Digital Repository Masters Projects Spring 2024 Enhancing Suicide Risk Management in Nursing Education Using Experts by Experience Daniel Grubb Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Grubb, D. 2024. Enhancing Suicide Risk Management in Nursing Education Using Experts by Experience Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Enhancing Suicide Risk Management in Nursing Education Using Experts by Experience Project Title by Daniel Grubb Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY 04/26/2024 Ogden, UT Date Daniel Grubb, BSN, RN, MSN Student 04/26/2024 Student Name, Credentials (electronic signature) Date Tressa Quayle, PhD, RN 4/26/2024 MSN Project Faculty Date (electronic signature) 4/26/2024 (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. Date 1 Enhancing Suicide Risk Management in Nursing Education Using Experts by Experience Daniel Grubb, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purpose/Aims: This MSN project aims to enhance undergraduate nursing students' competence and confidence in suicide management by integrating Experts by Experience (EBE) into the prelicensure nursing curriculum. Rationale/Background: Current prelicensure nursing education programs have a deficit in their curriculum with regard to developing confidence and competence in managing suicidal patients (Blair et al., 2018; Davison et al., 2017; Maina et al., 2019; Öztürk & Hiçdurmaz, 2022). Evidence suggests that using EBEs in the nursing curriculum supports positive shifts in student attitudes toward suicide prevention and increased empathy (Happell et al., 2018; Horgan et al., 2018; Kang & Joung, 2020). Methods: The instructional method of incorporating EBEs in nurses' education on managing patients was designed for future implementation. Educational presentations, course maps, assessment tools, and evaluations were designed to implement each stage of Lewin’s change management model. Ethical issues in incorporating EBE into undergraduate nursing curriculum were addressed throughout the project development. Results: Anticipated project outcomes are increased student confidence and competence in identifying and managing suicidal patients. These results will be gathered through surveys, summative assessments, and simulation activity. Conclusions: Integrating EBEs into nursing education is a promising approach to preparing students for effective management of suicidal patients and developing increased empathy and confidence. Keywords: suicide risk management, nursing education, expert by experience (EBE) Enhancing Suicide Risk Management in Nursing Education Using Experts by Experience 3 Across the United States, the COVID-19 pandemic exacerbated mental health issues, and Utah was not immune to this exacerbation (KFF, 2023, March 20). Among these issues, suicide is a serious public health problem – a leading cause of death whose annual incidence is increasing (KFF, 2023, March 20). Although Utah has one of the nation's healthiest populations, the state's suicide rates continue to climb (State of Suffering: Curbing the Rise of Utah Suicides, n.d.). Indeed, over the past several years, Utah's suicide rates have been consistently higher than the national average (Utah Department of Health, 2023). As a result, there is an urgent need for improved suicide prevention measures, particularly involving healthcare providers, including nurses (Berrigan et al., 2022). Current literature about suicide prevention efforts identifies nurses as holding a central role in the first line to identify individuals at risk or in a current crisis of suicide and commence preventative interventions (Ferguson et al., 2020; Vandewalle et al., 2019). Although the existing literature shows that educational and training programs can enhance competence levels as well as promote optimistic attitudes toward suicide among learners who wish to become nurses (Solin et al., 2021; Vedana & Zanetti, 2019), the teaching for managing suicidal patients is lacking in undergraduate nursing curricula (Maina et al., 2019; Öztürk & Hiçdurmaz, 2022; Zohn, 2022). Inadequate curricula create a significant education gap as many nurses indicate their incompetence in suicide risk management, thus leading to patient safety concerns (Blair et al., 2018; Maina et al., 2019). Nursing education programs can improve suicide training and help students feel more confident in providing care to patients who are feeling suicidal by improving how suicide management is taught. Involving people with lived experiences, also termed Experts by Experience (EBE), in the curriculum effectively improves mental health education in nursing 4 education (Happell et al., 2018; Horgan et al., 2018; Kang & Joung, 2020). EBE are individuals with lived experiences in mental health who are diagnosed with a mental health condition and are currently in a state of recovery (Happell et al., 2018; Horgan et al., 2018; Kang & Joung, 2020). The promising improvements in mental health education, even though they are not specifically focused on how to manage care for patients who are suicidal, can be adapted and focused more specifically to improve suicide training in nursing education programs. Statement of Problem The problem under investigation supports the inadequacy of existing educational systems in undergraduate nursing programs to prepare students for managing suicidal patients. Several studies highlight the need for addressing this gap; these reports indicate that nursing students and practitioners lack knowledge and certainty in detecting, appraising, and intervening in situations concerning suicide risk (Blair et al., 2018; Davison et al., 2017; Maina et al., 2019; Öztürk & Hiçdurmaz, 2022). While this is not locally exclusive, the circumstances place an additional responsibility on the state of Utah for having abnormally high suicide rates and familial risk factors (Berrigan et al., 2022). Rural settings and populations with unique socioeconomic challenges worsen this problem (Steelesmith et al., 2019). This MSN project aims to improve the competence and confidence of undergraduate nursing students in managing patients who are suicidal. This MSN project suggests a new, alternative curriculum based on practical life experience and gives a greater reality of education. The methodology employed for this project is a comparative evaluation of the effectiveness of the new curriculum versus traditional didactic instructions. The goal is to enhance competency and increase the confidence of nursing students in the management of suicidal patients. A suicide-focused curriculum utilizing EBE will be developed to provide multiple dimensions of 5 the complexities associated with suicide to achieve this goal (Darnell et al., 2023; Happell et al., 2018; Zohn, 2022). Significance of the Project The significance of this project is that it can fill a gap in prelicensure nursing education, specifically, training nursing students to manage suicidal patients. Many of the studies available find that nursing students and professionals' competence and confidence are insufficient in managing patients who are suicidal (Blair et al., 2018; Davison et al., 2017; Maina et al., 2019; Öztürk & Hiçdurmaz, 2022). This project is an evidence-based curriculum utilizing EBE as a pedagogical tool to achieve improved competence and confidence in managing patients who are suicidal. Mental health nursing education using this approach can empower nursing students to act more accurately and honestly concerning mental health (Darnell et al., 2023; Happell et al., 2018; Zohn, 2022). Incorporating EBE allows the project to be linked with existing literature while addressing shortfalls in theory and practice using a unique teaching strategy. Though traditional didactic-only instruction has merits, there is a growing need for experience-based teaching methods in healthcare education (Ferguson et al., 2020; Solin et al., 2021). This project provides practical insights regarding education on how nursing students can prepare to manage patients who are suicidal. This project focuses on undergraduate nursing students, which ultimately translates into better service to patients. A prelicensure nursing curriculum, including EBE, can enable nursing students to identify signs and risk factors of suicide better, improving the quality of care and potentially reducing suicide cases (Vedana & Zanetti, 2019; Wahab et al., 2021). The project results might also have local significance for improving educational programs more suitable to 6 the nature of rural communities like those found in Northern Utah, which have elevated suicide rates and different socioeconomic problems (Steelesmith et al., 2019; Utah - 2021 - III.B. Overview of the State, n.d.). Review of the Literature This literature review was conducted to discover the current literature regarding the question, in undergraduate nursing students, how does implementing a mental health curriculum involving EBE improve competence and confidence in managing patients who are suicidal? To answer the question, it is essential to understand what deficits in undergraduate nursing curricula regarding the management of patients who are suicidal exist and what current research shows as possible solutions. This section will discuss Lewin's change model framework for the project and synthesize the literature. Framework The evidence-based framework for implementation will be Lewin's Change Model. This Model consists of three stages: unfreeze, change, and refreeze (Mahmud et al., 2022). The first unfreeze stage is generating awareness. It will be essential to educate faculty, students, and administrators about the current deficiencies in the curriculum concerning suicide risk management (Allaoui & Benmoussa, 2020; Cadmus & Roberts, 2022). Everyone will be aware of the impacted changes, forming a basis for preparing them to adapt to the implemented strategy. It will assist in increasing the level of openness for every person to accept a different approach to teaching, which includes EBE comprehensive suicide curriculum. The next step after awareness will be the implementation stage of change. Development and the subsequent launch of the Model will be conducted during this stage with aid from the college (Jayasekara et al., 2018). For this step, faculty will need to partner with students and 7 persons experienced in living through the challenges of suicidal tendencies and ideation (Jayasekara et al., 2018). The third stage of Lewin's change model is refreezing, which solidifies and cements the curriculum changes. The joining process should involve the integration and evaluation practically before the final inclusion of the changes (Mahmud et al., 2022; Sharplin et al., 2019). The more accurate term to depict the project is the "refreeze" stage. Ongoing feedback cements the changes in the nursing program (Mahmud et al., 2022; Sharplin et al., 2019). Strengths and Limitations Lewin's Model is simple and practical, making flexibility practice one of its remarkable strengths (Mahmud et al., 2022). It critically underlines the need to incorporate all parties in an undergraduate nursing program educational environment (Allaoui & Benmoussa, 2020; Jo & Hwang, 2022). The change model is also helpful in minimizing resistance and building support. Minimizing resistance and building support is significant as there may be different readiness and acceptance of change in educational settings (Allaoui & Benmoussa, 2020). The model has some recognized shortcomings. Curriculum development faculty may need help merging changes into the institutional culture and may find it challenging to include all the complex activities of changing academic curricula (Jayasekara et al., 2018; Rosenbaum et al., 2018). The model’s straightforward progression through the three steps is restrictive to some extent, as it requires continuous revision and assessment. (Cadmus & Roberts, 2022; Rosenbaum et al., 2018). Therefore, the project can be more flexible and comprehensive with an integrated evaluation component. Analysis of Literature 8 An extensive search of the literature was conducted to identify relevant articles regarding the management of suicidal patients in undergraduate nursing education. A limited amount of research was found specific to this topic. The topic of the research identified deficits in the training of nurses in the management of suicidal patients but was not specific to the educational setting. The research also did not illustrate any specific comparison of educational modalities that are utilized currently to teach nurses how to manage patients who are suicidal. Further research was explored to understand how incorporating Experts by Experience could help improve undergraduate nursing education in suicide prevention. Much of the research