The Joint Commission Added the National Patient Safety Goal: Identifying Individuals at Risk for Suicide

hospitals, psychiatric hospitals, and hospitals claiming “other specialty”. The criteria for the study were previous suicide attempts, drug abuse, and being admitted to a hospital for suicidality. Whether or not the hospitals conducted a mental health assessment was not a requirement for participation in the study, but this factor was considered.

“The overall goal for the Quality and Safety Education for Nurses (QSEN) project is to meet the challenge of preparing future nurses who will have the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work”("Graduate KSAs," 2014 para.1) In looking through the competencies that this statement embodies, I have chosen the competency of safety. This competency is defined as minimizing the risk of harm to patients and providers through both system effectiveness and individual performance (2014). The topic I have chosen to discuss in regards to safety is the role that the Pediatric Nurse Practitioner (PNP) plays in the recognition and the treatment of teen suicide. According to the National Youth Risk Behavior Surveillance survey (2013) suicide among teens and adolescents is a major health problem. It is the 3rd leading cause of death in 10-24 year olds in the United States. In the survey, 17% of students reported seriously considering suicide in the 12 months prior to the survey (Center for Disease Control and Prevention (CDC), 2013). With these reported numbers in the pediatric population, it is of vital importance that the PNP as the primary care provider (PCP) knows how to appropriately screen for, refer and treat this patient. This paper discusses the suicidal teen and the role of the PNP to promote the

This report is a critical review of the evidence around the use of no-suicide contracts with mentally ill patients experiencing suicidal ideation. It will ask the question “When treating mentally ill patients, does the use of ‘No- Suicide contracts reduce suicide outcomes?”. Suicide is a global concern and given the current social and economic difficulties current society face, is imperative we continue to consider effective suicide prevention strategies. The literature suggests that no suicide contracts are widely used within this area of practice and are concerned with asking a person to promise not to harm themselves. This report suggests that there is limited evidence to support the effectiveness of no suicide contracts. However where they have been used successfully, it may be the use of the relationship between the clinician and patient which influences the positive outcome. Based on the findings the report recommends that further training around clinical risk management and suicide prevention strategies should be offered to a local team to reduce the use of no suicide contracts in isolation. Bridges transformation model was used to develop and implement an action plan to support change.

2. The patient are mentally healthy and that they understand the alternatives are provided (e.g. continue receiving treatments) yet still want to commit suicide by doctors’ assistance. In addition, further observation should be applied if the patient is diagnosed with depression.

Healthy People 2020 is a government site that identifies health concerns based on statistics observed and collected over a ten-year period. Mental Health and Mental Disorders is one of the many health concerns or topics listed on their website and has been further subcategorized into objectives and goals (U.S. Department of Health and Human Services [HHS], 2015). The first objective listed under this topic states “reduce the suicide rate” (HHS, 2015). The goal of this objective is to “reduce the suicide rate by ten percent” (HHS, 2015). Suicide is prevalent among varying age groups, ethnicities, and genders (HHS, 2012). It is an increasing problem prompting Healthy People 2020 to label it as a Leading Health Indicator or an extremely important issue (HHS, 2015). To meet their goal, Healthy People 2020 partnered with the U. S. Surgeon General and the National Action Alliance for Suicide Prevention (NAASP) to create a plan that can be utilized throughout the nation. Their plan focuses on removing the stigma associated with mental health and mental health disorders while simultaneously building supportive communities with increased access to care, creating a standardized model promoting the collaboration of health care professionals in order to increase identification and data collection of high-risk patients and provide continuity of care, and ensuring the education and the adequacy of patient support systems.

In 2014, suicide was the tenth leading cause of death overall in the United States. According to the National Institute of Mental Health (NIMH, 2015), there were twice as many suicides than there were homicides. Suicidal ideation (SI), defined as an individual thinking about, considering, or planning their suicide, is established before the act of committing suicide. Research suggests that adverse childhood experiences (CDC, 2015) will put an individual at risk for developing a mental illness that could result in SI and suicide attempt (SA). It is important for the psychiatric mental health nurse practitioner (PMHNP) to recognize the signs of SI and SA while assessing their client.

The eligible applicants must have the capability to help find solutions to the research findings that denotes that the period after emergency suicide interventions is one of heightened risk for suicide, with significant numbers of deaths occurring following discharge from either an emergency department or inpatient hospitalization.

This source conveys the message of ensuring safe care transitions. Whereby innovative methods are created for suicide attempts when one goes through this transitions which reduce suicide risk and creates a smooth and uninterrupted care transition from one setting to another. It tells us that in order to ensure suicide risk continuity it is important to remove barriers to scheduling a patients follow up appointments. It creates strategies such as a warm hand off, rapid referral, caring contacts and other bridging strategies.

