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It's extremely uncommon for residents to have suicide ideation. It is important

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that we identify the rare resident who is thinking in this way. Let's watch one

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way to handle thoughts of self-harm should it arise.

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"Mr. Royce, over the last two weeks have you been bothered by thoughts that you

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would be better off dead or of hurting yourself in some way?"

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"I tell you I can't do this anymore. I can't live like this. Like, I want to do something

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to end it all."

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"I know this is a difficult time for you, but it's important for me to

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understand how often you feel this way. Would you say that it would be not at

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all, several days, more than half the days..." (Mr. Royce interrupts)

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"Oh, oh this, several days, several days."

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"2 to 6 days, ok. I know that this is a tough time for you, and what you've told

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me makes me even more concerned. It's important that we help you to develop a

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plan to protect yourself, and to get help when you feel this way. And, part of

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that plan is going to be for us to talk with your doctor about developing a plan

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to help you feel better. But, before I do that I'd like to ask you some

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questions about things that are important to you to help you be more comfortable

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in the facility. And, I'd also like to be sure that you're not in any physical

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pain. So, how are you doing? Do you feel like you could answer some questions

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about your daily care and comfort?"

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"Yeah I think that it'll help actually. I can I can answer some more

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questions."

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"Ok. And then after we've done all that I'll ask the charge nurse to come in,

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and we can talk with her about how to help you with those feelings of not

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wanting to live like this anymore."

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(Fade to black)

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As significant and important as this resident's response is, you see that the

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caregiver did not panic. In cases where residents report thoughts of harming

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themselves it is important not to be alarmed. You are with the resident and are

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providing support by being there. Facilities have protocols for addressing this

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type of report. Most often you will ask the charge nurse or other responsible

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facility personnel to speak with the resident before you leave the room. You saw

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that Rena went on to ask additional questions. The information provided by

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completing questions about daily preferences and pain levels can be very helpful

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in identifying whether pain or unmet preferences are contributing to these

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thoughts.

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Follow up evaluation is beyond the scope of this video. But, your facility

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should already have protocols to handle the rare situations when a resident

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expresses or demonstrates the intent to harm themselves.