only focused on incorporating EBE in improving mental health nursing education. This section discusses search strategies and the identified themes in the literature synthesis. Search Strategies The literature search was conducted to identify current evidence utilizing various sources. Weber State University's Stewart Library Health professional databases were accessed to begin the search. Available Databases that were chosen were Medline, CINAHL, and Wiley. Google Scholar was also employed. The search terms used were "nursing education," "suicide risk management," "competence," "undergraduate nursing," "Nursing Curriculum," "Experts by Experience," and "lived experiences." Peer-reviewed articles published between 2015 and 2023 were preferred to keep the literature current. One article from 2006 was accepted because of its relevance. Various Boolean combinations were created to narrow the number of available articles and better refine the search. Synthesis of the Literature Collectively, the findings of the 35 studies were reviewed and categorized into three themes: (a) the prevailing lack of education and training for prelicensure nursing students on how 9 to manage patients who are suicidal, (b) the effectiveness of EBEs in improving nursing students' suicide prevention education, and (c) the challenges of incorporating EBEs into nursing students' suicide prevention education. This section will discuss each theme and the important implications for EBE involvement in undergraduate nursing education in curricula of the management of patients who are suicidal. Suicide Education for Undergraduate Nursing Students The current body of literature indicates a deficit in the undergraduate nursing curricula regarding the management of patients who are suicidal. Studies conducted by Vedana and Zanetti (2019) and Poreddi et al. (2021) have reported that nursing students’ had increased positive attitudes regarding their crucial role in suicide prevention after suicide preventionspecific education; these findings underscore the significant influence of educational exposure on the student’s readiness and viewpoints of caring and managing suicidal patients. Research by Blair et al. (2018) and Manister et al. (2017) has reported the beneficial outcomes of targeted educational programs. These outcomes evidence substantial enhancements in nonpsychiatric nurses' confidence and capabilities regarding suicide risk assessment and intervention strategies. These findings are further validated by comprehensive reviews by Ferguson et al. (2020) and Ferguson et al. (2018), both of whom argue for integrating such educational initiatives to improve nursing students' competencies, self-assurance, and attitudinal dispositions toward suicide prevention. Investigations of the experiences and perspectives of nursing students provide insights into the multifaceted challenges and emotional trajectories encountered in the provision of care to patients with suicidal behaviors. Sun et al. (2019) and Zohn (2022) have charted the psychological evolution of nursing from initial apprehension to the development of confidence 10 and empathy in managing patients who are suicidal. Türkleş et al. (2018) and Vandewalle et al. (2019) have expounded on the emotional and professional tribulations that nurses face, advocating for educational programs that not only enhance technical skills but also address the emotional labor involved in suicide care. The significance of understanding patients' perceptions of nurses' care, as explored by Vandewalle et al. (2020), underscores the value of empathy, connection, and personalized engagement in the therapeutic relationship. Expert by Experience Involvement in Nursing Education Incorporating EBEs into mental health nursing education results in substantial improvement in nursing students' attitudes toward mental health, recovery-oriented care, and consumer participation (Happell et al., 2019). This pedagogical strategy increases students' preparedness and fosters acceptance and implementation of recovery-oriented practices in mental health care, potentially leading to better patient outcomes. Studies in multiple countries, including Australia, Ireland, Finland, Norway, the Netherlands, and Iceland, have underscored the global relevance of integrating lived experience into nursing education (Bocking et al., 2019). Research such as the qualitative study by Scott et al. (2021) and the COMMUNE project (Horgan et al., 2018) further substantiate the value of embedding patient, caregiver, and service users' perspectives into health care curricula, markedly enhancing learning experiences and fostering a community among participants. The research emphasizes the importance of lived experience teaching for a better understanding of mental health recovery, reducing stigmatization, and improving patient relationships, thus advocating for a humanistic approach in nursing education (Bocking et al., 2019). Happell et al. (2019) and Happell et al. (2020), along with Kang and Joung (2020), have provided evidence that learning from consumer-taught mental health education leads to a deeper 11 understanding of holistic care and recovery-oriented practice, further enhancing students' competence and confidence in managing patients at risk for suicide. Although beneficial, the integration of EBE into nursing education faces challenges. Studies articulate the need for co-production in education to foster mutual learning and challenge traditional views on mental health care (Horgan et al., 2018). However, effective collaboration between academics and EBEs requires addressing significant challenges, including developing co-produced standards and structured student support (Horgan et al., 2020; Yousiph et al., 2023). Research by Winn and Lindqvist (2019) and Byrne et al. (2019) discuss the importance of including real-life experiences, which EBE brings into education for healthcare professionals. Winn and Lindqvist (2019) offer practical strategies for incorporating EBE into interprofessional education (IPE), emphasizing the need for clear rationales, co-production processes, and the creation of safe learning environments. Byrne et al. (2019) focus more on stigmatization and discrimination faced by lived experience practitioners, underscoring the need for supportive communities whose members value lived experience contributions to overcome these barriers. Ethical and Practical Considerations in Mental Health Nursing Education The ethical implications of patient involvement in health professions education are critically explored in the literature. Lefkowitz et al. (2022) advocate for a transformative approach by conceptualizing patients as experts in their illness experience. They propose an ethical framework that values patients' unique insights and experiences, thus enhancing healthcare students’ learning experience. This perspective challenges traditional educational models and addresses ethical dilemmas associated with patient representation, advocating for equity and respect in educational settings. Several studies have focused on the impact of EBE involvement in addressing stereotypes 12 and enhancing nursing students’ understanding of mental health issues. Świtaj et al. (2019) found that antistigmatization training led by EBEs significantly improved participants' attitudes towards people with mental illness, with lasting effects. Happell et al. (2019) have found positive results from the transformative educational impact of EBE involvement on nursing students, particularly in challenging and changing preconceived notions and stereotypes about mental health and in fostering a reflective practice by students. These studies illustrate the value of EBE in nursing education to combat stigma, enhance understanding of mental health issues, and promote a more empathetic and reflective approach to patient care, especially in the context of suicide prevention. Summary of Literature Review Findings and Application to the Project This literature review delves into the nuanced landscape of education for undergraduate nursing students about the management of patients who are suicidal based on an analysis of 35 articles. This exploration reveals critical insights into three main themes. These themes hold significant implications for the project. The literature highlights a concerning shortfall in education for undergraduate nursing students on the management of patients who are suicidal. Research by Vedana and Zanetti (2019) and Poreddi et al. (2021) sheds light on nursing students' positive perceptions regarding their essential role in suicide prevention, pointing to the transformative effect of educational exposure on their readiness and outlook. Studies by Blair et al. (2018) and Manister et al. (2017) further support the assertion that specialized educational programs help nursing students develop confidence in their ability to engage in suicide prevention. These studies show evidence of significant enhancements in the confidence and competencies of nurses in suicide risk assessment and management, thus arguing for the integration of such educational initiatives to 13 bolster nursing students' skills, self-efficacy, and attitudes about suicide prevention. The employment of EBEs in nursing education is a beneficial pedagogical strategy. The literature evidences the benefits of incorporating EBEs in enhancing nursing students' attitudes toward mental health care, recovery-oriented practices, and patient involvement. As detailed by Happell et al. (2019), this innovative educational approach underscores the significance of embedding lived experiences into nursing education to enhance preparedness and promote a more inclusive, recovery-oriented approach to mental health care. However, this endeavor is not without challenges and requires careful consideration and collaboration to challenge entrenched views on mental health care. Ethical considerations and efforts to dismantle stereotypes in mental health nursing education are important. Engaging patients as experts, advocating for an ethical framework that respects and values their unique insights, offers an educational strategy that could enrich nursing students' learning experience. The involvement of EBEs in education has shown great promise in challenging and reshaping nursing students' stereotypes and perceptions about mental health, thereby fostering a more empathetic and comprehensive understanding of mental illness and suicide prevention. This literature review articulates a clear need for a more robust suicide prevention training framework within nursing education. The review posits the integration of EBEs into the pedagogical approach as an effective means to enrich nursing students' educational experiences and their preparedness to confront suicidality. The MSN project aims to address these deficits and opportunities, drawing from the research literature to develop and evaluate an innovative mental health instruction module incorporating EBEs. This approach is geared toward enhancing the efficacy and readiness of nursing professionals in providing comprehensive care management 14 to individuals who are feeling suicidal, embodying a humanistic and empathetic approach to mental health care. Project Plan and Implementation The MSN project’s plan and implementation process for utilizing EBEs to co-instruct suicide education and management of patients who are suicidal for undergraduate nursing students will be informed by Kurt Lewin's change management model. The model proposes that, ideally, change in organizations should be designed to occur in three stages: unfreeze, change, and refreeze (Mahmud et al., 2022). The objective of the unfreeze stage is to inform the organization’s potentially affected members that a substantive change will occur. In Lewin’s model, the process of individuals becoming informed about a change is viewed as increasing “awareness.” In the change stage, the change is implemented. In the refreeze stage, the change is stabilized. The plan and implementation will be discussed in the following sections. The explanation will clarify how utilizing EBEs to teach about suicide and the management of suicidal patients among undergraduate nursing students will increase the student’s confidence and competence in the care of suicidal patients. Plan Development and Implementation The Unfreezing Stage In planning and developing a class for undergraduate nursing students to teach about suicide and management of patients who are suicidal, Lewin’s model indicates that the first stage of the planning–development process will entail increasing the nursing school administrators’ and faculty members’ awareness of the importance of suicide education as a component of the undergraduate curriculum and the curriculum’s current deficit