Volume 74, June 2024, 101444Author links open overlay panel, Highlights•

Suicide is a leading cause of death globally.

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Suicide loss impacts many people and often results in acute psychological reactions.

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Survivors of suicide loss are at higher risk of suicide themselves.

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Assessment and intervention by emergency nurses can assist coping in survivors of suicide loss.

Abstract

Introduction Suicide is among the leading causes of death and nurses care for survivors of suicide at many points in their grief journey. Every individual who dies by suicide leaves behind multiple affected survivors and how they are cared for immediately following the suicide influences how they cope with the death. The purpose of this article is to make recommendations for the care of survivors of suicide loss in the emergency department. Methods: A narrative review of the current literature was conducted using the databases CINAHL and ProQuest. Articles focused on survivors of suicide loss and their care in the immediate period after the death were utilized. Results: Four hundred and twenty-nine articles were found. Applying established inclusion and exclusion criteria and quality assessment using the SANSA guideline, 29 were included in the review. Discussion: Three themes were identified: 1. Risks for suicide in survivors of suicide loss; 2. Interventions in the immediate period after suicide loss; and 3. Active suicide postvention as suicide prevention. Emergency department nurses need to have the ability to readily assess and recognize the survivors of suicide loss who are at higher risk for complicated grieving, and providing rapid and immediate services and resources will help promote coping and positive mental health outcomes in survivors. Keywords: suicide; survivors of suicide loss; suicide prevention; suicide postvention; death notification; grief

Section snippetsBackground

Death by suicide is often sudden, traumatic, and one of the most painful experiences a loved one can suffer. According to the Centers for Disease Control and Prevention (CDC), suicide is among the nine leading causes of death for people ages 10–64 and the second leading cause of death for people ages 10–14 and 25–34 [1]. The World Health Organization (WHO), reports that globally, 800,000 people die by suicide each year – one death every 40 seconds [2]. For every death by suicide, there are

Aim

The purpose of this article is to make practical recommendations for the care of the survivor of suicide loss in the ED based on a narrative review of the literature to date.

Methods

After an initial search of the literature, a narrative literature review was deemed most appropriate for this topic because the diversity and quality of the evidence were not conducive to a scoping or systematic review. Narrative literature reviews describe, analyze, and summarize current key literature on a topic [5]. The review was conducted using the databases CINAHL and ProQuest to identify primary research and other scholarly literature about the care of the survivor of suicide loss in the

Results

The literature in this review included descriptive and correlational studies, narrative reviews, case reports, one guideline, three systematic reviews, and one scoping review. Most of the articles (n=14) were related to suicide risk, including one systematic review. Four articles were on death notification, including one systematic and one scoping review. Eleven articles were related to the care of survivors of suicide loss, including one systematic review on postvention and a guideline on the

Risks for Survivors of Suicide Loss

Survivors of suicide loss are at increased risk for mental health problems such as depression and anxiety, altered family functioning, and suicide themselves [7], [8]. The characteristics of death from suicide make it different, and possibly more difficult to cope with than other modes of death. With suicide, there is often ambiguity about the volition of the deceased, questions about whether the death could be prevented, stigma, and trauma due to the nature of self-inflicted death [8]. Studies

Suicide Risk Assessment

Survivors of suicide loss are at high risk for suicide themselves [5], [6] emphasizing the need for thorough assessment and intervention by ED nurses. Awareness of warning signs of suicide is important. These include being isolated, increased anxiety, increased substance use, increased anger or rage, extreme mood swings, expression of hopelessness, sleep alterations, talking or posting about wanting to die, and making plans for suicide [26]. The World Health Organization also emphasizes the

Limitations

Literature specific to the care of the survivor of suicide loss in the ED is sparse so much of what was used in this narrative review is related to the care in other contexts besides the ED. No literature could be identified that focused on death notification specific to suicide. Because of the nature of the topic, the recommendations made are based on primarily descriptive and correlational studies.

Conclusion

Emergency department nurses play a key role in the care of survivors of suicide loss. Death by suicide is a traumatic and highly emotional situation with multiple factors in play that require ED Nurses to provide sensitive and compassionate care to the survivors. Emergency department nurses must be able to readily assess and recognize the survivors of suicide loss who are at higher risk for complicated grieving, allowing for rapid and immediate services and resources to help promote coping and

CRediT authorship contribution statement

Elizabeth Roe: Writing – review & editing, Writing – original draft. Barb Smith: Writing – review & editing, Writing – original draft.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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