Suicide Prevention in a Rural, Critical Access Emergency Department: Development and Implementation of a Suicide Care Toolkit

Background: Suicide has become one of the leading causes of death in the United States during recent years. Throughout this time, Utah experienced one of the nation's highest suicide rates. During the onset of the coronavirus pandemic of 2019, hospitalizations for suicidality drastically increased throughout the United States. Unfortunately, many nurses report feeling unprepared to care for these suicidal patients, leading them to be uncomfortable as they do so. Local Problem: The Central Utah area has one of the highest suicide rates in Utah. Nurses in Central Utah lacked tools to assist them in their care of suicidal patients. A suicide care toolkit was developed and implemented for the nurses to utilize during their care of suicidal patients. Methods: This quality improvement project aimed to increase rural Emergency Department Nurse's knowledge and comfort level as they deliver care to patients with suicidality. A pre- and post-implementation design was used. Nurses comfort level and knowledge level were assessed at the start of the program and again after a six-week implementation period. Interventions: A suicide care toolkit was developed, presented to the nursing staff, and made available for them to use during their care of suicidal patients. This toolkit included best practices, policies, procedures, handouts, and other guidance regarding providing care to suicidal patients. An educational seminar was created and accomplished to provide staff members with knowledge regarding national and local suicide statistics, deliver information regarding best practices for suicide care, provide disparity education, and introduce the suicide toolkit. At the start of the project, a pre-implementation survey of participants assessed their knowledge and comfort level, as well as the emotional burden of the staff as it relates to suicide care. After a six- week implementation period, post-implementation surveys were completed by the participants to determine any changes in their knowledge and comfort level as they provide care to suicidal patients. Results: Due to a very small sample size, no significant statistical change was found in the comfort or knowledge level of the staff pre- and post-implementation. Despite this, 50% of participants (n=5) reported feeling a "greatly increased" or "substantially increased" knowledge level regarding suicide care, and (n=6) reported a "greatly increased" or "substantially increased" comfort level regarding suicide care. Conclusions: Appropriate training regarding suicide care and the implementation of a suicide care toolkit may be an effective means of increasing nurse's knowledge and comfort regarding delivering care to suicidal patients. This project should be employed with a larger group of participants to understand the true impact of the intervention. Additionally, further research should be conducted to determine the emotional burden inflicted on nurses as they provide suicide care, and the impact of this burden on patient outcomes.