Clinical Practice Guideline: Suicide Risk Assessment

"I want him to know that I'm on his side…" understanding the nature of suicide care from the perspectives of emergency department nurses

INTRODUCTION

This study was aimed at understanding emergency department (ED) nurses' experiences of caring for people who attempted suicide. ED nurses provide care to a great number of patients who have attempted suicide. EDs are accepted as an important environment to prevent repeat suicidal behavior and the importance of initiating interventions to prevent repeated attempts is emphasized.

METHOD

This study was a descriptive qualitative study. The study was conducted with 15 ED nurses who provided care to individuals who attempted suicide in two university hospitals in Turkey. Data were collected through face-to-face, semi-structured in-depth interviews. The data were analyzed using content analysis. Consolidated criteria for reporting qualitative studies (COREQ) were used to ensure the comprehensive reporting of this qualitative study protocol.

RESULTS

The data were categorized under the following four themes: elements of current care, barriers to effective care, dimensions that should be improved in providing care, and needs.

CONCLUSION

Biomedical approaches constitute the basic elements of nurses' care provided to a suicidal patient, and nurses have difficulty in providing emotional support. Caring for a suicidal patient creates an emotional burden for nurses. Nurses stated that they were faced with barriers related to emotional burden, stigma, lack of time, knowledge gaps, and unsuitable physical environment.

Adapting the Zero Suicide framework to the adult emergency department setting: Strategies for nurse leaders

The ED has been increasingly recognized as a key setting for suicide prevention. Zero Suicide (ZS) is an aspirational goal to eliminate suicide for all patients within a health care system through utilization of best practices. However, there has been limited exploration of ZS implementation within the ED. As ED nurses play an important role in suicide prevention through their close contact with patients at risk for suicide, ZS implementation would benefit from tailored strategies for ED nurse leadership. We describe the ZS framework and provides strategies for nurse leaders to adapt each ZS component in the adult ED.

Predictive value of suicidal risk assessment using data from China's largest suicide prevention hotline

BACKGROUND

Suicide hotlines are widely used, with potential for identification of callers at especially high risk.

METHODS

This prospective study was conducted at the largest psychological support hotline in China. From 2015 to 2017, all distressed callers were consecutively included and assessed, using a standardized scale consisting of 12 elements, yielding scores of high risk (8-16), moderate risk (4-7), and low risk (0-3) for suicidal act. All high-risk and half of moderate- and low-risk callers were scheduled for a 12-month follow-up. Main outcomes were suicidal acts (nonlethal attempt, death) over follow-up.

RESULTS

Of 21,346 fully assessed callers, 5822, 11,791, and 3733 were classified as high-, moderate-, or low-risk for suicidal acts, with 8869 callers (4076 high-, 3258 moderate-, and 1535 low-risk) followed up over 12 months. Over follow-up, 802 (9.0 %) callers attempted suicide or died by suicide. The high-risk callers (15.1 %) had 3-fold higher risk for subsequent suicidal acts than moderate- (5.1 %) and 12-fold higher risk than low-risk callers (1.3 %). The weighted sensitivity, specificity, and positive predictive value of high risk scores were 56.4 %, 74.9 %, and 14.4 %.

LIMITATIONS

Assessed callers with different risk levels were followed disproportionally.

CONCLUSIONS

Suicidal risk assessment during a hotline call is both feasible and predictive of risk, guiding resource allocation to higher risk callers.

A qualitative study on the perspectives and needs of oncology nurses about recognition and management of suicide risk in cancer patients

AIMS

To determine the perspectives and needs of the oncology nurses in recognising and managing the risk of suicide in cancer patients.

BACKGROUND

Cancer patients are one of the groups with a high risk of suicide. The perspectives and needs of oncology nurses regarding their recognition and management of suicide risk in such patients need to be clarified.

DESIGN AND METHODS

This qualitative descriptive study used a sample of 33 oncology nurses that were sampled by maximum variation sampling from different oncology units and hospitals. Data were collected with in-depth interviews via a semi-structured interview form and analysed with content analysis. The COREQ guideline was followed for the reporting of the study.

