Suicide Assessment In Acute Pediatric Settings

Suicide Assessment in Extreme Pediatric Settings

  • Research Literature

    This section aims in order to analyze the current literature and create an evaluation from the material to react to the main PICO question. In pediatric patients in an acute health care setting (P) does the use of suicide assessment tool (I) as compared to a standards pediatric assessment (C) reduce the risk of future suicide attempts (O)? Many medical practitioners observe children and adolescents at their risks of suicide because of different reasons. Some healthcare facilities provide strong assessment tools and techniques to identify possible mental health problems at their early stages. In many acute care settings, the reduction of the risk of future suicide attempts remains a problem. Suicide is defined as a leading cause of death among adolescents, and it is observed in about 16% of US cases (Bromber, Law, & Palermo, 2017). Therefore, multiple approaches to suicide prevention are developed regularly, and the creation of this evidence-based practice project requires a thorough analysis of past studies.

    The identification of suicide risks is a frequent practice in pediatric emergency departments (EDs). For example, Ballard et al. (2016) identified a pediatric ED as a critical location where children and adolescents at risk for suicide may be identified. The researchers aimed to present a brief suicide screening as a standard of care, using the Ask Suicide-Screening Questions (ASQ) for 970 patients. This retrospective cohort study from the Johns Hopkins Hospital Pediatric ED proved that the choice of specially developed screening instruments might considerably increase the chances to identify future suicidal behavior even without direct reports and complaints (Ballard et al., 2016). The main limitation of this study was a single site of the record data. Still, it did not influence the benefits of this project such as the possibility to incorporate ASQs for pediatric ED patients.

    The same setting was chosen for another important study on bullying victimization. Stanley et al. (2016) set the goal to describe the relationship between bullying and suicide risks of patients at the ED. In this perspective cross-sectional multisite project, 524 participants between 10 and 21 years were invited for interviews where they had to take the ASQ test and the Suicidal Ideation Questionnaire (SIQ) (Stanley et al., 2016). The results proved that a majority of people who reported bullying victimization had a positive attitude toward suicide risks. Despite the evident limitation from the impossibility in order to introduce causal inferences, the chosen research was a strong factor to future research because of its ability in order to gather collateral info from patients straight.

    Suicidal ideation (SI) and correspondant signs turn into the serious issue with regard to discussion in numerous healthcare settings. The particular role of Bromber et al. (2017) with this research are not able to be ignored because they aimed in order to determine SI rates plus characteristics regarding the particular presence and lack of chronic discomfort. With the assist of self-reports finished by adolescents along with and without persistent pain, a study was developed along with descriptive statistics becoming analyzed. The writers indicated adolescence because a developmental phase when increased dangers for thoughts of suicide can be observed (Bromber et al., 2017). Though the connection between pain plus suicide was not really recognized, the research experienced several strengths. 1 of them has been the focus on various mental health-related aspects like anxiety, depressive disorders, and personal shock to the system. Although the chance of biases within participant selection has been defined as the particular limitation of the particular study, Bromber ainsi que al. (2017) described why such problems as self-worth plus hopelessness should become constantly monitored. Security promotion among children with suicidal behavior is a responsibility of the medical staff.

    Several studies were developed to discuss the general aspects of suicide in adolescent populations. Montreuil, Butler, Stachura, and Pugnaire Gros (2015) developed a qualitative descriptive study to explore nursing care from the point of view of patients with suicidal thoughts and their parents. The data was gathered through observations, debriefing sessions with children, and interviews with parents. In the end, the need for a relational aspect in nursing care was proved because of social connectedness and cooperation with mental health practitioners. The study was limited because of the chosen themes that had to be common for parents and their children. No personalization was used in this project, but the participation of families made it possible to gather information about the intricate body-mind connection (Montreuil et al., 2015). Mental health care had to be offered to all families to reduce the risks of suicides later in life.

    Depression is one of the most common mental health problems in people of any age. Kodish et al. (2016) evaluated the risks of suicide focusing on different bullying experiences and depression impact. The Behavioral Health Screen (BHS) tool was used to assess the problems and behaviors of more than 5, 000 young participants (Kodish et al., 2016). The data was gathered from the screeners that participants agreed to complete electronically. The outcomes showed that any kind of type of intimidation could lead in order to suicidal thoughts. Nevertheless , a verbal sort had an distinctive effect on people leading to depression and a number of negative thoughts. Although self-data reports might be defined as the particular study’s limitation, this particular information helps you to realize the severity associated with suicidal risks inside patients.