in suicide education (Allaoui & Benmoussa, 2020; Cadmus & Roberts, 2022). Specifically, improving administrators’ and 15 faculty members’ awareness will involve their participating in a short presentation about incorporating EBE in the development and teaching of the class on suicide that will discuss five topics: (a) the importance of suicide prevention and nurses’ suicide prevention training, (b) current suicide education in the school of nursing’s undergraduate curriculum, (c) description of EBEs and their potential role in improving educational content authenticity, (d) incorporation of EBEs into the undergraduate nursing curriculum’s pedagogical approach, and (e) the benefits of implementing EBE pedagogical support to improve undergraduate nursing students' confidence and competence at the bedside. The presentation’s primary aim will be to educate the nursing school’s administrators and faculty members so that they will clearly understand how EBEs will be employed in the school’s curriculum that teaches about suicide and managing patients who are suicidal. Indeed, developing this understanding in these key stakeholders will be an essential first step in ensuring their support of the project. The Change Stage In the proposed MSN project, implementation of the change stage will be a multistep approach to improve undergraduate nursing student’s educational experience regarding the care of suicidal patients. This stage is important so that students have the necessary confidence and competence to address suicidal patients in every area of patient care effectively. The initial activity will be a precourse survey given to the students. This survey will help determine the students’ self-assessed levels of confidence and competence in managing the care of suicidal patients. The insights gained from the survey will guide the EBE and the instructor in tailoring the educational material to the student's needs and in ensuring that appropriate emphasis is placed on areas where students feel less prepared. Week 1. The course’s first week will cover the fundamental concepts of suicide and 16 suicidal ideation; this week’s content will focus on the risk factors, signs, and symptoms that nurses must be able to recognize. The instructional strategy will be collaborative, with the instructor and the EBE reviewing and co-presenting the material. The EBE must present a portion of the lesson, as this integration of the EBE’s perspectives and experience into the courses learning content will deepen students’ understanding. Week 2. The course’s second week will cover the patient's perspective on suicide. The EBEs’ contribution will be particularly significant in this module because their narratives will provide a unique and invaluable insight into the experiences of people with suicidal ideation. The opportunity to hear the narrative in person from an individual who has first-hand experience will enable the students to gain an understanding of suicidal ideation that cannot be obtained through just reading about the experience. This understanding will help the nursing students develop deeper empathy and improve their ability to provide excellent patient-centered care. Week 3. The course’s third week will explore current techniques and treatments for suicide prevention and managing suicidal patients. This session will be highly interactive, incorporating role-play exercises to cultivate practical skills for identifying and interacting with at-risk individuals. The EBEs and instructors will work in tandem to demonstrate effective patient interactions and will focus on active listening and risk factor identification abilities—key competencies in suicide prevention. Week 4. The fourth and final week will include a simulation that mirrors a real-world scenario nurses will likely encounter in their professional practice. The EBEs will review and actively contribute to the simulation, particularly in the debriefing stage, where their lived experiences can provide critical insights. After the simulation, a summative assessment comprising a multiple-choice examination will be administered through a learning management 17 system. This evaluation will measure the student's comprehension and retention of the material covered throughout the course. Upon completion of the educational sessions, a post-course survey will be used to evaluate changes in students' confidence and competence levels. This survey is an important component of the educational process, providing essential feedback that will inform future curriculum development and pedagogical strategies. This reflective practice is a sign of quality education and continuous improvement in nursing education. Interdisciplinary Team The integration of a volunteer psychiatric nurse, a nursing instructor, and an EBE will form the interdisciplinary team that will be used to implement this project in undergraduate nursing education. This interdisciplinary collaboration is necessary to create an educational framework that is comprehensive and reflective of the nature of patient care. Psychiatric Nurse. A volunteer psychiatric nurse will contribute clinical expertise and theoretical knowledge. Their role will be to review the curriculum and then share any current, evidence-based practices in mental health care—particularly practices related to suicide prevention. They will ensure that the material is academically sound and has direct clinical application. Nursing Instructor. The nursing instructor will act as the conductor of the educational experience and will ensure that the experience meets the course’s defined outcomes. This role will involve more than teaching; the role will entail creating a learning environment in which complex concepts can be considered in digestible, relatable pieces. The instructor will ensure that the expertise that the psychiatric nurse and the EBE will provide will be seamlessly integrated into the curriculum. The instructor's commitment to cultivating a collaborative 18 educational setting will nurture students’ ability to appreciate the value of interdisciplinary teamwork in delivering patient care. The EBE. With their personal experience of mental health challenges, EBEs will offer a learning experience that textbooks cannot provide. Their stories and insights will deepen the student's understanding of mental illness, emphasizing the human aspect of nursing care. This real-world perspective will be an essential part of teaching future nurses to see beyond the clinical presentation and to connect with patients on a more personal level. The contribution will help to nurture nursing students’ empathy, an affective capability that is crucial for the delivering patient-centered care that can significantly improve patient experiences and outcomes. These three perspectives form a holistic educational approach that is not just about imparting knowledge but about expressing knowledge in the form of compassionate action. The collaboration will ensure that nursing students will receive a well-rounded education that will prepare them to deliver care that will be informed by a deep understanding of both the science and the lived experience of mental health. This approach to education will have far-reaching implications, extending into the domain of patient care, where it can potentially foster a more empathetic and effective holistic approach to nursing practice. Description and Development of Project Deliverables Infographic. An infographic was developed to present the information to administrators and faculty members in a clear, concise, easy-to-read format to gain support for the project (see Appendix A). The infographic will be presented to the nursing faculty and administration at a meeting. The topics of the infographic that will be covered in the presentation will be, first, the need for change in nursing mental health education in suicide prevention and suicidal patient management. Then, the role of the nurse will be discussed, explaining their crucial role in patient 19 care and management of suicidal patients. The next topic on the infographic will cover what an EBE is, the goal of having EBEs participate in nursing education, and the significance of their contribution. The last part of the presentation and part of the infographic will illustrate the expected outcomes of the project and the impact that the project will have locally as well as nationally. Pre- and Post- survey. Determining the effect of incorporating EBEs into the curriculum on the students will be important—so that the EBEs’ involvement will be purposeful (Winn & Lindqvist, 2019). For this determination, a pre-and post-survey was prepared (see Appendix B). Each survey is a series of five questions that are quantitative and qualitative. Questions 1, 2, and 4 of both the pre- and post-survey utilize a Likert scale ranging from 1 (low) to 5 (very high). Questions 3 and 5 of both surveys are qualitative and ask open-ended questions. Question 1 pertains to knowledge and understanding of suicide risk factors and signs. Question 2 pertains to the student's comfort level when interacting with patients who are experiencing suicidal ideation. Question 3 asks about previous experiences and then changes of perception after the course. Question 4 pertains to how well the student feels prepared to handle a crisis. Question 5 pertains to whether the student knows of any procedures in the health care setting, and then the postsurvey asks if specific parts of the course improved confidence and competence. These surveys will help determine the project's benefits and possible improvement areas. Course Map. The next action item—a task that will be crucial to the project—will be the development of a course map that will provide a clear direction of what will be taught in the course (see Appendix C). The map will help define the EBEs’ role and the ways in which they will effectively contribute to the pedagogy and course content (Kerry et al., 2023; Winn & Lindqvist, 2019). The nursing instructor and the EBE will co-produce the content so that it will 20 have the intended effect of enhancing education (Happell et al., 2021). The course map begins by listing the course outcomes. The course map is designed in a table format that presents the course’s unit number, EBE contribution, Outline, Student Prep, Assessment, and Rubric. Under the first column, the table lists the topic of each unit, the concepts that are being taught, and unit outcomes. The EBE contribution column lists areas to which EBE contributes and how it will be implemented. The outline column has the unit topics, and then the student prep column lists the material students will be assigned to read or watch before course. The last two columns list the type of assessments—summative or formative—that will be used along with the rubric that will be used for assessment grading. Having a clear course map will provide direction to the course so that the course will be implemented effectively. Simulation. Simulation using the standardized patient method was chosen for the last unit (see Appendix D). Simulation designed with standardized patients was chosen because of its effectiveness, which has proven superior to mannequin simulation (Luebbert et al., 2023; Presno et al., 2021). Especially in mental health education for nursing, standardized patient simulation has been shown to improve clinical competence, reasoning, decision-making, and confidence (Hudgins et al., 2021). Unit outcomes, simulation outcomes, and concepts were all identified at the beginning of simulation. The students will also have pre- and post-course work to complete. The simulation was designed to indicate the EBE’s role, the necessary set-up items, students’ roles, scenarios, and dialogue. There will be two states with a debriefing in between each one. During the design of the simulation and the debriefing, the EBE will be used. The EBE’s participation will add to the scenarios’ validity and realism. The insight that the EBE will be able to bring to the simulation activity, which is a safe place of learning for the students, will contribute greatly to their skills and attitudes in a positive manner (Happell et al., 2021b). 