RESULTS

Three main themes and eight subthemes were identified, namely 'An uncertain atmosphere: sensing the risk of suicide but not seeing the picture' (Subthemes: Inability to identify suicide risk, Unclear responsibilities and Distress as a result of uncertainty), 'Efforts to give meaning to and compensate losses of patients' (Subthemes: Attributions to cancer-related losses of patients and Interventions to alleviate distress related to loss) and 'Hindrances beyond the nurse' (Subthemes: Stigma towards psychosocial problems and getting help, Disagreement with the Physician and A lack of institutional culture on suicide prevention).

CONCLUSIONS

Our study revealed that oncology nurses have insufficient knowledge and skills and unclear roles in recognising and managing suicide risk. In addition, nurses have difficulty in helping patients due to the insufficient support of team members, stigmas of patients and their relatives towards getting help, patient workloads, and inadequate institutional support in risk management. Training programmes aiming to increase nurses' awareness, knowledge and skills should be developed and embedded into current in-service education programmes and undergraduate education curricula as part of professional improvement.

RELEVANCE TO CLINICAL PRACTICE

The results of the study can contribute to planning the content and scope of suicide prevention training peculiar to oncology nursing.

Adherence to guideline creation recommendations for suicide prevention in the emergency department: A systematic review

OBJECTIVES

Suicide rates in the United States rose 35.2% from 1999-2018. As emergency department (ED) providers often have limited training in management of suicidal patients and minimal access to mental health experts, clinical practice guidelines (CPGs) may improve care for these patients. However, clinical practice guidelines that do not adhere to quality standards for development may be harmful both to patients, if they promote practices based on flawed evidence, and to ED providers, if used in malpractice claims. In 2011, the Institute of Medicine created standards to determine the trustworthiness of CPGs. This review assessed the adherence of suicide prevention CPGs, intended for the ED, to these standards. Secondary objectives were to assess the association of adherence both with first author/organization specialty (ED vs non-ED) and with inclusion of recommendations on substance use, a potent risk factor for suicide.

METHODS

This is a systematic review of available suicide-prevention CPGs for the ED in both peer-reviewed and gray literature. This review followed the PRISMA standards for reporting systematic reviews.

RESULTS

Of 22 included CPGs, the 7 ED-sponsored CPGs had higher adherence to quality standards (3.1 vs 2.4) and included the highest-rated CPG (ICAR²E) identified by this review. Regardless of specialty, nearly all CPGs included some mention of identifying or managing substance use.

CONCLUSIONS

Most suicide prevention CPGs intended for the ED are written by non-ED first authors or organizations and have low adherence to quality standards. Future CPGs should be developed with more scientific rigor, include a multidisciplinary writing group, and be created by authors working in the practice environment to which the CPG applies.

Suicide Screening and Risk Assessment in the Emergency Department: Case Review of a Suicide Attempt Survivor

One in 10 of those who die by suicide are seen in an emergency department within the 2 months before their death. Despite national guidelines and resources (including from the Joint Commission and Emergency Nurses Association) for suicide screening, risk assessment, and follow-up care, suicidal ideation and behavior continue to go undetected in emergency departments, leading to gaps in care. This case review was conducted as part of a larger electronic medical record review of emergency department practices and aims to highlight potential gaps in care and identify missed opportunities for suicide screening and risk assessment. In addition to highlighting these missed opportunities, this case review provides recommendations for suicide screening and risk assessment resources with options for evidence-based follow-up care for suicidal patients.

CONTENT VALIDATION FOR THE BRAZILIAN VERSION OF THE NURSES GLOBAL ASSESSMENT OF SUICIDE RISK INDEX

ABSTRACT Objective: to perform the content validation of the Nurses Global Assessment of Suicide Risk index for the Brazilian population served in primary care. Method: a methodological study of cultural adaptation and content evaluation of the NGASR index, original scale from the United Kingdom, carried out through the stages: evaluation of verbal comprehension by an experts committee (semantic, idiomatic, conceptual and cultural equivalence and content validity), back-translation and verification of clarity by means of a pre-test. The experts committee was composed of nine judges and the pre-test with 30 users of primary care services and 19 nurses. The Content Validation Index was calculated. Results: the final validated version is composed of 15 items that obtained a Content Validation Index greater than 0.78 by the experts committee and in the application of the pre-test with users and nurses. Conclusion: the instrument favors the performance of professional nurses in primary health care in the prevention of suicidal behavior by facilitating risk assessment and the adoption of relevant actions.