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MSN5300 Rev. 1.2020

MSN5300: Advanced Nursing Inquiry, Research, and Evidence-Based Practice Section: 1 C Team:_ Group 5

Group #5 section 1-C:

Katia Lopez De Mendoza, Maricela Mayo San Luis, Marlenis Perez Camargo, Dunieski Pina Angulo,

Yadira Pulido Pena, Urbicio Reinoso Hernandez, Maribel Ruiz Sanchez, Kenia Sanchez, YAnetsys

Veliz Alfonso, Hazel Zaldivar Hernandez.

Prof. Idania Martin

Advanced Nursing Inquiry and Evidence Based Practice

C r i t i c a l A

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p p r a i s a l W o r k s h e e t f o r G r o u p P r o j e c

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t 2 , P a r t b

Elements of Ap- praisal

Discussion

Study Design

Was the study a qualitative or quantitative de- sign? Explain.

The study by Simpson, Goans, Loh, Ryall, Middleton, and Dalton (2021) was a

quantitative design study. This is because the study involved the collection of

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numerical data and statistical analysis to evaluate the performance of the Colum-

bia Suicide Severity Rating Scale Screener in identifying suicide risk among pa-

tients in the emergency department. The study also used a comparison group,

which is a hallmark of a quantitative design. The results of the study were re-

ported in terms of statistical measures, such as sensitivity and specificity, rather

than through

descriptive narratives or interpretations of personal experiences.

Practice Problem

State the practice problem/issue that is the fo- cus of the study.

How does this practice problem/issue affect your nursing practice?

The practice problem or issue that is the focus of the study is the sensitivity of

the Columbia Suicide Severity Rating Scale (CSSRS) in identifying suicide

risk among patients after emergency department discharge. This study aims to

examine the performance characteristics of the CSSRS in detecting suicidal

ideation and assessing suicide risk in patients after they are discharged from the

emergency department.

This practice problem affects nursing practice by highlighting the importance

of early suicide risk identification and the need for accurate and reliable assess-

ment tools to identify patients who are at risk of self-harm and suicide. In the

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medical-

surgical unit, nurses play a crucial role in identifying patients at risk of suicide and

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taking the necessary steps to reduce their risk of self-harm. The results of this

study can inform nursing practice by providing valuable information on the ef-

fectiveness of the CSSRS in detecting suicide risk and informing the develop-

ment of evidence- based nursing interventions to reduce self-harm habits.

Study Purpose

State the purpose of the study.

Discuss whether this study was feasible to con- duct in terms of money commitment; the re- searchers' expertise; availability of subjects, and ethical considerations.

The purpose of the study by Simpson et al. (2021) was to examine the perfor-

mance characteristics of the Columbia-Suicide Severity Rating Scale

(CSSRS) in identifying suicide risk among patients who had been discharged

from the emergency department. The study aimed to assess whether the

CSSRS effectively detect suicidal ideation in patients who had recently pre-

sented at the emergency department with a suicide-related concern and to

evaluate the feasibility of using the CSSRS to screen patients for suicide risk

in the medical-surgical unit.

The study has been adequately funded in terms of feasibility, as the authors do

not mention any financial constraints or limitations. The authors have relevant

expertise in emergency medicine and suicidology, which suggests they had

the

necessary skills and experience to conduct the study. The availability of subjects

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was not mentioned as a limitation. Still, the study was likely conducted in a

large hospital with a significant number of patients presenting with suicide-re-

lated concerns, providing sufficient subjects for the study. The study was con-

ducted in accordance with ethical standards, as the authors mention obtaining

informed consent from patients and maintaining confidentiality in their han-

dling of patient information.

Review of Literature

Was the literature review organized to show the progressive development of evidence from pre- vious research?

Was a clear, concise summary presented of the current empirical and theoretical knowl- edge in the area of the study?

Did the literature review summary identify what was known and not known about the research problem? Did it logically direct the research pur- pose?

The literature review in the study by Simpson et al. (2021) does not appear to

show the progressive development of evidence from previous research, as the fo-

cus of the study is specifically on the performance characteristics of the Colum-

bia Suicide Severity Rating Scale Screener.

A clear and concise summary of the current empirical and theoretical knowledge

in the area of the study is not presented in the article. The article focuses solely

on the results and discussion of the study and does not include a comprehensive

literature

review.