21 Final Exam and Answer Key. The courses’ last component of the course will be a final examination (see Appendix E). This examination will use the summative method of evaluation to determine the base of the students' knowledge learned throughout the course. The exam will not reveal the thoughts and feelings of the students but will provide a picture of what knowledge was obtained in the course. The final examination will consist of 50 multiple-choice questions. The questions are designed to test students’ didactic knowledge. The examination’s answer key was prepared separately so that the presentation of the test could be viewed as the students would view it (see Appendix F). The EBE will review the test, and will provide input and insight on the questions that were prepared. Timeline The timeline will be implemented in a clear and linear manner (see Appendix G). The implementation timeline will begin with setting a date and conducting the presentation to the faculty and administration of the nursing school. Conducting this meeting at least one academic year before the project's implementation will be important. This time will enable faculty and administration to ask any questions they may have and to thoroughly understand the project’s importance. Once this step has been completed, an EBE will be contacted and will work in collaboration with the faculty member who will teach the course. The EBE and instructor will review the surveys, the course map, the simulation, and the final exam. This review will occur at least one semester prior to the project’s implementation. After the EBE and instructor have reviewed the course’s deliverables and have had an opportunity to make any adjustments, the students will be given the opportunity to participate in the 4-week course in the next semester. After registration for the course is completed and all the materials have been finalized, the course will be held at the start of the next semester. The course’s timeframe will be four weeks, as 22 outlined in the course map. After the completion of the course and collection of all the surveys, the next step will be to evaluate the course's effectiveness. The time to complete the evaluation of the effectiveness of the course will be given until four weeks after the course has finished, at which time the results will be discussed with all the faculty and administrators to determine whether incorporation of the course into the mental health curriculum will be initiated. Project Evaluation The project will be evaluated by utilizing both formative and summative methods. The formative methods used throughout the project will be the rubrics found in the course map (see Appendix B). Each formative assessment will evaluate the student's understanding of the material with the unit that the formative assessment evaluates. The summative assessment will be a final covering all the material presented in the course. The other summative methods that will be utilized will be pre- and post-surveys. The surveys will collect data indicating students' comfort level and self-perceived competence in caring for suicidal patients. These surveys will be collected and reviewed by the EBE and instructor. The formative and summative assessments will ascertain whether the learning objectives of each unit and of the course as a whole were achieved. The assessments’ results will also be useful data for determining whether incorporating an EBE increased students’ understanding of the care and management of patients who are suicidal. Gathering informal qualitative feedback from the EBE and instructor will also complement the formative and summative assessment results. EBE and the instructor’s perceptions about what went well and areas they feel should be improved are invaluable in determining whether it is plausible to implement EBE instruction into the curriculum permanently. Their input and suggestions will be compiled into a report that can be easily 23 disseminated to all stakeholders. Ethical Considerations Since the MSN project covers material that can be sensitive, at any point, the students, instructor, or EBE will be permitted to withdraw from participation in the project; there will be no reprisal or consequence for such action. Maintaining psychological safety for all involved is paramount. Many students may have personal experience with the topic of suicide or other mental health conditions. In seeing an individual, the EBE, participate in the course, students may feel the inclination to self-disclose their mental health struggles or those of close friends and family. At the beginning of the course, it will be important to remind the students that information is being shared openly and willingly. The information from the individual can be sensitive and very personal, so to create a safe space for everyone to learn, students will be asked to abide by the principles of professionalism and to treat others with dignity and respect. One concern that nursing faculty and administration may have is the EBEs’ mental health history and current mental health status. This concern can best be addressed through education and planning. Illustrating to nursing faculty and administration that a nursing instructor will lead the course and that it is a collaboration and not just an EBE-taught course. The nursing instructor has the training and understanding to provide a psychologically safe environment for the EBE and students. Also, before involving an EBE in the planned course, discussing and devising clear guidelines on how the position will be filled will be essential. The description will be drafted as a voluntary position description. If an EBE position is implemented permanently, this voluntary position description will be revised and converted into an official job description with the administration’s and Human Resource’s approval. Upon converting into an official permanent position, the position will also switch from a voluntary to a full-time compensated 24 faculty position. The description of the position will be reviewed with the school's administration and legal team to ensure that there are no concerns. The EBE will participate in an orientation similar to paid employees’ orientations. Expectations, duties, and rights will be explained. The EBE will then be requested to sign the document indicating they understand and are willing to participate in the design and instruction of the suicide course. The EBE will work with the instructor to further inform how the course will be developed. The EBE will be held to the same standards as any health care professional when disclosing health information about others with whom the EBE has contact—this is why the curriculum development will be co-produced with the instructor and the EBE. The instructor will be assumed to have the expertise and training in teaching and performing the nurse's duties. The EBE possesses the expertise of living with a mental illness and utilizing mental health services. The EBE’s teaching position is a role that the EBE is participating in, freely and openly agreeing to disclose their personal experience and being open and transparent about the risk of their story being shared outside the course will be made clear before their involvement. EBEs will be able to withhold any information they feel they need to, but the project's purpose is for them to share their experience and offer their insight in designing and teaching the course. By carefully considering the EBE’s well-being, adherence to professional standards, and collaborative curriculum development, this project can enable nursing students to gain a greater understanding of mental health care relating to the management of suicidal patients, thereby enriching the educational experience while ensuring the dignity, respect, and safety of all participants. Discussion 25 Suicide rates continue to increase in Utah, across the United States, and throughout the world (reference). In nursing education, improving the curriculum pertaining to the care and management of patients who are suicidal will help new RNs be prepared to provide care—and feel confident in caring—for these patients. This section will discuss how the project’s results will be disseminated, their significance to nursing practice, and their implications for nursing education. Evidence-based Solutions for Dissemination The MSN project’s results will be presented to Weber State University faculty and MSN student peers via a poster presentation. Other dissemination methods include developing a presentation that can be shared with faculty and students at the school of nursing where the project is proposed to be implemented. Thorough analysis and evaluation of the results would make publication possible after the project's implementation. Further research could also be conducted if the findings are promising. Significance to Advance Nursing Practice This MSN project can be a step toward improving overall mental health education in prelicensure nursing programs. Mental health discussions are becoming more and more common in society, and national governments are recognizing the need to bring these topics forward and educate the public. Happell and Gaskin (2012) emphasize the importance of educational strategies in positively influencing nursing students' attitudes toward mental health nursing. Their systematic review gives insight into how innovative educational approaches can significantly impact students' readiness and confidence in managing mental health issues, which is the MSN project’s primary goal. Nurses who are better prepared and confident in their abilities to care for patients who are 26 suicidal can improve patient-centered care. Betterprepared nurses can enter the workforce with the knowledge and opportunities to implement larger-scale changes and can improve the nursing culture overall. Happell et al. (2013) highlight the critical role that nurses play in providing comprehensive health care to people with serious mental illnesses, indicating the necessity for nurses to be well-prepared in mental health care. This necessity underscores the significance of enhancing mental health education within nursing programs to prepare nurses effectively for their roles in patient care. Implications Implementing EBEs in nursing education introduces a unique perspective on mental health care, potentially enriching the curriculum and enhancing student learning experiences. This MSN project showcases the benefits and feasibility of EBE in action. The project also underscores the value of experiential learning in mental health education and its potential implications for nursing practice and education. Limitations The MSN project faces and addresses several limitations. These limitations include the project’s focus on undergraduate nursing students, which may not reflect the complexities that experienced nurses encounter. The unique experiences of the EBE facilitator cannot represent all individuals with suicidal tendencies, highlighting the need for a nuanced approach to generalizing findings. Anticipated challenges include an EBE’s potential reluctance to participate and legal or administrative hurdles. Addressing these concerns proactively involves contingency planning, such as broadening recruitment strategies and establishing clear legal and ethical guidelines. Recommendations 27 Several recommendations are proposed for future endeavors to build on the insights gained from this project. Extending the project's duration and involving multiple student cohorts could provide a more comprehensive understanding of EBEs’ impact on nursing education regarding suicide prevention. Comparative research with alternative educational methods could further elucidate the benefits and challenges of integrating EBE into nursing curricula. Conclusions The implementation of EBEs has demonstrated success in various contexts worldwide, although acceptance and integration into educational frameworks vary. This MSN project contributes to the growing evidence supporting EBEs’ value in nursing education, particularly in mental health and suicide prevention. By preparing nursing students more effectively for the challenges of mental health care, this initiative represents a step toward addressing the critical issue of rising suicide rates. The project's potential findings highlight the importance of innovative educational strategies in enhancing future nurses' readiness to provide compassionate, informed care to patients at risk of suicide, marking a meaningful advancement in nursing education and practice. 