    An understanding of taking once life thoughts in the chidhood and adolescent individuals can be arrived at through different evaluation tools. Desjardins, Cats-Baril, Maruti, Freeman, plus Althoff (2016) targeted at developing 1 of such tests at the MALE IMPOTENCE to predict dangers within 72 hrs, to define a good intervention, and in order to identify the amount of individual satisfaction. A randomized cross-sectional study has been conducted in the university-affiliated academic clinic plus consisted of 3 phases, including advancement, sampling, and duplication (Desjardins et ing., 2016). 174 individuals from the MALE IMPOTENCE and surgical models were invited in order to validate the created model. It will be one of the particular main strengths from the study that almost all the participants discussed their positive behaviour towards tool credited to its simpleness and convenience, showing the correctness from the decisions made simply by the researchers. Nevertheless, the participation price and exclusion requirements were defined because the limitations from the project.

    Screening for suicide dangers in hospitals is a frequent topic for numerous projects. Ross ainsi que al. (2016) concentrated on the explanation of opinions regarding screening. Diamond ainsi que al. (2017) created a comprehensive testing of suicidal individuals to identify danger behaviors and connected stress. Patel ainsi que al. (2018) meant to clarify the particular risks of committing suicide and described the screening in the pediatric unit. Within these three research, different research methods were chosen. Patel et al. (2018) implemented intervention plus screened a lot more than four, 500 patients among 12 and nineteen years. Screening queries were posed in order to participants and examined retrospectively by using content material analyses. Despite the small sample dimension, the results demonstrated that lots of adolescents experienced mental health issues that resulted in taking once life risks. The recognition of patients’ perceptions toward suicide screening was an important aspect of this work.

    Almost the same research method was used in another study. Diamond et al. (2017) used the data from about 2, 500 patients using a web-based comprehensive tool known BHS. Patients’ profiles helped to identify the risks and focus on such factors as psychiatric syndromes, behaviors, family problems, and violence exposure. The authors concluded that the influence of sexual assault, unsafe sex, and substance use determined suicidal risks (Diamond et al., 2017). The sample is a limitation in the study, and the introduced BHS became a promising tool in suicide rate evaluation.

    One of the screenings helped to recognize new suicide themes, including prevention, responsibilities of providers, and emotional benefits. Ross et al. (2016) invited 200 pediatric patients to respond to several questions about suicidal thoughts and the role of nurses in care as a part of qualitative research. Quantitative information included descriptive statistics about the various demographic characteristics of patients. A small clinical sample did not influence the benefit of the study that was several revealing comments on suicidal risks given by ill youth.

    Finally, the necessity to prevent suicides in youth cannot be neglected. However , many hospitals fail to succeed in suicide prevention, and Leavey et al. (2017) set the goal to examine the challenges from the point of view of family members. Qualitative in-depth interviews with the families whose members made attempts to commit suicide and the general practitioners who experienced the patient’s death because of suicide were developed to gather enough information for analysis. It was discovered that relatives could not detect suicide symptoms and within behaviors correctly, and practitioners had been not capable to realize the needs associated with patients because associated with their social situations (Leavey et ing., 2017). Along with other research, this article will be limited in the sample size. Nevertheless, the possibility to check into the same subject from two various perspectives and determine the attitudes associated with two groups associated with people is a strength that cannot be observed in past projects. All the chosen qualitative and quantitative articles help create a solid background for discussing and investigating the main research question about the importance of assessment tools for preventing suicides in pediatric and adolescent patients.

    Research Design

    This EBP project is planned to use a qualitative research approach to identify the worth of suicide assessment tools compared to standard pediatric assessments in pediatric patients. A quasi-experimental intervention for 200 patients between 12 and 16 years will be employed at one of the local hospitals. A similar approach was developed by Desjardins et al. (2016) who used a cross-sectional study to analyze the value of assessment tools in the EDs with the only difference was the established period. This research design should help clarify a cause-effect relationship between several variables.

