Document Type

Final Project

Graduation Date

Spring 5-2-2024

Degree Name

Doctor of Nursing Practice

First Advisor

Dr. Carithers

Abstract

Purpose. Suicide is the second leading cause of death among adults in the United States and Nebraska. Death by suicide impacts millions of adults every year in the United States but warning signs are often missed during visits with primary care providers. The University of Nebraska at Kearney (UNK) Student Health Center (SHC), like many other primary care clinics, did not routinely screen patients for suicide risk. According to the Joint Commission, all patients over 12 years of age should be screened for suicide using a validated screening tool if the visit is for any behavioral health concern. The project’s goals were to implement a validated suicide screening tool, evaluate the use and effectiveness of the suicide screening tool, and evaluate the relationship between the depression screening tool and suicide screening tool. Theoretical Framework. The Advancing Research and Clinical Practice through Close Collaboration (ARCC) model was used to guide this project. The ARCC model is a five-step quality improvement plan that includes, assessment of culture and organizational readiness, identification of facilitators and barriers, identification of evidence-based practice (EBP) mentors, implementation of the evidence into practice, and evaluation of the outcomes (University of Maryland School of Nursing, 2020, para. 3). Methods. UNK is a public university in central Nebraska with over 6,000 undergraduate and graduate students. The Columbia Suicide Screening Scale (C-SSRS), a validated six-question yes/no style screening questionnaire, was implemented in UNK's SHC campus clinic for all patients who screened positive for depression on the Patient Health Questionnaire (PHQ-2) or by provider preference. The C-SSRS was administered to the patients by the nurse practitioners to determine the patient's level of suicide risk and appropriate intervention. Interventions included a mental health resource sheet for lowrisk patients, establishing a safety plan with the provider for moderate-risk patients, or referral to an inpatient psychiatric facility for a full psychiatric evaluation for high-risk patients. Results. Over a 14-week period, UNK’s SHC had a total of 773 visits with 729 (94.3%) PHQ-2 screenings completed and 301 (38.9%) C-SSRS screenings completed. Of the 301 C-SSRS screenings completed, 69.8% of patients were at no risk, 17.6% were at low risk, 9.6% were at moderate risk and no patients were at high risk of suicide. Two hundred fifty-eight students completed the PHQ-2 and the C-SSRS screenings. Seven patients (3.7%) were at low risk and three patients (1.6%) were at moderate risk of suicide while scoring two or less on the PHQ-2 screening. Of the patients who scored three or higher on the PHQ-2, six patients (8.6%) declined the C-SSRS screening, 31 patients (44.3%) were at no risk, 19 patients (27.1%) were at low risk, and 14 patients (20%) were at moderate risk for suicide. Eight patients declined the C-SSRS but had an average PHQ-2 score of 4.25. Conclusions. Based on the data, implementation of a validated suicide screening tool is sustainable and beneficial for recognition of suicide risk in the college population. It is vital to screen for suicide risk and connect at-risk college students with appropriate, algorithm-based interventions to work toward decreasing suicide rates across the country. Of note, it may be beneficial to implement the C-SSRS to all students as there were a small number of students (n=10) identified at low or moderate risk without a PHQ-2 score of three or higher. It is also important to ensure the patients who decline the suicide screening still may need to receive intervention as if they are low or moderate risk of suicide based on provider discretion.

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