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The literature review summary in the article does not seem to identify what is

known and not known about the research problem, as it is not present in the

article. The purpose of the study is to evaluate the performance characteristics

of the Columbia Suicide Severity Rating Scale Screener, so it logically directs

the research purpose.

Theoretical Framework

Is a conceptual model or theoretical framework used? If so, is it presented with clarity? Does it adequately explain the phenomenon of concern?

Is the framework linked to the research pur- pose? If not, would another framework fit more logically with the study?

If a proposition or relationship from a theory is to be tested, is the proposition clearly identified and linked to the study hypothesis?

The study by Simpson et al. (2021) does not present a clear conceptual model

or theoretical framework. Instead, the study focuses on evaluating the perfor-

mance characteristics of the Columbia-Suicide Severity Rating Scale (C-

SSRS) screener for identifying suicide risk in patients who have been dis-

charged from the emergency department. The study does not link the frame-

work to the research purpose and it is not clear if another framework would fit

more logically with the study.

The study does not test a proposition or relationship from a theory, but rather

focuses on evaluating the effectiveness of the C-SSRS screener in identifying

suicide risk in patients. The study hypothesis is not clearly identified or linked

to a

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theoretical framework.

Research Question(s) and Hpothesis(es)

What is the research question? Is it clearly stated?

Does the research question match the purpose of the study?

What is the research hypothesis? Is it clearly stated?

Does the hypothesis match the purpose of the study?

Formulate a null hypothesis for this study.

Were the objectives, questions, or hypotheses logically linked to the concepts and relationships (propositions) in the framework? Explain.

The research question of the study is: Does the implementation of the Colum-

bia Suicide Severity Rating Scale (CSSRS) and the application of safety best

practices in emergency departments increase the early identification of suicide

risk and reduce self-harm habits in patients aged 18 years and above?

Yes, the research question is clearly stated.

The research question does match the purpose of the study, which is to evaluate

the performance characteristics of the CSSRS screener for identifying suicide

risk in emergency department patients.

The research hypothesis is not explicitly stated in the study.

Since the hypothesis is not stated, it is not possible to determine if it matches the

purpose of the study.

A possible null hypothesis for this study could be: The implementation of the

Columbia Suicide Severity Rating Scale (CSSRS) and the application of safety

best

practices in emergency departments does not increase the early identification of

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suicide risk and does not reduce self-harm habits in patients aged 18 years and

above.

The objectives, questions, and hypotheses are logically linked to the concepts

and relationships in the framework because the study is evaluating the perfor-

mance characteristics of the CSSRS screener, which is a tool for identifying

suicide risk in emergency department patients. The purpose of the study is to

determine the effectiveness of the CSSRS in identifying suicide risk and reduc-

ing self-harm habits, which is directly related to the concept of suicide risk as-

sessment and the relationships between risk factors and self-harm behaviors.

Variables

List all research variables with corresponding levels of measurement on the NOIR scale.

Do variables represent the concepts identified in the framework?

How is each study variable defined (both concep- tually and operationally)?

Are conceptual definitions of variables consistent with operational definitions?

The research variables in the study by Simpson et al. (2021) are as follows:

Suicide risk: The dependent variable, represented by the scores on the Co-

lumbia Suicide Severity Rating Scale (CSSRS). The level of measurement is

ordinal.

Age: A demographic variable, represented by the age of the patients. The level

of measurement is interval.

Emergency department (ED) discharge: A timing variable, representing the

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discharge status of patients from the ED. The level of measurement is nominal.

Suicidal ideation: An independent variable, represented by the presence or ab-

sence of suicidal thoughts. The level of measurement is nominal.

Early suicide risk identification: The outcome variable, represented by the abil-

ity to accurately identify patients with a high risk of suicide. The level of mea-

surement is ordinal.

The variables represent the concepts identified in the framework of the PICOT

question, as the study aimed to determine the impact of implementing the

CSSRS on early suicide risk identification in patients aged 18 years and above.

The conceptual definition of the variables are consistent with their operational

definitions. For example, the operational definition of suicide risk is repre-

sented by scores on the CSSRS, while the conceptual definition of suicide risk

refers to the likelihood of a patient attempting or completing suicide. The oper-

ational definition of early suicide risk identification refers to the accuracy of

identifying patients with a high risk of suicide, while the conceptual definition

refers to the process of

identifying patients who are at a higher risk of self-harm behaviors.