28 References Allaoui, A., & Benmoussa, R. (2020). Employees' attitudes toward change with Lean Higher Education in Moroccan public universities. Journal of Organizational Change Management, 33(2), 253–288. https://doi.org/10.1108/jocm-08-2018-0232Links to an external site. Berrigan, J., Miller, M. J., Zhang, W., Azrael, D., & Barber, C. (2022). Hospital visit histories of suicide decedents: a study in Utah. Injury Prevention, 28(3), 259-262. https://doi.org/10.1136/injuryprev-2022-044524 Blair, E. W., Chhabra, J., Belonick, C., & Tackett, M. (2018). Non-Psychiatric nurses' Perceived Self-Efficacy after an educational intervention on suicide prevention and care. Journal of Psychosocial Nursing and Mental Health Services, 56(6), 43–51. https://doi.org/10.3928/02793695-20180305-03 Byrne, L., Roper, C., Happell, B., & Reid‐Searl, K. (2016). The stigma of identifying as having a lived experience runs before me: challenges for lived experience roles. Journal of Mental Health, 28(3), 260–266. https://doi.org/10.1080/09638237.2016.1244715 Cadmus, E. & Roberts, M. L. (2022). First year outcomes. JONA: The Journal of Nursing Administration, 52(12), 672-678. https://doi.org/10.1097/nna.0000000000001230Links to an external site. Darnell, D., Pierson, A., Whitney, J. D., Wolkow, C. A., Dorsey, S., Boudreaux, E. D., Areán, P. A., & Comtois, K. A. (2023). Acute and intensive care nurses' perspectives on suicide prevention with medically hospitalized patients: Exploring barriers, facilitators, interests, and training opportunities. Journal of Advanced Nursing, 79(9), 3351–3369. https://doi.org/10.1111/jan.15650 29 Davison, J., Mackay, B., & McGivern, M. (2017). The Potential of simulation to Enhance nursing Students' Preparation for Suicide Risk Assessment: A review. Open Journal of Nursing, 07(02), 129–144. https://doi.org/10.4236/ojn.2017.72012 Utah Department of Health (2023, March 5). IBIS-PH - Complete Health Indicator Report Suicide. Utah's Public Health Data Resource. Retrieved December 1, 2023, from https://ibis.health.utah.gov/ibisph-view/indicator/complete_profile/SuicDth.html Ferguson, M., Reis, J., Rabbetts, L., Ashby, H., Bayes, M., McCracken, T., Ross, C., & Procter, N. (2018). The effectiveness of suicide prevention education programs for nurses. Crisisthe Journal of Crisis Intervention and Suicide Prevention, 39(2), 96–109. https://doi.org/10.1027/0227-5910/a000479 Ferguson, M., Reis, J., Rabbetts, L., McCracken, T., Loughhead, M., Rhodes, K., Wepa, D., & Procter, N. (2020). The impact of suicide prevention education programmes for nursing students: A systematic review. International Journal of Mental Health Nursing, 29(5), 756–771. https://doi.org/10.1111/inm.12753 Happell, B., & Gaskin, C. J. (2012). The attitudes of undergraduate nursing students towards mental health nursing: a systematic review. Journal of Clinical Nursing, 22(1–2), 148– 158. https://doi.org/10.1111/jocn.12022 Happell, B., Platania‐Phung, C., & Scott, D. (2013). Are Nurses in Mental Health Services Providing Physical Health Care for People with Serious Mental Illness? An Australian Perspective. Issues in Mental Health Nursing, 34(3), 198–207. https://doi.org/10.3109/01612840.2012.733907 Happell, B., Platania‐Phung, C., Scholz, B., Bocking, J., Horgan, Á., Manning, F., Doody, R., Hals, E., Granerud, A., Lahti, M., Pullo, J., Vatula, A., Koski, J., Van Der Vaart, K. J., 30 Allon, J., Griffin, M., Russell, S., MacGabhann, L., Björnsson, E., & Biering, P. (2018). Changing attitudes: The impact of Expert by Experience involvement in Mental Health Nursing Education: An international survey study. International Journal of Mental Health Nursing, 28(2), 480–491. https://doi.org/10.1111/inm.12551 Happell, B., Waks, S., Bocking, J., Horgan, Á., Manning, F., Greaney, S., Goodwin, J., Scholz, B., Van Der Vaart, K. J., Allon, J., Hals, E., Granerud, A., Doody, R., Chan, S. W., Lahti, M., Ellilä, H., Pulli, J., Vatula, A., Platania‐Phung, C., . . . Biering, P. (2019). "But I'm not going to be a mental health nurse": nursing students' perceptions of the influence of experts by experience attitudes to mental health nursing. Journal of Mental Health, 30(5), 556–563. https://doi.org/10.1080/09638237.2019.1677872 Happell, B., Waks, S., Horgan, Á., Greaney, S., Manning, F., Goodwin, J., Bocking, J., Scholz, B., Hals, E., Granerud, A., Doody, R., Platania‐Phung, C., Griffin, M., Russell, S., MacGabhann, L., Pulli, J., Vatula, A., Browne, G., Van Der Vaart, K. J., . . . Biering, P. (2020). "It is much more real when it comes from them": The role of experts by experienceintegration of mental health nursing theory and practice. Perspectives in Psychiatric Care, 56(4), 811–819. https://doi.org/10.1111/ppc.12496 Happell, B., Warner, T., Waks, S., O'Donovan, Á., Manning, F., Doody, R., Greaney, S., Goodwin, J., Hals, E., Griffin, M., Scholz, B., Granerud, A., Platania‐Phung, C., Russell, S., MacGabhann, L., Pulli, J., Vatula, A., Van Der Vaart, K. J., Allon, J., . . . Biering, P. (2021). Something special, something unique: Perspectives of experts by experience health nursing education on their contribution. Journal of Psychiatric and Mental Health Nursing, 29(2), 346–358. https://doi.org/10.1111/jpm.12773 31 Happell, B., Warner, T., Waks, S., O'Donovan, Á., Manning, F., Doody, R., Greaney, S., Goodwin, J., Hals, E., Griffin, M., Scholz, B., Granerud, A., Platania‐Phung, C., Russell, S., MacGabhann, L., Pulli, J., Vatula, A., Van Der Vaart, K. J., Allon, J., . . . Biering, P. (2021). Becoming an Expert by Experience: Benefits and Challenges of Educating Mental Health Nursing Students. Issues in Mental Health Nursing, 42(12), 1095–1103. https://doi.org/10.1080/01612840.2021.1931583 Happell, B., O'Donovan, Á., Sharrock, J., Warner, T., & Gordon, S. (2022). Understanding the impact of expert by experience roles in mental health education. Nurse Education Today, 111, 105324. https://doi.org/10.1016/j.nedt.2022.105324 Happell, B., Gordon, S., Sharrock, J., Donovan, A., & Warner, T. (2023). 'We only come from one perspective': Exploring experiences of allies supporting expert by experience leadership in mental health education. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/jpm.12955 Horgan, Á., Manning, F., Bocking, J., Happell, B., Lahti, M., Doody, R., … & Biering, P. (2018). 'to be treated as a human': using co‐production to explore experts by experience involvement in mental health nursing education – the commune project. International Journal of Mental Health Nursing, 27(4), 1282-1291. https://doi.org/10.1111/inm.12435 Hudgins, T., Camp-Spivey, L. J., & Lee, S. (2021). Leveraging innovation to design a psychiatric mental health simulation for undergraduate nursing students during the COVID-19 global pandemic. Nursing Education Perspectives, 44(1), 59–60. https://doi.org/10.1097/01.nep.0000000000000922 Jayasekara, R., Smith, C., Hall, C., Rankin, E., Smith, M., Visvanathan, V., & Friebe, T. (2018). The effectiveness of clinical education models for undergraduate nursing programs: A 32 systematic review. Nurse Education in Practice, 29, 116– 126. https://doi.org/10.1016/j.nepr.2017.12.006Links to an external site. Kang, K. I., & Joung, J. (2020). Outcomes of Consumer Involvement in Mental Health Nursing Education: An Integrative review. International Journal of Environmental Research and Public Health, 17(18), 6756. https://doi.org/10.3390/ijerph17186756 Kerry, E., Collett, N., & Gunn, J. R. (2023). The impact of expert by experience involvement in teaching in a DClinPsych programme; for trainees and experts by experience Expectations, 26(5), 2098–2108. https://doi.org/10.1111/hex.13817 KFF (2023, March 20). Mental Health and Substance Use State Fact Sheets. KFF The Independent Source for Health Policy Research, Polling, and News. Retrieved December 1, 2023, from https://www.kff.org/statedata/mental-health-and-substance-use-state-factsheets/ Lefkowitz, A., Vizza, J., & Kuper, A. (2022). Patients as experts in the illness experience: Implications for the ethics of patient involvement in health professions education. Journal of Evaluation in Clinical Practice, 28(5), 794–800. https://doi.org/10.1111/jep.13672 Luebbert, R., Perez, A., Andrews, A., & Webster-Cooley, T. (2023). Standardized patients versus mannequins in mental health simulation. Journal of the American Psychiatric Nurses Association, 29(4), 283–289. https://doi.org/10.1177/10783903231183322 Maina, R., Bukusi, D., & Kumar, M. (2019). Suicide prevention by emergency nurses: perceived self-efficacy in assessment, management and referral at Kenyatta National Hospital in Kenya. Annals of General Psychiatry, 18(1). https://doi.org/10.1186/s12991-019-0240-8 33 Mahmud, M. E., Baharun, H., Asykur, M., & Rochmatin, Z. (2022). Increasing teacher professionalism through change management in madrasah: Kurt Lewin's perspective. Southeast Asian Journal of Islamic Education, 5(1), 47– 63. https://doi.org/10.21093/sajie.v5i1.5330 Manister, N. N., Murray, S., Burke, J. M., Finegan, M., & McKiernan, M. E. (2017). Effectiveness of nursing education to prevent inpatient suicide. Journal of Continuing Education in Nursing, 48(9), 413–419. https://doi.org/10.3928/00220124-20170816-07 Mental Health and Substance Use State Fact Sheets | KFF. (2023, March 20). KFF. https://www.kff.org/statedata/mental-health-and-substance-use-state-factsheets/utah/#:~:text=As%20shown%20in%20the%20figure,of%20adults%20in%20the% 20U.S. National Institute of Mental Health. Suicide. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/statistics/suicide Öztürk, S., & Hı̇ Çdurmaz, D. (2022). A qualitative study on the perspectives and needs of oncology nurses about recognition and management of suicide risk in cancer patients. Journal of Clinical Nursing, 32(5–6), 749–763. https://doi.org/10.1111/jocn.16304 Poreddi, V., Anjanappa, S., & Reddy, S. (2021). Attitudes of undergraduate nursing students to suicide and their role in caring of persons with suicidal behaviors. Archives of Psychiatric Nursing, 35(6), 583–586. https://doi.org/10.1016/j.apnu.2021.08.005 Presno, Å. K., Øgård-Repål, A., & Fossum, M. (2021). Simulations with Standardized Patients for Nursing Students in Preparation for Clinical Placements in Mental Health Care. Clinical Simulation in Nursing, 54, 70–76. https://doi.org/10.1016/j.ecns.2021.01.009 34 Rosenbaum, D., More, E., & Steane, P. (2018). Planned organisational change management. Journal of Organizational Change Management, 31(2), 286– 303. https://doi.org/10.1108/jocm-06-2015-0089Links to an external site. Scott, L., Hardisty, J., Cussons, H., Davison, K., Driscoll, H., Powell, S. K., & Sturrock, A. (2021). Exploring a collaborative approach to the involvement of patients, carers and the public in the initial education and training of healthcare professionals: A qualitative study of patient experiences. Health Expectations, 24(6), 1988–1994. https://doi.org/10.1111/hex.13338 Sharplin, G., Adelson, P., Kennedy, K., Williams, N., Hewlett, R., Wood, J., Bonner, R., Dabars, E., & Eckert, M. (2019). Establishing and Sustaining a Culture of Evidence-Based Practice: An evaluation of barriers and facilitators to implementing the Best Practice Spotlight Organization Program in the Australian healthcare context. Healthcare, 7(4), 142. https://doi.org/10.3390/healthcare7040142Links to an external site. Solin, P., Tamminen, N., & Partonen, T. (2021). Suicide prevention training: self-perceived competence among primary healthcare professionals. Scandinavian Journal of Primary Health Care, 39(3), 332–338. https://doi.org/10.1080/02813432.2021.1958462 State of Suffering: Curbing the rise of Utah suicides. (n.d.). https://utahhealth.shorthandstories.com/state-ofsuffering/index.html#:~:text=An%20unrelenting%20stigma%20and%20limited,to%20bu llying%20and%20other%20factors. Steelesmith, D. L., Fontanella, C. A., Campo, J. V., Bridge, J. A., Warren, K., & Root, E. D. (2019). Contextual factors associated with County-Level suicide rates in the United 35 States, 1999 to 2016. JAMA Network Open, 2(9), e1910936. https://doi.org/10.1001/jamanetworkopen.2019.10936 Świtaj, P., Grygiel, P., Krzyżanowska-Zbucka, J., Sonik, J., Chrostek, A., Jahołkowski, P., Wciórka, J., & Anczewska, M. (2019). The evaluation of the impact of anti-stigma training led by "experts by experience" on participants' attitudes towards persons with mental illness. Psychiatria Polska, 53(6), 1219–1236. https://doi.org/10.12740/pp/109818 Sun, F., Long, A., Chiang, C., Wu, M., & Yao, Y. (2019). The psychological processes voiced by nursing students when caring for suicidal patients during their psychiatric clinical practicum: A qualitative study. Journal of Clinical Nursing, 29(3–4), 525–534. https://doi.org/10.1111/jocn.15090 Türkleş, S., Yılmaz, M., & Soylu, P. (2018). Feelings, thoughts and experiences of nurses working in a mental health clinic about individuals with suicidal behaviors and suicide attempts. Collegian, 25(4), 441–446. https://doi.org/10.1016/j.colegn.2017.11.002 Utah - 2021 - III.B. Overview of the state. (n.d.). https://mchb.tvisdata.hrsa.gov/Narratives/Overview/b659aee2-3530-4e9f-ba5507f91d6cf75f#:~:text=Utah%20is%20geographically%20the%20thirteenth,rural%2C%2 0and%2012%20frontier%20counties. Vandewalle, J., Beeckman, D., Van Hecke, A., Debyser, B., Deproost, E., & Verhaeghe, S. (2019). 