Suicide Risk Assessment Discussion

Clinical Practice Guideline: Suicide Risk Assessment

Evidence-based practice guidelines are recommendations that are made by a special group of experts in a field after extensive consultation and consideration of the evidence available in support of such recommendations. Practitioners in the field or specialty then use the practice guidelines to direct their interventions in the spirit of evidence-based practice (EBP) as best practice for the best patient outcomes (Melnyk & Fineout-Overholt, 2019). This paper is a critical appraisal of a set of such guidelines developed by the Emergency Nurses Association (ENA) for suicide risk assessment. The guideline was recovered from the MEDLINE/ PubMed database.

Guideline Developers, Developer Representation of Stakeholders, and Funding

The developers of this clinical practice guideline on suicide risk assessment are the Emergency Nurses Association (ENA). This is a professional nursing organization dedicated to advocacy and professional development in the area of emergency nursing. The developers of this guideline were indeed representative of key stakeholders in the field of emergency nursing. Theirs was a multidisciplinary team working in the context of suicidality as a life-threatening emergency. The funding for the development of the guideline came from the Emergency Nurses Association. However, no evidence has been found to suggest that any of the guideline developers were funded researchers of the reviewed studies (GuidelineCentral, 2020; Zaleski et al., 2018). Suicide Risk Assessment Discussion

Development Strategy, Selection and Combination of Evidence, Literature Review

The team that developed this strategy had a valid development strategy. This is evidenced by the fact that there was a committee – the 2012 ENA Emergency Nursing Resources Development Committee – that was formed for this specific reason. The fact that funding was also set aside for the purposes of accomplishing this objective is further testament to the validity of the development plan that the team had. That an explicit, open, sensible, impartial, and thorough process was used to choose and combine evidence to back the guideline is not in doubt. This is because the 53 articles selected were arrived at by not only searching electronic databases, but also hand searching of both primary and secondary sources. The literature review that the developers carried out within the last one year before the guideline’s publication was sufficiently comprehensive and reproducible (GuidelineCentral, 2020; Zaleski et al., 2018).

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Consideration of All Important Options and outcomes, Level/ Strength of Evidence, and Explicit Recommendations

In coming up with and writing this guideline, the team considered all important options and outcomes of the risk of suicidality. For instance, they included screening tools that could be used to evaluate for lethality when a patient is being considered for discharge. These tools include the Behavioral Health Screening-Emergency Department (BHS-ED) and the Columbia-Suicide Severity Rating Scale or C-SSRS) amongst others. There is also a table of description of decision options and interventions as well as the level of recommendation. On the evidence supporting the specific recommendations, the team ensured that each of the recommendations was tagged by the strength of evidence on which it is based. The levels of evidence are also clearly classified and stated as level A (high), level B (moderate), level C (weak), and so on. Most importantly, the guidelines are not ambiguous but make explicit recommendations that reflect the value judgements on the expected outcomes (GuidelineCentral, 2020; Zaleski et al., 2018).

Peer Review and Testing, Intent of Use, and Clinical Relevance of Recommendations

This guideline by ENA has undergone internal peer review and testing and this is explicitly stated in the summary of the guideline information on GuidelineCentral (GuidelineCentral, 2020). That the guideline recommendations were also published in the fifth issue of the 44^th volume of the authoritative Journal of Emergency Nursing also means that the guideline underwent comprehensive objective peer review before publishing. The intent of use of the guideline is not explicitly stated. However, it is implicit in the background statement and statement of significance that the guideline is intended for national use in the United States of America. All the recommendations in this guideline are clinically relevant. This is because a lot of thought by the team went into making sure that the recommendations are clinically feasible and can be applied in an emergency set up where suicidal ideation is suspected (GuidelineCentral, 2020; Zaleski et al., 2018).  Suicide Risk Assessment Discussion

Applicability to Practice, Feasibility of Recommendations, and Possibility of Variation from Current Practice

The recommendations in this guideline cover the scope of suicidal ideation and are intended to benefit nurses, hospitals, physician assistants, advanced practice nurses, physicians, paramedics, social workers, and psychologists amongst other healthcare professionals. They cover the specialties of emergency medicine, psychiatry, nursing, and psychology. Their target patient population are those patients presenting to the emergency department with suicidality or suicidal ideation and those at risk of future suicidality. This means that these recommendations are highly applicable to practice and will indeed help these professionals care for their patients. The recommendations are practical and the human resource is available to implement them. Lastly, the recommendations are not a major variation from current practice but an improvement on it. The outcomes can be measured through standard care (GuidelineCentral, 2020; Zaleski et al., 2018).  Suicide Risk Assessment Discussion

Conclusion

Evidence-based practice (EBP) guidelines are developed by experts in a field and are intended to improve practice and ultimately patient outcomes. One example of these EBP guidelines is the one for suicide risk assessment developed by the Emergency Nurses Association (ENA) and enabled by funding from the same association.

References

GuidelineCentral (2020). Clinical practice guideline: Suicide risk assessment. https://www.guidelinecentral.com/summaries/clinical-practice-guideline-suicide-risk-assessment/#section-date

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4^th ed. Wolters Kluwer.

Zaleski, M.E., Johnson, M.L., Valdez, A.M., Bradford, J.Y., Reeve, N.E., Horigan, A., Killian, M., Reeve, N.E., Slivinski, A., Stapleton, S., Vanhoy, M.A., Proehl, J., Wolf, L., Delao, A., & Gates, L. (2018). Clinical practice guideline: Suicide risk assessment. Journal of Emergency Nursing, 44(5), 505.e1–505.e33. http://dx.doi.org/10.1016/j.jen.2018.07.012

Suicide Risk Assessment Discussion