Journal of Psychosocial Nursing and Mental Health Services, 2018;56(10):21–26
Abstract
American individuals attempt suicide at alarmingly high rates of approximately 1.1 million times per year. Yet the United States has failed to adopt a systematic approach to suicide prevention, particularly via universal screening. Given the increasing number of individuals with suicidal ideation presenting to emergency departments (EDs), all patients who present to the ED for treatment should be screened, as opposed to only individuals with mental health complaints. In the current article, barriers to suicide screening in the ED are discussed, as well as strategies to move ED providers toward the goal of universal screening. The current article entreats nurses to be leaders in achieving universal screening and provides practical actions to begin the process. Specific recommendations for action include improving training, increasing lethal means assessment, and achieving compliance with The Joint Commission suicide screening guidelines. [Journal of Psychosocial Nursing and Mental Health Services, 56(10), 21–26.]
- Agency for Healthcare Research and Quality. (2017). Emergency department visits related to suicidal ideation, 2006–2013. Retrieved from https://www.hcup-us.ahrq.gov/reports/statbriefs/sb220-Suicidal-Ideation-ED-Visits.jsp Google Scholar
- Association of American Medical Colleges. (2016, April5). New research confirms looming physician shortage. Retrieved from https://www.aamc.org/newsroom/newsreleases/458074/2016_workforce_projections_04052016.html Google Scholar
- Babeva K., Hughes J.L., Asarnow J. (2016). Emergency department screening for suicide and mental health risk. Current Psychiatry Reports, 18, 100.
10.1007/s11920-016-0738-6 Crossref MedlineGoogle Scholar - Bandura A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215.
10.1037/0033-295X.84.2.191 Crossref MedlineGoogle Scholar - Bernert R.A., Hom M.A., Roberts L.W. (2014). A review of multidisciplinary clinical practice guidelines in suicide prevention: Toward an emerging standard in suicide risk assessment and management, training and practice. Academic Psychiatry, 38, 585–592.
10.1007/s40596-014-0180-1 Crossref MedlineGoogle Scholar - Betz M., Boudreaux E.D. (2016). Managing suicidal patients in the emergency department. Annals of Emergency Medicine, 67, 276–282.
10.1016/j.annemergmed.2015.09.001 Crossref MedlineGoogle Scholar - Betz M.E., Arias S.A., Miller M., Barber C., Espinola J.A., Sullivan A.F., Boudreaux E.D. (2015). Change in emergency department providers' beliefs and practices after use of new protocols for suicidal patients. Psychiatric Services, 66, 625–631.
10.1176/appi.ps.201400244 Crossref MedlineGoogle Scholar - Betz M.E., Miller M., Barber C., Miller I., Sullivan A.F., Camarago C.A., Boudreaux E.D. (2013). Lethal means restriction for suicide prevention: Beliefs and behaviors of emergency department providers. Depression and Anxiety, 30, 1013–1020.
10.1002/da.22075 Crossref MedlineGoogle Scholar - Betz M.E., Sullivan A.F., Manton A.P., Espinola J.A., Miller I., Camargo C.A., Boudreaux E.D. (2013). Knowledge, attitude, and practices of emergency department providers in the care of suicidal patients. Depression and Anxiety, 30, 1005–1012.
10.1002/da.22071 Crossref MedlineGoogle Scholar - Boudreaux E.D., Camargo C.A., Arias S.A., Sullivan A.F., Allen M.H., Goldstein A.B., Miller I.W. (2016). Improving suicide risk screening and detection in the emergency department. American Journal of Preventive Medicine, 50, 445–453.
10.1016/j.amepre.2015.09.029 Crossref MedlineGoogle Scholar - Boudreaux E.D., Miller I., Goldstein A.B., Sullivan A.F., Allen M.H., Manton A.P., Camargo C.A. (2013). The Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE): Method and design considerations. Contemporary Clinical Trials, 36, 14–24.
10.1016/j.cct.2013.05.008 Crossref MedlineGoogle Scholar - Caine K. (2013). Forging an agenda for suicide prevention in the United States. American Journal of Public Health, 103, 822–829.
10.2105/AJPH.2012.301078 Crossref MedlineGoogle Scholar - Centers for Disease Control and Prevention. (2015). Welcome to WISQARS. Retrieved from https://www.cdc.gov/injury/wisqars/index.html Google Scholar
- Crosby A.E. (2015, September15). Preventing suicide: A comprehensive public health approach. Retrieved from https://stacks.cdc.gov/view/cdc/34311 Google Scholar
- Currier G.W., Litts D., Walsh P., Schneider S., Richardson T., Grant W., Moscati R. (2012). Evaluation of an emergency department education campaign for recognition of suicidal patients. Western Journal of Emergency Medicine, 13, 41–50.
10.5811/westjem.2011.6.6803 Crossref MedlineGoogle Scholar - Egan R., Sarma K.M., O'Neill M. (2012). Factors influencing perceived effectiveness in dealing with self-harming patients in a sample of emergency department staff. Journal of Emergency Medicine, 43, 1084–1090.