'Promoting and preserving safety and a life‐oriented perspective': A qualitative study of nurses' interactions with patients experiencing suicidal ideation. International Journal of Mental Health Nursing, 28(5), 1122–1134. https://doi.org/10.1111/inm.12623 36 Vedana, K. G. G., & Zanetti, A. C. G. (2019). Attitudes of nursing students toward to the suicidal behavior. Revista Latino-americana De Enfermagem, 27. https://doi.org/10.1590/1518-8345.2842.3116 Wahab, S., Shah, N. E., Sivachandran, S., Shahruddin, I., Ismail, N. N. S., Mohan, L. D., Kamaluddin, M. R., & Nawi, A. M. (2021). Attitude towards suicide and Help-Seeking behavior among medical undergraduates in a Malaysian university. Academic Psychiatry, 45(6), 672–680. https://doi.org/10.1007/s40596-021-01513-z Winn, S., & Lindqvist, S. (2019). Purposeful involvement of experts by experience Clinical Teacher, 16(3), 183–188. https://doi.org/10.1111/tct.13032 Yousiph, T., Patterson, C. F., & Moxham, L. (2023). Exploring the benefits and challenges of being a consumer educator in nursing education: A scoping review. Journal of Psychiatric and Mental Health Nursing, 30(4), 679–698. https://doi.org/10.1111/jpm.12909 Zohn, J. H. (2022). The experiences of nursing students while caring for patients at risk for Suicide: A Descriptive phenomenology. Nursing Education Perspectives, 43(6), E91– E93. https://doi.org/10.1097/01.nep.0000000000000950 37 Appendix A Infographic for Faculty and Administration presentation 38 Appendix B Pre and Post Surveys 39 Appendix C 40 Involving an Expert by Experience in Curriculum Development Introduction Steps for Involvement 1. Initial Consultation and Planning 2. Curriculum Review and Feedback 3. Co-creation of Learning Materials 4. Integration of Personal Experiences 5. Training and Support for Faculty Detailed Description: Initial Consultation and Planning • Meetings: Arrange meetings between the expert by experience and nursing faculty. • Objectives: Discuss course goals and the role of the expert in curriculum development. Curriculum Review and Feedback • Expert Review: Have the expert review the existing curriculum. • Feedback Sessions: Organize sessions where they can provide feedback and suggestions. Co-creation of Learning Materials • Joint Development: Work collaboratively to develop or revise course materials. • Incorporation of Insights: Ensure the materials reflect the expert's unique perspective. Integration of Personal Experiences • Storytelling: Encourage the expert to share their journey and experiences. • Case Studies: Develop case studies based on real-life scenarios experienced by the expert. Training and Support for Faculty • Faculty Training: Provide training sessions for faculty led by the expert. • Ongoing Support: Ensure continuous support and consultation throughout the course. Guidance for Implementation 1. Establish Clear Communication Channels: Ensure regular and effective communication between the expert and the nursing faculty. 2. Respect and Value Expertise: Acknowledge the unique insights and experiences of the expert, integrating them meaningfully into the curriculum. 3. Evaluate and Iterate: Regularly assess the impact of the expert's contributions and make iterative improvements to the curriculum. 41 Appendix D Simulation Unit Number/Title: Unit 4 – Suicide risk identification and management Curriculum Alignment Unit Concepts: Risk assessment, Crisis intervention, Communication skills, Patient safety Unit Exemplars: Personal recovery story, Risk assessment tools, De-escalation techniques Unit Outcomes: • • • Simulation Outcomes • • • Students will accurately conduct suicide risk assessments using standardized tools and patient interviews during simulations. Students will effectively apply crisis intervention strategies in a simulated environment, demonstrating the ability to de-escalate situations and provide immediate support. Students will develop and implement personalized safety plans during simulations, showcasing the ability to involve the patient in the process and ensure the plan's practicality and relevance. Students will engage with simulated patient in a manner that reflects real-world interactions, ensuring a patient-centered approach and demonstrating empathetic communication skills. Students will collaborate effectively within an interdisciplinary team in a simulated healthcare setting, displaying the ability to work with peers, simulated family members, and other healthcare professionals. After each simulation, students will critically reflect on their performance, incorporating feedback to adapt and improve their approach to patient care. Student Pre-work Pre-work: 1. Review of Suicide Risk Assessment Tools: & Post-work: • Students will study various suicide risk assessment tools and methodologies to prepare for accurate patient evaluations. 2. Crisis Intervention Training: • Students will complete online module on crisis intervention techniques, emphasizing verbal de-escalation strategies and the use of nonverbal cues. 3. Safety Plan Formulation Training: • Engagement with resources provided by the Expert by Experience on creating effective, collaborative safety plans, including the use of case studies or templates. Post-work: 1. Simulation Debriefing Session: • Students will participate in a debriefing session, led by the instructor and Expert by Experience, to discuss what transpired during the simulation and identify areas for growth. 2. Reflective Journaling: 42 • Students will submit a reflective journal entry discussing their personal experiences, challenges faced, and lessons learned from the simulation activity. 3. Research and Evidence Synthesis: • Conduct research on recent developments in suicide prevention and compare them with the approaches taken during the simulation, synthesizing the information into a brief report outlining potential improvements or changes to practice. Simulation Set-Up: Patient Location: Behavioral Health Unit • Room Design: Minimalist for safety, with limited items and furniture Environment • Standardized Patient Props: secured or built into the structure to prevent harm. Safety Features: Rooms equipped with unbreakable glass, absence of sharp objects, and doors that allow staff to lock and unlock from the outside only. • Clothing: Hospital gown and non-slip socks provided for the standardized patient to wear. • Accessories: Non-hazardous items like a soft bracelet representing an ID band. Equipment in Room: • Communication Device: Intercom system for patient to communicate with nursing staff. • Furniture: Bed bolted to the floor, bedside table without drawers, chair fixed to the floor. • Safety Tools: Cutlery made of soft, harmless materials for meal times if needed. Simulation Roles: Simulation Roles: Standardized Patient: • Role: The patient exhibiting signs of suicidal ideation, providing real-time responses and feedback. Student 1: Primary Nurse • Responsibilities: Lead the assessment, interact directly with the patient, and coordinate with the team for care delivery. Student 2: Secondary Nurse • Responsibilities: Assist the primary nurse, manage documentation, and ensure the implementation of safety measures. Student 3: Family Liaison • Responsibilities: Role-play as a family member or friend, providing background information and raising concerns to the healthcare team. 43 Student 4: Mental Health Counselor • Responsibilities: Engage with the patient for psychosocial support and contribute to the development of the safety plan. Student 5: Observer/Recorder • Responsibilities: Observe the simulation, take notes on the interactions, and collect data for the debriefing session. Student 6: Crisis Intervention Specialist • Responsibilities: Implement crisis intervention strategies, including deescalation techniques and emergency response if required. Introductory Report for Students Name: Jamie Taylor Gender/Age: Female/24 Weight 68kg/165cm (kg)/Height: Attending Dr. Susan O’Connell Provider: Allergies: NKA Home Medications: Sertraline 100mg daily Past History: Major Depressive Disorder, Anxiety Disorder History of Present Increasing depressive symptoms over the part 3 weeks, expressed suicidal Illness: ideations without a plan Diagnosis/Rationale Acute exacerbation of Major Depressive Disorder with suicidal ideation for Admission: Suicide risk assessment, constant observation, sertraline continuation, Admission Orders: Labs given in SBAR: CBC, BMP, Liver function tests Released during simulation the initial cues/hypotheses/actions that should be able to be State 1 Identify achieved during this state Clinical Patient appears withdrawn, has flat affect, low eye contact, and slow presentation speech. Expresses feelings of hopelessness. Maintain on current medication, initiate safety precautions, constant MD Orders observation, and engage in therapeutic communication. Released in State Labs Released in CBC and BMP within normal limits, liver function tests pending. State Scenario Specific Content 44 Cognitive: • The student needs to display knowledge of assessing mental status, identifying risk factors for suicide, and applying the appropriate risk assessment tools. Affective: • Use therapeutic communication techniques to establish rapport with the patient, assess the patient’s emotional state, and engage the patient in discussing their feelings and safety. Psychomotor: • Skills required include conducting a mental status examination, documenting findings, and implementing immediate safety measures as needed. STATE 1 - SCRIPTS Patient General: Appears disheveled, responds to questions after a delay. Health History: Reviews history of depression and anxiety, recent stressors. During initial assessment: Reports feeling overwhelmed and hopeless, denies current plan for suicide but admits to past thoughts. During pain assessment: Denies physical pain but expresses emotional distress. Respiratory:Breathing is regular but shallow. Cardiovascular:Heart rate is within normal range, but patient occasionally reports palpitations when anxious. GI/GU:Reports reduced appetite, no other issues. Neuro:Alert and oriented, but shows signs of psychomotor retardation. Mental Status:Affect is flat, mood is depressed, thought processes are slowed, denies hallucinations or delusions. HEENT:Eyes are downcast, no signs of physical trauma. Skin:Pale, no lesions or marks, skin is dry. MD General (if a complete assessment/SBAR is given): Acknowledges the nurse’s assessment, discusses next steps for care, emphasizes safety and observation. General (if incomplete SBAR is given by nurse): Requests further information, clarifies the need for detailed mental status examination. Orders Given: Orders for sertraline continuation, safety precautions, constant observation, referral to psychiatry, and a follow-up assessment after 24 hours. STATE 1 - DEBRIEFING Debriefing Questions 1. Noticing: • What did you observe about the patient's behavior and statements that indicated a risk of suicide? • Were there any changes in the patient's condition that you noticed but did not address during the simulation? If so, why? 2. Interpreting: • How did you interpret the patient's mental and emotional state based on your observations? • What diagnostic reasoning led you to your conclusions about the patient's needs? 3. Responding: • What interventions did you prioritize, and what was the rationale behind those choices? 45 • Can you describe how you modified your approach based on the patient’s responses during the simulation? 4. Reflecting: • Reflecting on the simulation, what aspects of your performance do you think were most effective? • What would you do differently if you were to encounter a similar situation in the future? 5. Clinical Learning: • What key points from the pre-simulation preparation helped you during the scenario? • How did the simulation enhance your understanding of caring for patients with suicidal ideations? 6. Teamwork and Communication: • How well did you communicate with your team members, and how did it affect patient care? • What communication strategies were effective, and which ones could be improved? Expert by Experience Contribution to Debriefing 1. Personal Insight: • The EBE can share their feelings and reactions to the students' approaches, highlighting what made them feel safe or anxious. 2. Feedback on Communication: • They can provide feedback on the communication styles used by the students, advising on what is comforting or distressing from a patient’s perspective. 3. Validation of Care Strategies: • The EBE can affirm the effectiveness of the interventions from their experience, suggesting alternative strategies that may have been helpful in their own journey. 4. Enhancing Empathy: • By sharing their story, the EBE can help students understand the impact of their actions and words on patients, thus fostering a deeper level of empathy. 5. Real-World Application: • The EBE can help bridge the gap between theory and practice, discussing how the simulated scenarios mirror real-life situations. 