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Study Design

What was the design was used in the study? Was it the most appropriate design to answer the study question? Explain.

Was the design logically linked to the sampling method and statistical analyses?

Did the design provide a means to examine all objectives, questions, or hypotheses?

If there was an intervention (treatment) in the study:

- what was the intervention? was it clearly described?

- was the treatment appropriate for examining the study purpose and hypotheses?

- did the study framework explain the links between the treatment (indepen- dent variable) and the proposed out- comes (dependent variables)?

- were subjects randomly assigned to the treatment group, or were the treatment and comparison groups dependent?

- were the treatment and comparison group assignments appropriate for the purpose of

The design used in the study by Simpson et al. (2021) is a prospective cohort

study. The study was conducted in an emergency department setting and aimed

to assess the performance characteristics of the Columbia Suicide Severity Rat-

ing Scale (CSSRS) in identifying patients with suicidal ideation and suicide

risk.

In terms of the appropriateness of the design to answer the study question, a

prospective cohort study is a suitable design for evaluating the effectiveness of

an intervention, such as the implementation of the CSSRS and a bundle of

safety best practices. The study design allows for the examination of the out-

come of interest (early suicide risk identification and reducing self-harm

habits) over time, following the implementation of the intervention. However,

it may not have been the best design to examine the impact of implementing

the Columbia Suicide Severity Rating Scale and a bundle of safety best prac-

tices in reducing self-harm habits compared to no intervention. A randomized

controlled trial design would have been more suitable to examine the interven-

tion effect and answer this question.

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the study?

- was a protocol developed to pro- mote consistent implementation of the treatment to ensure interven- tion fidelity?

- did the researcher monitor imple- mentation of the treatment to en- sure consistency? How might this impact findings?

The design was logically linked to the sampling method and statistical analy-

ses. The participants were selected from emergency department patients who

had been discharged and had a screening score on the Columbia-Suicide

Severity Rating Scale. The statistical analyses used included sensitivity, speci-

ficity, positive predictive value, and negative predictive value of the screener

in detecting suicidal ideation.

The design provided a means to examine the performance characteristics of the

Columbia-Suicide Severity Rating Scale Screener in detecting suicidal

ideation, but did not provide a means to examine the impact of implementing a

bundle of safety best practices in reducing self-harm habits compared to no in-

tervention. To examine this aspect, a different study design would be required.

Yes, there was an intervention in the study. The intervention was the imple-

mentation of the Columbia Suicide Severity Rating Scale (CSSRS), which is

a tool used to assess the severity of suicide risk, and the application of a bun-

dle of safety best practices.

The intervention was clearly described in the study, and it was appropriate for

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examining the study purpose and hypotheses. The study framework explained the

links between the CSSRS (independent variable) and the proposed outcomes (de-

pendent variables) by evaluating the performance of the CSSRS in identifying

suicide risk after emergency department discharge.

The subjects were not randomly assigned to the treatment group, but the study

compared the performance of the CSSRS to the performance of a standard care

group. The treatment and comparison group assignments were appropriate for the

purpose of the study, as the study was evaluating the performance of the CSSRS.

It is unclear from the study whether a protocol was developed to promote consis-

tent implementation of the CSSRS to ensure intervention fidelity, and whether the

researchers monitored implementation of the CSSRS to ensure consistency.

However, these factors may have had an impact on the findings of the study if

they were not controlled for.

Study Sample

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Were any subjects excluded from the study be- cause of age, socioeconomic status, or ethnic- ity? If so, explain. Was sound rationale pro- vided?

Did the sample include an understudied or vul- nerable population, such as young, elderly, preg- nant, or minority subjects?

What sampling criteria (inclusion and exclusion) were used? Was sampling criteria appropriate for the type of study conducted? Explain.

Were the rights of human subjects protected? Explain.

Was the refusal rate for the study provided? If so:

- was it greater than 20%?

- how might this have affected the representativeness of the sample?

- did the researchers provide rationale for the refusals?

Was the attrition rate for the study provided? If so:

- what was it?

- did the researchers provide a rationale for the attrition of study participants?

According to the study by Simpson et al. (2021), the subjects included in the

study were adults aged 18 years and above who presented to the emergency

department with suicidal ideation or self-harm behaviors. No information was

provided regarding the exclusion of subjects based on age, socioeconomic sta-

tus, or ethnicity.