    As soon as the intervention is identified and discussed, participants will be randomly divided into two groups. On the one hand, an experimental group of participants will take the specially developed committing suicide assessment tool. Upon the other hands, a regular pediatric evaluation tool will become used with the control group. 2 independent variables, the suicide assessment device, along with a standard evaluation, can not be manipulated. This is necessary in order to stick to post-test just design to evaluate the results both in groups and examine where the decrease of future committing suicide attempts is feasible. This study will certainly help to evaluate the consequence of two various assessments on committing suicide rates in the chidhood patients during the certain period.

    The data will be gathered from a questionnaire that is offered to every participant. The chosen method and the number of patients create certain limitations and benefits to the project. The main advantage of the selected design is the possibility to evaluate the worth of two different assessment tools on pediatric patients using their reports and personal information. However , there is also a disadvantage in this sample size to be mentioned. Statistical analysis in this study may not be meaningful enough because of the lacked randomization and internal validity threats. Human errors cannot be neglected, but the decision to develop quasi-experimental research is rationalized by the absence of time constraints and true experimental concerns. There are several important reasons why this research design should be chosen to answer the currently developed PICO query. First, one individual can easily expose an intervention, collect the material, plus analyze the information in terms associated with this study. 2nd, validity threats can easily be identified in the initial phases of the task and become removed simply by a researcher. Lastly, it does not really take much period to get ready for this type of intervention.


    One associated with the most essential measures in developing the quasi-experimental study is the particular selection of individuals, also known while sampling. The prospective populace of the research includes pediatric individuals who may possess suicidal thoughts as time passes. The possibility in order to cooperate with community hospitals provides a good opportunity to concentrate on random selection as part of probability sampling. This means that all units in the chosen population have equal chances for participation. However, to strengthen the study, it is necessary to make sure that sufficient subjects are enrolled within the selected groups which are easy to administer (Patel et al., 2018). This type of sampling is called stratified random and combines people about their interests, physical conditions, or certain problems. In this case, a researcher is interested in pediatric patients who should become assessed for committing suicide attempts. The primary addition criteria are:

    • Patients between 12 plus 16 years;
    • English speaking people;
    • Children who can go through and write within English.
  • Patients between 12 plus 16 years;
  • English speaking people;
  • Children who can go through and write within English.
  • The exclusion requirements, in this instance, will become:

    • Children who alreay have produced suicidal attempts prior to the intervention;
    • Orphans
    • [newline]

      Children who are younger than 12 years and older than 16 years.
  • Children who have already made suicidal attempts before the intervention;
  • Orphans
  • Children who are younger than 12 years and older than 16 years.
  • It is expected to cooperate with about 200 children, and both groups (control and experimental) will include 100 participants each. All participants must stay unaware of what kind of tool is applied in their cases. The study should be approved by the appropriate research ethics committee. A nurse may be invited to provide participants with information about the intervention, its potential importance, and their roles in research. In addition , such information as the approximate time required, possible risks, and benefits have to be discussed. As a rule, informed consent has to be obtained from each participant in a written form so that participants can learn their duties and withdraw from an intervention anytime they want. It helps protect patients’ confidentiality, anonymity, and other rights with all possible harms being avoided.


    The PDSA change model is the core method to implement the offered intervention. It consists of four steps: planning, doing, studying, and acting. Its main goal is to promote improvements and ensure quality during working processes (Christoff, 2018). However , to succeed in this EBP project, it is not enough to set an goal and create the team. It will be important to become prepared for a big change and check each step of the process and its feasible impact on patients plus the treatment for the problem. To check a big change in conditions of the PDSA cycle means in order to develop a solid plan, take the particular first implementation actions, take notice of the results, plus act by the particular results obtained. Within this study, the primary change includes the need to replace the standard pediatric evaluation tool having an unique suicide assessment device for patients. The particular task of studies to monitor switch and ensure that almost all new information may be rapidly moved between all the particular participants of the particular intervention (Leavey ainsi que al., 2017). The particular PDSA cycle will be an interactive design that tests surgery from multiple viewpoints.

    The selection of this model will be the result of the requirement to introduce a good intervention which has not really yet been examined in pediatric treatment settings. It offers a simple framework, and a specialist could be properly led throughout the whole procedure. The change of tools can lead to unpredictable results in care and attitudes to care, and this project should not put participants, as well as other stakeholders, under threat.