In addition, for patients who are being treated for mental health problems or for those patients who I may suspect as being suicidal, I can work on gradually leading the patient to talk about their suicidality in order to get them to open up and gain their trust (Bryan & Rudd, 2006). For patients who have show suicidal thoughts or ideation in the past, I will work on treating the suicide as the behavior to change instead of focusing just on any comorbid mental health disorders (M. Class 4/10). I will focus on getting to know my patients better and the factors that have lead them to where they are in life. In order to help them the most, I will need to know their drivers and in order to do that, I will need to build rapport with them, so that they share with me. We will also work to build their coping skills, because I know how hard it can be to figure out coping mechanisms on your own especially when you are dealing with a crisis (M. Class

Medical care in America is estimated to cost $2.7 trillion each year with roughly 30 percent of that cost attributed to ineffective or redundant care, approximately $800 billion (America's Health Insurance Plans, 2014; FOX, 2010). Within this section $44.6 billion is attributed to suicide treatment and medical cost (Center for Disease Control and Prevention, 2015). The CDD further estimates that with approximately 40,000 people dying of suicide annually suicide contributes to the 10th leading cause of death for Americans, narrowly being outstrode by kidney disease and influenza yet still achieving a higher overall medical cost than the ninth and eighth ranked causes of death (Keren, Zaoutis, Saddlemire, Luan, & Coffin, 2006;Webberley, 2015).

Due to the variety of different programs that were implemented by grantees, there were many different evaluation techniques. Therefore, not all suicide prevention program evaluations were comparable (Goldston et al., 2010). However, these evaluations were helpful in informing changes in programming based on locality. Cross-site evaluations were also conducted under the GLSMA. According to Goldston et al (2010), these evaluations were more thorough, consisting of four main stages. First, evaluators aimed to get a better understanding of the environment in which the suicide prevention programs were being implemented. Next, evaluators examined the development, utilization, and budget allocation of programs and services. Evaluators then looked at key activities related to the implementation of each suicide prevention plan that was developed by grantees in order to receive federal funding. Finally, evaluators examined the impact that the programs had on participants that were considered to be at a higher risk of suicide. These evaluations were primarily used for federal performance measurement and program management. As evidenced by the many methods of evaluation utilized under the GLSMA, it is clear that the effectiveness and feasibility of these services are of high

The first aspect I picked is the Suicide Prevention Resource Center. I feel that this resources can help in understand the resources available to clients who are suicidal. It also provides some training information on assessing and managing suicide risk. This web site has many pages on effective prevention including Care Transitions. This could be useful in assessing a patient and offering them resources to help them get over the feeling of being suicidal.

Nurses who are practicing in public health, psychiatric units, schools, clinics, and hospitals can bring differences by creating awareness about the magnitude of the suicide problem, its risk factors, and preventive strategies. They can act as a bridge or liaisons between the community and available resources. The nursing profession always gives priority to prevention and promotion of health. Instead of watching and waiting for the signs and symptoms to exhibit themselves, nurses can take part in equipping teens and their parents with preventive skills to reduce the risk of suicide attempts (King & Vidourek, 2012). The nurses’ involvement in this issue increases the patient outcome. Early intervention of suicide is successful in lowering the risk factors among teens. It helps to promote and maintain their health from youth to adulthood without complications. Nursing profession can be at the forefront by promoting awareness, preventing risk factors, equipping teens with coping skills, and encouraging them to seek professional help. Increasing protective factors for teens can result in effective patient outcomes by reducing suicide ideations and

Chan, Chien and Tso (2008) developed an 18-hour suicide prevention program for nurses to evaluate nursing attitudes, confidence, and skills. The program resulted in increased awareness of the importance of suicide assessment, therapeutic communication, and proper documentation while also increasing their confidence levels (Chan et al., 2008). Chan et al. (2008) reported the need for follow-up using interactive methods to relate knowledge to the clinical setting to improve their program. Bolster et al. (2015) and Valente and Saunders (2004) further implicate the need for interactive education programs by recommending the use of simulation. The literature consistently attributes the failure of suicide risk assessment to lack of education (Bajaj et al., 2008; Bolster et al., 2015; Valentine & Saunders, 2004). Which reveals the need for education based on interactive and simulated environments to impede healthcare provider’s fear of suicide risk assessments.

The National Suicide Prevention Strategy (NSPS) promotes prevention and early intervention on suicide. It originated in 1995, and then expanded in 1999 when more evidence for the risk of suicidal behaviours emerged. The main objectives of NSPS are to target suicide prevention activities, create standards and raise the quality of suicide prevention, build and educate on self-help, improve the community, and improve the understanding of suicide prevention. The components of the strategy are listed in four inter-related components: