age. Hanging (49%) and poisoning with organo-phosphorus compound (40.5%) were commonest method of suicide. sharp or chronic stress was elicited for nearly all subjects. More men suffered from chronic stress while more women had acute precipitating events (x2= 4.58 pA study conducted on risk factors for completed suicide in Banglore, India. A case control s tudy conducted with families of 269 completed suicides and 269 living control within the broader population of city, using psychological autopsy method. Result shows that several factor in the areas of family, marriage, education, occupation, general health, mental health and absence of protective factors contribute significantly for suicides .The significance factor were presence of previous suicidal attempt in self (odds ratio OR = 42.62), interpersonal conflicts and marital disharmony with spouse (O =27.98), alcoholism in self (OR=23.38), presence of mental illness (OR=11.07), sudden economic bankruptcy (OR=7.1), domestic violence (OR=6.82) and unemployment(OR= 6.15). Individual completing suicide did not have a positive outlook towards life, problem solving approaches and coping scale (Gururaj G and Isaac MK, 2007).A study was conducted on psychosocial risk factors associated with suicide attempts among psychiatric inpatient and this study examine how suicide attempts and violen t behavior associated with various psychosocial problems. This study included 216 inpatient who had physically assaulted another patient and a comparison group of 81 inpatient who had not assaulted any one. The result was suicide attempts were associated with a history of head trauma harsh parental discipline and parental psychopathology (Menhem.I and Krakowski, 2004).A study conducted on psychosocial stressors may be strongly associated with suicide attempts the aim of the study was to clarify the importance of psychosocial stressors in suicidal behavior and 250 suicide attempts seen at general hospital emergence room. Acute and chronic life events were assessed with the St. Paul Ramsey life experience scale Holmes and Rahes social adjustment scale respectively, life long adverse experience were also assessed. The logistical regression with dependent variable included psychosocial stressor (Odds ratio (OR)=33.6) And other interpersonal conflicts (OR =10.5) modification of life hab its (OR = 14.6) adult physical abuse (OR = 7.1) confounding factors with significant ORS were bunch up B traits (OR = 21.2) and finally this study mainly a replication of prior knowledge of psychosocial stressors.( Enrique Baca-Garcia, and Claudia.P.Parra,2007).A cross-sectional study of 342 adolescents aged 10-19 years from 19 schools. variable analysis showed that a history of self-violence, violent thoughts toward others, mental health diagnoses other than depression, and a history of sexual abuse were positively associated with suicide attempt. Sexual abuse, mental health diagnoses other than depression, self-violence, and ease of access to lethal substances/weapons were positively associated with suicide ideation and found a relatively high prevalence of suicide ideation and suicide attempts among adolescents living in Western Jamaica. An accurate understanding of the prevailing risk factors for suicide attempts will promote a more sympathetic approach to victims and facilit ate legal profession efforts.( Rudatsikira E,2010).A cross-sectional school survey of 4,500 adolescent students base on a structured suspicionnaire. entropy were collected using the supervised self-administered questionnaire (modified version of the juvenility Risk Behavior Surveillance in the Malaysian National Language, Bahasa Malaysia). Seven percent (312 of 4,454) of the adolescent students had seriously considered attempting suicide. Among the adolescents, 4.6% had attempted suicide at least once during the 12 months preceding the survey. Female adolescents were more likely to put their suicidal thoughts into suicidal action than were male adolescents. Malay and Indian people are more likely than the Chinese to respond, Felt sad and hopeless. However, Malay adolescents had the lowest rate of attempted suicide. Based on multiple logistic regression, factors significantly related to urban adolescents suicide behavior are Felt sad or hopeless, Number of days felt unsafe to go to school, Riding with a driver who had been alcohol addiction alcohol, Physical fight, and Number of days absent from school. In comparison, factors relating to rural adolescents suicide behavior are Felt sad or hopeless, Physical fight, Physical fight resulting in injury, and Drive a vehicle after drinking alcohol. Adolescent suicide behavior should be viewed as a serious problem. Measures can be interpreted to prevent suicide by looking at the factors significantly linked to suicidal behavior among adolescents. Steps can then be taken to identify adolescents who have serious suicidal ideation so that intervention can be taken to reduce the suicidal rate.( Chen PC and Lee LK,2005).A comparative study conducted at Slovenia in 2006 to compare coping styles among adolescents with and without deliberate self-harm concluded that suicidal ideation was associated with higher scores on emotional coping and visit scores on rational and detachment coping styles. Deliberate self-harm was associated with significantly higher scores on avoidance coping strategies and set a need for improving coping strategies among deliberate self harm adolescents(Marusic A, Goodwin RD,2006).A study conducted on the associations between peer and parental relationships and suicidal behaviour in early adolescents. Method used statistics Canadas National Longitudinal Survey of Children Youth as the dataset. This cross sectional sample included 1049 girls and 1041 age 12 to 13 years. Answers obtained through self- report questionnaires that included measures of peer relationships, parental nurturance, and parental rejection, suicidal ideation and attempts. Result shows that among early adolescent boys and girls, depression, poor peer relationships, decrease parental nurturance and increase parental rejection wear all significantly associated with suicidal ideation and attempt.