6. Suggest Improvements: • Drawing from personal experiences, the EBE can suggest improvements for future simulations and offer advice for clinical practice. Transisitonal Report from Instructor: Nurse to Nurse Bedside Report (SBAR): • Situation: Jamie Taylor, a 24-year-old female patient, continues to express feelings of hopelessness and is now less responsive to engagement attempts. She has not participated in any group activities today. • Background: Jamie has a history of Major Depressive Disorder and is currently on Sertraline. She has had an increase in depressive symptoms over the past three weeks and has expressed suicidal ideations. • Assessment: Jamie's mood appears to have further declined since admission. She remains on suicide watch and constant observation is required. No self-harm attempts have been noted. • Recommendation: Continue to monitor Jamie's mental status closely, encourage her to engage in therapeutic activities, and reassess her risk for suicide. Review new lab results and MD orders to adjust care as needed. the initial cues/hypotheses/actions that should be able to be State 2 Identify achieved during this state 46 Clinical Jamie is now more withdrawn, exhibiting minimal interaction with staff and Presentation peers. She shows signs of psychomotor retardation and has neglected self-care. • Review med history and make sure med rec is accurate. MD Orders • Encourage participation in individual therapy sessions. Released in • Reassess need for constant observation. State Labs Released Liver function tests indicate slightly elevated enzymes; consider medication in State impact. Scenario Specific Content Cognitive: • • Affective: • • Psychomotor: • • • Students must demonstrate understanding of the impact of depression on liver enzymes and consider the implications for pharmacotherapy. Recognize signs of worsening depression and formulate a plan to address Jamie's declining engagement and self-care. Students should employ advanced communication strategies, demonstrating empathy and patience when engaging with Jamie. Work collaboratively with family and healthcare professionals to update the care plan according to Jamie’s changing condition. Perform a comprehensive mental health reassessment. Document and report findings accurately and efficiently. Implement new MD orders, ensuring Jamie’s safety and promoting her participation in care. STATE 2 - SCRIPTS Patient • Exhibits minimal verbal communication, responds to direct questions with one-word answers or not at all. • Shows a lack of interest in discussing feelings or engaging with the healthcare team. • • • Instructs to review the medication effectiveness given the lab results. MD Orders additional therapeutic interventions to engage Jamie and reassess her risk level. Suggests possible engagement strategies such as one-on-one therapy sessions or family meetings. STATE 2 - DEBRIEFING Debriefing Questions for State 2 Noticing: 1. What changes in Jamie's behavior and responses did you notice compared to the initial assessment? 2. Were there any particular cues that indicated a change in her risk level for suicide? Interpreting: 47 1. How did you interpret the significance of Jamie's liver enzyme levels in relation to her medication and overall health? 2. What did you infer from Jamie's lack of engagement in group activities and self-care? Responding: 1. Which interventions did you prioritize in response to Jamie's change in behavior? 2. How did you modify the plan of care based on the new lab results and clinical presentation? Reflecting: 1. Reflecting on your actions, what do you feel was effective and what could have been improved? 2. How has this simulation impacted your understanding of caring for a patient with severe depression? Expert by Experience Contribution to Final Debriefing Insights on Patient Behavior: 1. The EBE can share their thoughts on how accurately the simulation reflected the behaviors and emotions of someone experiencing a depressive episode. Validation of Student Responses: 1. They can provide feedback on the appropriateness and effectiveness of the students' interventions from a patient perspective. Communication Feedback: 1. The EBE can discuss the communication strategies used by the students, emphasizing which approaches can be comforting or could potentially alienate a patient in a real-life scenario. Perspective on Care Plans: 1. The EBE can offer insights into the care plan adjustments, suggesting what aspects could be more patient-centered and collaborative. Reflecting on Personal Experiences: 1. The EBE can share how they felt and what they needed during similar experiences, helping students understand the patient's perspective better. Recommendations for Future Practice: 1. Based on their own journey through the healthcare system, the EBE can make recommendations for clinical practice and the education of future nurses. 48 Appendix E Final Exam Question 1: Which of the following is a common risk factor for suicide in adolescents? A) Increased academic performance B) Stable family relationships C) Substance abuse D) Regular physical activity Question 2: What is the initial step in conducting a suicide risk assessment? A) Arranging for hospital admission B) Assessing the immediacy of risk by asking about suicidal thoughts C) Prescribing antidepressant medication D) Encouraging the patient to participate in group therapy Question 3: Which coping mechanism is considered a healthy way to deal with stress? A) Substance misuse B) Avoidance of social interaction C) Engaging in regular physical exercise D) Excessive eating Question 4: In the context of suicide prevention, what does a safety plan typically include? A) A list of triggers that may lead to a crisis B) Financial planning for the future C) Steps to take when feeling suicidal D) Both A and C Question 5: What therapeutic communication technique is essential when speaking with a suicidal patient? A) Offering advice based on personal experiences B) Using medical jargon to explain their condition C) Active listening and reflecting feelings D) Discussing the consequences of suicide Question 6: 49 Which intervention is most appropriate for a patient with suicidal ideation who has a plan and means to carry it out? A) Scheduling an outpatient counseling session B) Immediate hospitalization for safety C) Encouraging the patient to talk to friends D) Prescribing anxiolytics for home use Question 7: What is a common side effect to monitor for when a patient starts a new selective serotonin reuptake inhibitor (SSRI)? A) Increased energy levels B) Decreased appetite C) Suicidal thoughts, particularly in young adults D) Hypertensive crisis Question 8: Which theory of suicide emphasizes the significance of a person's sense of belonging and selfefficacy in preventing suicidal behavior? A) Biological theory B) Cognitive theory C) Interpersonal theory of suicide D) Psychoanalytic theory Question 9: In dealing with a patient experiencing suicidal thoughts, which of the following would NOT be an appropriate initial response? A) Dismissing the patient's feelings as not serious B) Asking the patient if they have a plan C) Ensuring the patient is not left alone D) Removing any potential means for self-harm from the patient's environment Question 10: The nursing process of evaluating the effectiveness of interventions in a suicidal patient involves: A) Reassessment of the patient’s mental status B) Updating the patient’s safety plan as needed C) Communication with the patient's support system D) All of the above Question 11: A patient with a history of bipolar disorder mentions feeling "especially down" during a routine check-up. What is the nurse's best course of action? 50 A) Schedule a follow-up appointment in a month B) Immediately start the patient on antidepressants C) Conduct a detailed suicide risk assessment D) Advise the patient to engage in more social activities Question 12: Which of the following is a key objective when designing a post-discharge plan for a patient with suicidal ideation? A) Scheduling daily psychiatric evaluations B) Ensuring continuity of care and support systems C) Recommending complete isolation from stressors D) Increasing the dosage of antidepressants weekly Question 13: A nurse is educating a patient on the use of a crisis hotline. What is the MOST important piece of information to provide? A) The hotline number is only for non-emergency situations B) Callers can remain anonymous if they prefer C) The hotline is only available during business hours D) It is better to call the hotline than to visit the emergency room Question 14: Which medication class is typically prescribed as a first-line treatment for major depressive disorder? A) Benzodiazepines B) Antipsychotics C) Selective Serotonin Reuptake Inhibitors (SSRIs) D) Stimulants Question 15: What is a primary goal of Cognitive Behavioral Therapy (CBT) in the treatment of suicidal patients? A) To explore the patient's past experiences in depth B) To change patterns of thinking or behavior contributing to the patient's suffering C) To provide a safe space for venting emotions only D) To prescribe and monitor the effects of psychotropic medications Question 16: Which statement about suicide clusters is TRUE? A) They occur exclusively in adolescent populations B) They are unaffected by media reporting practices 51 C) They can result from the social learning of suicide-related behaviors D) They are legally mandated to be reported to public health departments Question 17: When creating a safety plan with a suicidal patient, what is important to include? A) A detailed schedule of the patient's daily activities B) A list of personal triggers that might lead to a crisis C) The names of all the patient's previous mental health providers D) A legal agreement not to attempt suicide Question 18: What factor has been shown to reduce the risk of suicide in individuals? A) Access to lethal means B) Increased alcohol consumption C) Strong community support networks D) The belief that one's mood cannot change Question 19: A nurse is assessing a patient for suicidal ideation. What question is essential to ask directly? A) "Why do you feel you want to end your life?" B) "How do you typically manage your stress?" C) "Do you have thoughts of harming yourself?" D) "Can you promise me that you won't hurt yourself?" Question 20: Which of the following is a protective factor that may decrease the likelihood of suicide? A) Chronic physical illness B) High levels of impulsivity C) A strong sense of personal responsibility to family or friends D) Social isolation Question 21: In the context of suicide prevention, "means restriction" refers to: A) Limiting patients' ability to travel. B) Reducing access to methods of self-harm. C) Decreasing the time allowed for individual therapy. D) Restricting communication between patients and outsiders. Question 22: Which symptom is most indicative of a patient entering a major depressive episode? 52 A) Hyperactivity B) Excessive sleep C) Rapid speech D) Sudden onset of euphoria Question 23: When considering the ethical principles in nursing, patient autonomy in the context of suicidal ideation is best demonstrated by: A) Respecting a patient's decision to refuse treatment. B) The nurse deciding what is best for the patient. C) Family members making decisions for the patient. D) Adhering strictly to hospital policies without exception. Question 24: Which of the following is considered a long-term goal in the treatment of a patient with suicidal ideation? A) The patient expresses a desire to stay alive for the next 24 hours. B) The patient agrees to take prescribed medication for one week. C) The patient develops coping strategies to deal with stress and emotional pain. D) The patient agrees to a no-suicide contract for the duration of hospitalization. Question 25: A nurse is using the SAD PERSONS scale to assess a patient's risk of suicide. Which factor is NOT included in this scale? A) Previous suicide attempts B) Excessive optimism C) Loss of rational thinking D) Recent significant life changes Question 26: The primary purpose of "postvention" after a suicide in a community is to: A) Punish those who were close to the individual for not preventing the suicide. B) Provide closure to family members by detailing the reasons for the suicide. C) Prevent the development of suicidality in others and provide support to bereaved individuals. D) Gather data for epidemiological studies on suicide. Question 27: A psychiatric mental health nurse is planning care for a patient with chronic suicidal ideation. What is an important consideration in the plan of care? A) Avoiding any discussion of suicide to not reinforce the behavior. B) Collaborating with the patient to identify triggers and warning signs. 