    There are four main steps in this model with the help of which a researcher can accomplish the goals set. First, a plan should be developed to identify the tasks. In this case, an intervention will be offered to the pediatric patients at the local hospital during their first visits. It is expected to inform all participants about the risks of suicide at early stages and check their emotional and behavioral concerns. The next step, doing, concentrates on carrying out the particular intervention and confirming on all related data. At this particular stage, a specialist offers an unique tool to a good experimental group plus a standard device to a handle group. Then, the particular “study” step will be delivered to evaluate almost all the observations plus answers obtained. Participants’ attitudes toward the particular tools and the particular details about their psychological states have in order to be analyzed plus presented in the table format. Lastly, when the appropriateness plus worth of the particular tool are demonstrated, and the treatment is successfully launched, it should become adopted to see if this particular change is able to reduce the particular number of taking once life attempts.

    A serious barrier within the implementation associated with this intervention might occur because associated with the inability in order to establish trustful associations with participants. In order to overcome this problem, a researcher might cooperate with the nurse and understand how to expose the information in order to people in health care settings. The introduction of conversation skills and innovative thinking may furthermore facilitate the EBP results and easily simplify a functional process. In addition, the environment that has to be developed to support EBP may considerably foster the future practice setting. A researcher will learn how to talk to patients, establish clear goals, and develop plans. The exchange of personal information and research objectives is a solid skill that may be applied in future projects.


    Ballard, E. D., Cwik, M., Van Eck, K., Goldstein, Meters., Alfes, C., Pat, M. E., … Wilcox, H. Chemical. (2016). Identification associated with at-risk youth simply by suicide screening inside a pediatric emergency division. Prevention Science, 18(2), 174–182. Web.

    Bromberg, M. They would., Law, E. Farrenheit., & Palermo, To. M. (2017). Taking once life ideation in children with and without having chronic pain. The Clinical Journal associated with Pain, 33(1), 21-27. Web.

    Christoff, P. (2018). Operating PDSA cycles. Current Problems in The chidhood and Adolescent Wellness Care. Internet.

    Desjardins, We., Cats-Baril, W., Maruti, S., Freeman, E., & Althoff, L. (2016). Suicide danger assessment in private hospitals: An expert system-based triage tool. The Journal of medical psychiatry, 77(7), 874-882. Web.

    Diamond, G. S., Herres, J. L., Krauthamer Ewing, E. H., Atte, T. U., Scott, S. Watts., Wintersteen, M. W., & Gallop, L. J. (2017). Extensive screening for committing suicide risk in main care. American Diary of Preventive Medication, 53(1), 48–54. Internet.

    Kodish, To., Herres, J., Shearer, A., Atte, To., Fein, J., & Diamond, G. (2016). Bullying, depression, plus suicide risk inside a pediatric primary treatment sample. Crisis, 37(3), 241-246. Web.

    Leavey, G., Mallon, S., Rondon-Sulbaran, M., Galway, K., Rosato, M., & Barnes, L. (2017). The particular failure of committing suicide prevention in main care: Family plus GP perspectives – A qualitative research. BMC Psychiatry, 17(1), 369-379. Web.

    Montreuil, M., Retainer, K. J. D., Stachura, M., & Pugnaire Gros, C. (2015). Exploring helpful nursing nare in pediatric mental health settings: The perceptions of children with suicide risk factors and their parents. Issues in Mental Health Nursing, 36(11), 849–859. Web.

    Patel, A., Watts, C., Shiddell, S., Couch, E., Smith, A. Meters., Moran, M. M., & Conners, Gary the gadget guy. P. (2018). Common adolescent suicide testing in a the chidhood urgent care middle. Archives of Committing suicide Research, 22(1), 118-127. Web.

    Ross, A. M., White colored, E., Powell, Deb., Nelson, S., Horowitz, L., & Wharff, E. (2016). In order to ask delete word in order to ask? Opinions associated with pediatric medical inpatients about suicide danger screening in the particular hospital. The Diary of Pediatrics, 170, 295–300. Web.

    Stanley, I. They would., Horowitz, L. Meters., Bridge, J. The., Wharff, E. The., & Teach, H. J. (2016). Teasing and suicide danger among pediatric crisis department patients. Pediatric Emergency Care, 32(6), 347-351. Web.

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