10.1016/j.jemermed.2012.01.049 Crossref MedlineGoogle Scholar - Giordano R., Stichler J.F. (2009). Improving suicide risk assessment in the emergency department. Journal of Emergency Nursing, 35, 22–26.
10.1016/j.jen.2007.11.003 Crossref MedlineGoogle Scholar - Gordon J.T. (2012). Emergency department junior medical staff's knowledge, skills and confidence with psychiatric patients: A survey. The Psychiatrist, 36, 186–188.
10.1192/pb.bp.111.035188 CrossrefGoogle Scholar - The Joint Commission. (2015). National patient safety goals effective January 1, 2015. Retrieved from http://www.jointcommission.org/assets/1/6/2015_NPSG_HAP.pdf Google Scholar
- The Joint Commission. (2016). Sentinel event alert. Retrieved from https://www.jointcommission.org/assets/1/18/SEA_56_Suicide.pdf Google Scholar
- Mackay N., Barrowclough C. (2005). Accident and emergency staff's perceptions of deliberate self-harm: Attributions, emotions and willingness to help. British Journal of Clinical Psychology, 44, 255–267.
10.1348/014466505X29620 Crossref MedlineGoogle Scholar - McAllister M., Creedy D., Moyle W., Farrugia C. (2002). Nurses' attitude towards clients who self-harm. Journal of Advanced Nursing, 40, 578–586.
10.1046/j.1365-2648.2002.02412.x Crossref MedlineGoogle Scholar - Olfson M., Marcus S.C., Bridge J.A. (2014). Focusing suicide prevention on periods of high risk. JAMA, 311, 1107–1108.
10.1001/jama.2014.501 Crossref MedlineGoogle Scholar - Owens P.L., Fingar K.R., Heslin K.C., Mutter R., Booth C.L. (2017). Emergency department visits related to suicidal ideation, 2006–2013. Retrieved from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb220-Suicidal-Ideation-ED-Visits.pdf Google Scholar
- Patterson R., Whittington R., Bogg J. (2007). Testing the effectiveness of an educational intervention aimed at changing attitudes to self-harm. Journal of Psychiatric and Mental Health Nursing, 14, 100–105.
10.1111/j.1365-2850.2007.01052.x Crossref MedlineGoogle Scholar - Petrik M.L., Gutierrez P.M., Berlin J.S., Saunders S.M. (2015). Barriers and facilitators of suicide risk assessment in emergency departments: A qualitative study of provider perspectives. General Hospital Psychiatry, 37, 581–586.
10.1016/j.genhosppsych.2015.06.018 Crossref MedlineGoogle Scholar - Roy W., Roaten K., Downs D., Khan F., Pollio D.E., North C.S. (2017). Suicide risk assessment and management: Real-world experience and perceptions of emergency medicine physicians. Archives of Suicide Research, 21, 365–378.
10.1080/13811118.2016.1199987 Crossref MedlineGoogle Scholar - Schmitz W.M., Allen M.H., Feldman B.N., Gutin N.J., Jahn D.R., Kleespies P.M., Simpson S. (2012). Preventing suicide through improved training in suicide risk assessment and care: An American Association of Suicidology Task Force report addressing serious gaps in U.S. mental health training. Suicide and Life-Threatening Behavior, 42, 292–304.
10.1111/j.1943-278X.2012.00090.x Crossref MedlineGoogle Scholar - Seidel R.W., Kilgus M.D. (2014). Agreement between telepsychiatry assessment and face-to-face assessment for emergency department psychiatry patients. Journal of Telemedicine and Telecare, 20, 59–62.
10.1177/1357633X13519902 Crossref MedlineGoogle Scholar - Suicide Prevention Resource Center. (2015). Caring for adult patients with suicide risk: A consensus guide for emergency departments. Retrieved from https://www.sprc.org/resources-programs/caring-adult-patients-suicide-risk-consensus-guide-emergency-departments Google Scholar
- Ting S.A., Sullivan A.F., Miller I., Espinola J.A., Allen M.H., Camargo C.A., Boudreaux E.D. (2012). Multicenter study of predictors of suicide screening in emergency departments. Academic Emergency Medicine, 19, 239–243.
10.1111/j.1553-2712.2011.01272.x Crossref MedlineGoogle Scholar - Zun L.S. (2012). Pitfalls in the care of the psychiatric patient in the emergency department. Journal of Emergency Medicine, 43, 829–835.
10.1016/j.jemermed.2012.01.064 Crossref MedlineGoogle Scholar - Zun L.S., Rozel J.S. (2016). Looking past labels: Effective care of the psychiatric patient. In (Eds.), Diversity and inclusion in quality patient care (pp. 121–129). Cham, Switzerland: Springer.
10.1007/978-3-319-22840-2_11 CrossrefGoogle Scholar