53 C) Only allowing the patient to socialize with individuals who do not know of their condition. D) Ensuring the patient is under continuous sedation to prevent self-harm. Question 28: Dialectical Behavior Therapy (DBT) is particularly effective for patients with which of the following conditions? A) Schizophrenia B) Borderline Personality Disorder C) Alzheimer's Disease D) Generalized Anxiety Disorder Question 29: Which medication is known to have a lower risk of overdose lethality and is therefore often prescribed to suicidal patients? A) Tricyclic antidepressants B) Monoamine oxidase inhibitors C) SSRIs D) Benzodiazepines Question 30: A patient in a mental health facility suddenly reports feeling hopeful and has made future plans. How should the nurse interpret this behavior change? A) The patient is responding well to treatment and is no longer at risk. B) The patient may be at increased risk of suicide as they might now have the energy to carry out a plan. C) The patient's mental state is unrelated to their suicide risk. D) The patient is likely pretending to get discharged earlier. Question 31: Which intervention is crucial when a patient expresses thoughts of self-harm but has no specific plan? A) Providing detailed information about harmful effects of self-harm. B) Engaging the patient in a safety contract. C) Discharging the patient with a list of local support groups. D) Isolating the patient to prevent any possibility of self-harm. Question 32: What is the primary purpose of a crisis intervention team in the context of suicidal ideation? A) To provide long-term psychotherapy for chronic mental illness. B) To offer immediate, short-term assistance to reduce emotional intensity and stabilize the situation. 54 C) To prescribe medications for patients showing signs of acute stress. D) To transfer the patient to a long-term care facility. Question 33: When assessing a patient's potential for suicide, which of these observations is most concerning? A) The patient has a detailed plan with the means to carry it out. B) The patient appears sad but denies having any thoughts of self-harm. C) The patient is unable to identify any personal strengths or reasons for living. D) The patient expresses a wish to die but does not have a plan. Question 34: A nurse is caring for a patient who has attempted suicide. What is an important aspect of care during the post-attempt phase? A) Ensuring that the patient is always left alone to provide a calm environment. B) Discussing the details of the suicide attempt in-depth during every interaction. C) Monitoring the patient for signs of a repeated suicide attempt. D) Encouraging the patient to accept full responsibility for the attempt. Question 35: Which is an essential component of psychoeducation for patients at risk of suicide? A) Teaching them about the impact of suicide on societal statistics. B) Informing them about the different types of antidepressants available. C) Educating them about recognizing and managing their warning signs and symptoms. D) Instructing them on the financial implications of mental health care. Question 36: What is a therapeutic outcome of using role-play in suicide prevention training for nurses? A) It allows nurses to experience the emotions of being suicidal. B) It prepares nurses to perform in theatrical productions. C) It provides a method for nurses to assess each other's clinical skills. D) It enhances nurses' skills in managing real-life patient scenarios. Question 37: What should a nurse prioritize when communicating with a patient who has recently voiced suicidal thoughts? A) Discussing the legal consequences of suicide. B) Building rapport and trust to encourage open communication. C) Convincing the patient that suicide is a moral failing. D) Focusing on the negative outcomes of the patient's actions. 55 Question 38: Which of the following is NOT a goal in the management of a patient with suicidal ideation? A) Reducing psychological pain. B) Enhancing environmental modification. C) Promoting feelings of hopelessness. D) Increasing coping skills. Question 39: What is the nurse's role in managing a patient who presents with self-inflicted injuries and suicidal ideation? A) To primarily provide wound care for self-inflicted injuries. B) To focus on physical restraint to prevent further self-harm. C) To assess the patient's mental status and risk for further self-harm. D) To admonish the patient for self-harming behaviors. Question 40: When a suicidal patient is placed on a 1:1 observation, what is the observer's most critical responsibility? A) Engaging in therapeutic conversations to solve the patient's problems. B) Providing constant surveillance to ensure the patient's safety. C) Administering medications to keep the patient calm. D) Preparing discharge planning as soon as the patient is stable. Question 41: Which statement accurately reflects the role of electroconvulsive therapy (ECT) in managing severe depression with suicidal ideation? A) ECT is the first-line treatment for any patient with suicidal thoughts. B) ECT is contraindicated for patients with suicidal ideation. C) ECT may be considered for patients with treatment-resistant depression who are at significant risk of suicide. D) ECT is used solely to improve the mood of patients who express a fear of medication side effects. Question 42: A patient with suicidal ideation has no immediate plans for suicide but feels hopeless. What is the best nursing intervention? A) Advise the patient to sleep and reconsider their thoughts upon waking. B) Engage the patient in discussing reasons for living and reinforcing coping strategies. C) Ignore the ideation as there is no immediate plan for suicide. D) Inform the patient that this is a common feeling and it will pass with time. 56 Question 43: When considering the legal and ethical responsibilities of a nurse, which action is appropriate if a patient with suicidal ideation refuses treatment? A) Respecting the patient's wishes without further discussion. B) Seeking a court order to treat the patient against their will. C) Arranging for an immediate psychiatric evaluation to determine the patient's decision-making capacity. D) Informing the patient about the natural consequences of their decision and leaving the matter. Question 44: In a community health setting, which initiative has been shown to effectively prevent suicide? A) Decreasing public awareness campaigns about mental health. B) Implementing school-based programs that teach coping and problem-solving skills. C) Limiting access to mental health services to only those with severe symptoms. D) Encouraging the media to publish detailed reports about suicide methods. Question 45: Which of the following medications requires careful monitoring due to the risk of increasing suicidal ideation in children and adolescents? A) Acetaminophen B) Ibuprofen C) Fluoxetine D) Calcium supplements Question 46: A nurse is developing a community presentation on suicide prevention. Which topic should be prioritized to have the most significant impact? A) The history of suicide in various cultures. B) How to recognize and respond to signs of potential suicide in peers and family. C) The economic impact of suicide on healthcare systems. D) Philosophical discussions about the ethics of suicide. Question 47: A nurse is caring for a patient immediately after a suicide attempt. Which of the following actions is a priority? A) Discussing the moral implications of suicide with the patient. B) Conducting a physical and psychological assessment to determine care needs. C) Encouraging the patient to apologize to affected family members. D) Advising the patient on the legal consequences of their actions. 57 Question 48: Which therapeutic approach aims to improve a patient's problem-solving skills and decrease suicidal behaviors by focusing on interpersonal relationships? A) Psychodynamic therapy B) Behavioral therapy C) Interpersonal psychotherapy D) Existential therapy Question 49: What is a nurse's best response when a patient with a history of suicidal ideation expresses a desire to discuss their will and end-of-life wishes? A) Redirect the conversation to a more positive topic. B) Acknowledge the patient's wishes and provide an opportunity to discuss them openly. C) Inform the patient that such topics are not relevant to their care. D) Immediately notify the psychiatric team to evaluate the patient for imminent risk of suicide. Question 50: A patient with suicidal ideation is being discharged from an inpatient unit. What is an essential component of the discharge plan? A) Scheduling follow-up appointments with mental health professionals. B) Advising the patient to avoid discussing their hospitalization with others. C) Recommending that the patient self-monitor their symptoms without professional support. D) Ensuring the patient leaves with a comprehensive list of all possible mental health disorders. 58 Appendix F Answer Key Question 1: Answer: C) Substance abuse Question 2: Answer: B) Assessing the immediacy of risk by asking about suicidal thoughts Question 3: Answer: C) Engaging in regular physical exercise Question 4: Answer: D) Both A and C Question 5: Answer: C) Active listening and reflecting feelings Question 6: Answer: B) Immediate hospitalization for safety Question 7: Answer: C) Suicidal thoughts, particularly in young adults Question 8: Answer: C) Interpersonal theory of suicide Question 9: Answer: A) Dismissing the patient's feelings as not serious Question 10: Answer: D) All of the above Question 11: Answer: C) Conduct a detailed suicide risk assessment Question 12: Answer: B) Ensuring continuity of care and support systems Question 13: Answer: B) Callers can remain anonymous if they prefer Question 14: Answer: C) Selective Serotonin Reuptake Inhibitors (SSRIs) Question 15: Answer: B) To change patterns of thinking or behavior contributing to the patient's suffering Question 16: Answer: C) They can result from the social learning of suicide-related behaviors Question 17: Answer: B) A list of personal triggers that might lead to a crisis Question 18: Answer: C) Strong community support networks Question 19: Answer: C) "Do you have thoughts of harming yourself?" Question 20: Answer: C) A strong sense of personal responsibility to family or friends Question 21: Answer: B) Reducing access to methods of self-harm. 59 Question 22: Answer: B) Excessive sleep Question 23: Answer: A) Respecting a patient's decision to refuse treatment. Question 24: Answer: C) The patient develops coping strategies to deal with stress and emotional pain. Question 25: Answer: B) Excessive optimism Question 26: Answer: C) Prevent the development of suicidality in others and provide support to bereaved individuals. Question 27: Answer: B) Collaborating with the patient to identify triggers and warning signs. Question 28: Answer: B) Borderline Personality Disorder Question 29: Answer: C) SSRIs Question 30: Answer: B) The patient may be at increased risk of suicide as they might now have the energy to carry out a plan. Question 31: Answer: B) Engaging the patient in a safety contract. Question 32: Answer: B) To offer immediate, short-term assistance to reduce emotional intensity and stabilize the situation. Question 33: Answer: A) The patient has a detailed plan with the means to carry it out. Question 34: Answer: C) Monitoring the patient for signs of a repeated suicide attempt. Question 35: Answer: C) Educating them about recognizing and managing their warning signs and symptoms. Question 36: Answer: D) It enhances nurses' skills in managing real-life patient scenarios. Question 37: Answer: B) Building rapport and trust to encourage open communication. Question 38: Answer: C) Promoting feelings of hopelessness. Question 39: Answer: C) To assess the patient's mental status and risk for further self-harm. Question 40: Answer: B) Providing constant surveillance to ensure the patient's safety. Question 41: Answer: C) ECT may be considered for patients with treatment-resistant depression who are at significant risk of suicide. Question 42: Answer: B) Engage the patient in discussing reasons for living and reinforcing coping strategies. 60 Question 43: Answer: C) Arranging for an immediate psychiatric evaluation to determine the patient's decision-making capacity. Question 44: Answer: B) Implementing school-based programs that teach coping and problem-solving skills. Question 45: Answer: C) Fluoxetine Question 46: Answer: B) How to recognize and respond to signs of potential suicide in peers and family. Question 47: Answer: B) Conducting a physical and psychological assessment to determine care needs. Question 48: Answer: C) Interpersonal psychotherapy Question 49: Answer: B) Acknowledge the patient's wishes and provide an opportunity to discuss them openly. Question 50: Answer: A) Scheduling follow-up appointments with mental health professionals. 61 Appendix G Timeline for Implementation