APNA Nurses in Action: Barbara Limandri on Suicide Prevention
As a psychiatric-mental health nurse for over 40 years, Dr. Barbara Limandri, PhD, PMHNP, BC understands that her chosen career will put her close to individuals in pain. "It is a hard job, and we must do it," she says. To empower nurses to address the phenomenon of suicide, Dr. Limandri applied her expertise to the APNA Competency Based Training for Suicide Prevention. We spoke with Dr. Limandri about her work with the training, becoming a facilitator, and the impact nurses can have on suicide prevention.
Q: What has been your involvement with the APNA Competency Based Training for Suicide Prevention?
A: I chaired the work group that wrote the white paper to support development of the competencies then helped facilitate the writing of the competencies with a group of dedicated, knowledgeable, and persevering nurse scholars. Then many from that same group plus many other great women worked to develop and pilot the curriculum. This was truly a work of many based on everyone’s passion about the issue of suicide in our population. I have worked with Pam Greene and several others to develop the curriculum to train facilitators to teach the curriculum. APNA staff has committed hours of work and resources to bring about this project.
Q: What key takeaways do you hope attendees will receive from this training?
A: Suicidal thinking and behavior are painful experiences that can be reversed. The person who is experiencing suicidal thoughts is in agony that prevents her/him from making rational decisions. Nurses are key players to prevent suicide and suicide attempts of patients who are hospitalized. We all must develop the tools to assess and intervene and use these tools constantly.
Q: What experiences can you share that speak to the importance of this topic?
A: Being a psychiatric nurse places us in close proximity to people who are in pain. In my 45 yrs of practice I have had two clients kill themselves and one colleague kill herself. Each time I was humbled beyond speech. Once I considered changing fields. It causes one to become painfully reflective, question and doubt oneself, but I decided I needed to make a difference instead of retreating from the experience. Yesterday while volunteering at a food bank a gentleman came in after a couple of weeks absence. I greeted him and said I missed him and had asked about him. He said, “I tried to take my life, but once again proved to be a failure.” I talked with him for a while (not as a psychiatric nurse but as a person who has these basic competencies in suicide assessment and intervention) and encouraged him to use the mental health resources. He said, “I’m not mentally ill. Those resources are for those who really need it. I’m just a miserable person.” That is why this suicide prevention training is necessary for all of us. I could hang in there with him instead of shy away or mumble clichés. I learned how to be there for him through this training.
Q: What should nurses in other specialties know about the phenomenon of suicide?
A: Suicide is an act of irrational thinking under desperate conditions of hopelessness and isolation. Recognizing those conditions in another person then extending realistic hope and connection is the simplest and most essential intervention that another person can extend. I have heard colleagues in nursing and medicine comment, “if a person really wants to kill themselves, there is nothing anyone can do.” That kind of thinking must stop. We must at least extend ourselves and demonstrate a caring attitude. When my client killed herself, I wondered what I did wrong or what more I could have done. My colleagues reminded me that I did all I could do. I believe that now, and questioning oneself is a way to be sure we are doing all we can do.
Q: What role can nurses play in suicide prevention?
A: Every nurse needs to recognize the risk factors and warning signs of suicide. When we see these signs, we need to follow through with the person. Suicide assessment, intervention, and prevention is CPR. You don’t just walk away when you witness a cardiac arrest, so why would you walk away when someone says they are thinking of suicide? It is a hard job, and we must do it.
Learn more about the APNA Psychiatric-Mental Health Nurse Essential Competencies for the Assessment and Management of Suicide Risk and find a Competency Based Training for Suicide Prevention near you.