( Sarah A and Laurence YK, 2006).2.2 Literatures related to Prevention of suicidal ideationAn observational stu dy was conducted to evaluate the effectiveness of a school based suicide awareness intervention among adolescents in Louisville, Kentucky. A self report questionnaire was used to collect data. A Solomon four groups design was used to assess the cleverness of suicide intervention classes. The results revealed that, the experimental groups as compared with control groups showed significant gains in relevant knowledge about suicidal peers and significantly more positive attitudes toward help seeking and intervening with troubled peers. (Kalafat J.,2006).A study was conducted to assess the efficacy of a school based prevention programme for reducing suicide potence among high risk youth in Washington, USA. A sample of 105 subjects at suicide risk participated in a three group, repeated measures, intervention study. Participants in (1) an assessment plus 1 semester experimental programme, (2) an assessment plus 2- semester experimental programme, and (3) an assessment only grou p were compared, using data from pre intervention, 5 month, and 10 month follow up assessments. The results kindleed that, all groups showed decreased suicide risk behaviours, depression, despair, stress, and anger all groups also reported increased self- esteem and network social support. Increased personal control was observed only in the experimental groups, and not in the assessment only control group. The potential efficacy of the experimental school based prevention programme was demonstrated. The study concluded that, the necessary and sufficient strategies for suicide prevention have to be adopted. (Eggert LL, 2004).A study was conducted to assess the impact of a suicide prevention programme for adolescents on suicidal tendencies, hopelessness, ego identity, and coping ability in Israel. 393 adolescents from six schools participated in the study. The subjects were randomly shared out into experimental (n = 215) and control (n= 178) groups. The experimental groups took part in seven weekly 2 hour meetings. In this pre-test function-test design, the students completed questionnaires of suicidal tendencies, hopelessness, ego identity, and coping ability before and after the programme. The statistical analysis showed that the experimental groups were superior to the controls, with at least some of the dependent measures pointing out the effectiveness of the programme ( Orbach I, 2003).An experimental study was conducted to evaluate the effectiveness of the Signs of Suicide (SOS) prevention programme in Farmington, USA. 2,100 students in 5 high schools were randomly assigned to intervention and control groups. Self administered questionnaire were completed by students in both groups approximately 3 months after programme implementation. The results revealed that, significantly lower rates of suicide attempts and greater knowledge and more adaptative attitudes about depression and suicide were observed among students in the intervention group than control group. The study concluded that, SOS is the first school based suicide prevention programme to demonstrate significant reductions in self reported suicide attempts (Eggert LL and Thompson EA,2007).A study was conducted on the effectiveness of school based psycho-educational programme in suicide prevention in adolescents. Sample collected from 172 high school students in the 16-18 age group include 108 girls and 64 boys. Method used a structured self-report questionnaire. The results show that the programme had no effect on coping styles and level of hopelessness. However positive effect on knowledge could be identified an interaction effect of the programme with gender on attitude was also found. A negative impact of programme could not be found. Findings from study suggest that psycho-educational programs in schools may influence knowledge about suicide and attitudes towards suicidal persons but may not affect the use of coping styles or levels of hopelessness (Gwendolyn P and Kees VH,2006).A study was conducted on the evaluation of the signs of suicide prevention program where data was collected from 4133 students in 9 schools. Method used self administered questionnaires completed by students in both groups approximately 3 month after the program implementation. Result shows significantly lower rates of suicide attempts and greater knowledge and more adaptive attitude about depression and suicide were observed in intervention group.( Robert H and Asetine J,2007).A study was conducted on to develop and evaluate the effectiveness of an Informational Booklet on cancer risk factors among college students, nurses and doctors at university of Delhi. The objectives of the study was (1) to prepare an informational cusp on cancer risk factors (2) to assess the knowledge before and after the administration of informational booklet on cancer risk factors and (3) to determine the acceptability and utility of an informational booklet by college students, nurs es and doctors. The one group pre-test post-test pre experimental research design adopted Convenient sampling method was used to select sample size 30. The data arrangement instruments used were (I) a structured knowledge questionnaire to assess the knowledge of students and (2) two structured opinionnaires were used to gather opinion regarding acceptability and utility of the booklet from college