Date on Paper
7-2020
Document Type
Doctoral Paper
Degree Name
D.N.P.
Department
Nursing
Committee Chair
Coty, Mary-Beth
Committee Member
Clark, Rudy
Author's Keywords
suicide; high risk for suicide; no-suicide contract; safety planning intervention
Abstract
Background: In 2017, suicide was the 10th leading cause of death in the United States. There are multiple interventions used for individuals at risk for suicide. No-suicide contracts are commonly used by clinicians who treat individuals at high risk for suicide, but there is no evidence supporting this intervention in preventing suicides. A safety planning intervention has been shown to decrease the risk of suicide in individuals at high risk for suicide by helping individuals recognize warning signs of a suicidal crisis, use their internal coping strategies, and contact social network or community resources to assist in reducing suicidal thoughts. Safety plans provide individuals with tools to help manage crisis situations. Purpose: To address the risk of suicide in patients on an inpatient psychiatric unit at a community hospital, the focus of this DNP evidence-based practice (EBP) project was twofold: to implement a safety planning intervention for all patients found to be at high risk for suicide, and to evaluate the efficacy of the safety plan intervention among nurses (RNs and LPNs). Methods: An educational module was developed for this project on the use of safety plans and how to create individualized safety plans with patients. Nurses completed a demographic questionnaire and pre-test prior to receiving education on risks of suicide and safety planning, and post-test following the completion of educational module. The sample size consisted of 13 nurses. A Wilcoxon signed-rank test was used to assess knowledge level of the nurses from pretest to posttest on suicide risk factors and use of safety plans. To evaluate the efficacy of the safety planning intervention, descriptive statistics (frequencies/percentages) were used to determine if all patients at high-risk for suicide completed safety plans; if safety plans were fully completed; and if the patients were given a copy of the safety plan at discharge. A post implementation questionnaire was provided to nurses at six weeks post intervention to elicit evaluative information on the effectiveness of the safety plan intervention from the nurse’s perspective. Findings: A Wilcoxon Signed-Ranks Test indicated that post-test scores (Mean= 66.15) were statistically significantly higher than pre-test scores (Mean= 87.69, Z=36, p=.011). There were 58 patients admitted to the psychiatric unit during this project, with 47% (n=27) found to be at high-risk for suicide per the Columbia-Suicide Severity Rating Scale (C-SSRS). Of the 27 patients found to be at high-risk for suicide, 81% (n=22) completed a safety plan and 78% (n=21) had a safety plan included in their discharge instructions. Of the 13 nurses, 85% (n=11) strongly agreed that they felt confident in creating safety plans with patients at high risk for suicide and 77% (n=10) strongly agreed that they were satisfied with the practice change of implementing safety plans as part of their plan of care for patients at high risk for suicide. Implications: This project supports the implementation of an educational module to increase nurses’ knowledge of suicide risk and safety plan implementation on an inpatient psychiatric unit. Education of suicide risk and safety plan implementation is important to ensure nurses feel confident in using safety plans with patients at high-risk for suicide. Future studies should be done to evaluate the efficacy of safety plans on decreasing suicide risk.
Recommended Citation
Houser, Kevin Luke, "Implementation of a safety planning intervention on an inpatient psychiatric unit." (2020). Doctor of Nursing Practice Papers. Paper 78.
Retrieved from https://ir.library.louisville.edu/dnp/78
