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Specialized training helps ER nurses better manage children at risk for suicide

As many as 12 percent of children ages 6 to 12 and 53 percent of adolescents ages 13 to 19 think about suicide, and 8 to 10 percent of all U.S. children attempt suicide at some point during their childhood. A growing number of these troubled children and adolescents are showing up at hospital emergency departments (EDs) primarily for self-destructive behavior. A previous study showed that by simply asking these children four questions using the Risk Suicide Questionnaire (RSQ), ED triage nurses could identify 98 percent of children at risk for suicide.

Select for the RSQ article in the August 2001 issue of Research Activities.

A recent study at Boston Children's Hospital, also supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00063), goes a step further. It found that when ED nurses at one hospital attended educational sessions on psychiatric issues based on a Risk of Suicide Clinical Practice Guideline (CPG), including use of the RSQ, they were better equipped to manage potentially suicidal children in the ED. The guideline packet consisted of a decision algorithm, a mental health patient flowsheet (including the RSQ), a doctor's order sheet, and a copy of the Hopelessness Scale for Children to be used for all children arriving in the ED for treatment of mental health problems. The educational sessions included a review of the CPG and provided information on how to perform patient searches, de-escalating techniques, risk factors for suicide, and other psychiatric issues.

After the training, there was a marked increase in nurses' knowledge about the CPG and care of ED mental health patients. Prior to implementation of the CPG, 52 percent of nurses said they were uncomfortable working with children with psychiatric problems, and 37 percent were uncomfortable talking to children about hurting themselves or asking parents about their child's suicidal tendencies. When surveyed 2 years after guideline implementation, the nurses reported that they were more comfortable with items on the RSQ, better able to work with potentially suicidal children who arrive at the ED, and had significantly decreased stress when managing these patients.

See "Recognizing suicide risk in a pediatric emergency department: A change in nursing care," by Lisa M. Horowitz, Ph.D., M.P.H., Mary Fallon Smith, R.N., M.S.N., Cynthia Levin, R.N., C.S., M.A., and Susan Klavon, M.S.S.W., in Pediatric Emergency Care 17(4), pp. 306-309.

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