students, doctors and nurses. The results shown that information booklet is effective in increasing the knowledge of the college students as evident from t (29) = 52.44 higher significant. Doctors and nurses were higher and close to the maximum possible acceptability and utility scores. The study concluded that the informational booklet was acceptable and useful for findings cancer risk factors ( Bairwa KS,2002).CHAPTER IIIMATERIALS AND METHODSResearch design provides the glue that holds the research project together. A design is used to structure the research, to show how all of the ma jor parts of the research project. This study was designed to find out effectiveness of structured teaching programme in promoting knowledge on preventive measures of suicidal ideation among adolescents. This study was conducted by adopting following steps of research process as research design, setting, population and sampling, criteria for selection of samples, instruments and tools for data collection and methods of data analysis. Pilot study was conducted and changes were incorporated.3.1 Research DesignThe study was based on one group pre test and post test design. Pre test knowledge on preventive measures of suicidal ideation among adolescents was assessed before providing education programme. Education regarding what is suicide, risk factors,misconceptions and facts, preventive measures of suicide was delivered through lecture cum discussion method by using LCD, blackboard. After a period of 5 to 7 days of education, the knowledge on preventive measures of suicidal ideation a mong adolescent was reassessed. The paired t test was used to compare the pre test score and post test score and assosciation was used to find among variables.3.2 Setting of the landing field The study was conducted in Priyadarshini High school Pithapuram, Andhra Pradesh.3.3 people The population of this study consisted of adolescents in the 9th standard.3.3.1 Sample size Size was determined by purposive sampling. All adolescents in the 9th standard were taken for the study 50 students.3.4 Criteria for selection of sampleInclusion criteriaAdolescents in the class of 9th standardVariables of the study3.5.1 Independent variable The independent variable in this study is structured teaching programme on preventive measures of suicidal ideation.3.5.2 Dependent variable The dependent variable in this study is knowledge level gained by adolescent.3.6 Instruments and tools for data collection A questionnaire was prepared to assess the knowledge of adolescents towards preventive measures o f suicidal ideation . A structured questionnaire was developed based on literature, journal, text book. The questionnaire has two aspects demographic data and questionnaire on preventive measures of suicidal ideation.Section A The demographic data includes sample number, age, sex, number of siblings, religion, family profile.Section B This section consists of 25 questions, for each question 4 options were given in that only one is correct, students have to tick any one of the 4 options. For each question one mark was awarded, maximum mark obtained was 25. It was mandatory that all the 25 questions should be responded by the student.ScoringAdequate 75%Moderately adequate 50 -75%Inadequate 3.7 Reliability and validity of instruments and tools for data collection The tool was prepared with the help of literature, research and subject guides. The reliability and validity was tested through pilot study. Additions and modifications suggested by experts were included in the tool.3.8 Data Collection Procedure Data collection was done in the month of July data was collected through self administered questionnaire. After assessment education was delivered through lecture cum discussion using LCD, charts, black board. Doubts were clarified at the end of teaching. The reassessment was done after 5 to 7 days from the day the education started.3.9 Method of Data Analysis and Interpretation Frequency distribution tables were formulated for all baseline information. Frequencies were tabulated to understand the knowledge on preventive measures of suicidal ideation. The distribution pattern was depicted through appropriate graphical methods. Results were inferred through statistical techniques likes paired t test and association was used among variables.3.9.1 Paired t test This formula was adopted to find out the significant difference between pretest and post test score, of adolescents to understand the knowledge on preventive measures of suicidal ideation.= Mean difference between pretest and post test score.d = Difference between pretest score and post test score.SD = Standard deviation of the pretest score and post test score.= number of samples.3.10 Report of Pilot Study Pilot study was conducted in Priyadarshini School, Pithapuram,Andhra Pradesh. For the Pilot Study 16 Students were taken from 9th standard. The questionnaire was given to the students for the assessment of knowledge on Prevention Of suicidal ideation, after Pre-test it was found that only 2 students had adequate knowledge, 13 had moderately adequate knowledge,1 had in adequate knowledge. After structured teaching programme, the result of the Post test is as follows, 8 students had adequate knowledge, 8 students had moderately adequate knowledge. None of them had inadequate knowledge.3.11. Changes Brought After pilot Study After the pilot study changes were made in the questionnaire.CHAPTER -IVDATA ANALYSIS AND INTERPRETATIONData analysis is the process of analyzing the data in such a way that the research questions can be answered (Hungler and Polit, 2004). This chapter deals with analysis and interpretation of data collected from students of Priyadarshini high school in Pithapuram, A.P. Students knowledge on preventive measures of suicidal ideation w