Date on Paper


Document Type

Doctoral Paper

Degree Name




Committee Chair

Mary-Beth Coty

Committee Member

Ruth Staten

Author's Keywords

suicide, suicide prevention, universal screening tool, Columbia Suicide Severity Rating Scale, suicide assessment, suicide risk, emergency department, adults, risk assessment, feasibility, nursing, patient


Background: Suicide is the tenth leading cause of death in the United States. Individuals who ultimately commit suicide often seek healthcare in the year prior to their death for unrelated medical complaints without detection of suicidal ideation. The Emergency Department (ED) has been identified as a key stakeholder in detecting suicide risk. Research supports the use of a universal evidence-based screening tool for all patients who present to the ED in order to identify those at risk for future suicide attempt, and to provide appropriate follow-up resources.

Aims: The aim of this scholarly project was to promote a practice change by implementing the Columbia Suicide Severity Rating Scale (C-SSRS) in an effort to identify adult patients at risk for future suicide attempt as part of the ED assessment, and to provide either inpatient or outpatient follow-up resources as indicated by the C-SSRS. A second aim was to increase nursing staff knowledge of suicide risk and prevention and increase their confidence in utilizing the C-SSRS for assessing at-risk patients.

Methods: This project was two-fold and included: 1) administration of a pre-test to ED staff prior to an educational module provided by the hospital, followed by a post-test for assessing staff knowledge and confidence in suicide risk assessment using the C-SSRS; and 2) implement the C-SSRS in the ED to all adult patients as a means for detecting at-risk adult patients for future suicide attempt and provide outpatient follow-up resources.

Findings: Descriptive statistics were used to analyze the demographic data of the nurse and patient samples. A paired t-test with repeated measures was used to analyze the ED nurses’ satisfaction and confidence scores for the pre- and post- tests. The results of the pre- and post- tests were clinically significant and showed an increase in nursing knowledge and confidence in suicide risk assessment using the C-SSRS. The findings will be disseminated to the ED and administrative staff [RNs, NAs, CNO) and to local and regional psychiatric nursing conferences and relevant psychiatric/mental health journal for manuscript submission.

Linking Evidence to Action: This study supports the implementation of a universal screening tool, the C-SSRS, for suicidal risk assessment in the general population of ED adult patients. Health care providers should perform the C-SSRS on all adult patients to identify those at-risk for suicide and provide appropriate follow-up resources. Education of suicide prevention and the use of the tool is important to ensure nurses feel confident in assessing for suicide risk. Future studies should be done that evaluate the efficacy of the C-SSRS in ED nurses’ practice.

Included in

Nursing Commons