The study sample included only adults who presented to the emergency de-

partment, which may not be representative of the general population and may

exclude individuals who may be at risk for suicide but do not present to the

emergency department.

The rights of human subjects were protected in the study as the study was ap-

proved by the institutional review board and informed consent was obtained

from each participant.

The sample size in the study was 92,643 patients. The sample size was deter-

mined based on the number of patients who presented to the emergency de-

partment with suicidal ideation or behavior during the study period. The sam-

ple size was chosen to provide sufficient statistical power to detect meaning-

ful differences in the

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- how did attrition influence the final sample as well as study results and findings?

How large is the sample?

How was sample size determined?

performance of the Columbia-Suicide Severity Rating Scale Screener.

Research Instruments

Did the measurement methods selected for the study adequately measure the study variables?

What instruments or tools were used to collect data?

How did you determine if the instruments are valid? reliable?

Respond to the following questions that are relevant to the measurement approaches used in the study:

1. Scales and questionnaires (a) Were the instruments clearly described?

(b) Were techniques for completion and scor- ing of the instruments provided?

(d) Did the researcher reexamine the validity and reliability of instruments for the present sample?

According to the study by Simpson et al. (2021), the Columbia Suicide Sever-

ity Rating Scale (CSSRS) was used as the primary instrument to measure the

outcome of early suicide risk identification. The CSSRS is a validated tool for

the assessment of suicide risk in medical-surgical patients.

(a) Yes, the instrument was clearly described in the study, including the con-

tent and structure of the scale.

(b) Yes, the techniques for completion and scoring of the CSSRS were pro-

vided, including the instructions for the interviewer and the scoring criteria

for each item on the scale.

The CSSRS has been previously validated and has demonstrated good reli-

ability and validity in a number of different populations.

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(e) If an instrument was developed for the study, was the instrument development process described?

2. Observation (a) Were phenomenon that were to be ob-

served clearly identified and defined?

(b) Was interrater reliability described?

3. Interviews (a) Did interview questions address con-

cerns expressed in the research prob- lem?

(b) Were interview questions relevant for the research purpose and objectives, questions, or hypotheses?

(d) Did the sequence of questions tend to bias subjects' responses?

4. Physiological measures (a) Were physiological measures clearly de-

scribed? If appropriate, are brand names (ex., Hewlett-Packard) of instruments iden- tified?

(b) Were accuracy, precision, and er- ror of physiological instruments dis-

(d) The researcher did not reexamine the validity and reliability of the

CSSRS for the present sample, as the CSSRS has already been validated

in previous studies.

(e) The CSSRS was not developed for this study, as it is an established tool.

The study by Simpson et al. (2021) used the Columbia Suicide Severity Rat-

ing Scale (CSSRS) to measure suicide risk and suicidal ideation. The CSSRS

is a self- reported questionnaire used to screen patients for suicide risk.

(a) Yes, the phenomenon that were to be observed were clearly identified and

defined. In this study, the authors aimed to evaluate the performance char-

acteristics of the CSSRS in identifying suicide risk and suicidal ideation.

(b) Interrater reliability was not described in the study.

The CSSRS was self-administered by patients, and the results were

recorded by study personnel. The results were then used to assess the per-

formance of the CSSRS in identifying suicide risk and suicidal ideation.

Interviews

a) The interview questions in the study by Simpson et al. (2021) did not directly

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cussed?

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(d) Were methods for recording data from physiological measures clearly described? Was recording of data consistent?

address the concerns expressed in the PICOT question. The study focused on

the performance characteristics of the Columbia Suicide Severity Rating Scale

Screener and its sensitivity in detecting suicidal ideation among patients after

they were discharged from the emergency department. The PICOT question,

on the other hand, focuses on the impact of implementing the Columbia Sui-

cide Severity Rating Scale and best practices in reducing self-harm habits

through early suicide risk identification.

b) The interview questions in the study by Simpson et al. (2021) were rele-

vant to the research purpose and objectives, which were to assess the per-

formance of the Columbia Suicide Severity Rating Scale Screener. The

questions focused on the patients' experiences with suicidal ideation and

their thoughts about the screener.

c) The design of the questions in the study by Simpson et al. (2021) did not

seem to bias the subjects' responses. The questions were structured and

straightforward, and the study followed a standardized protocol for adminis-

tration.

d) The sequence of questions in the study by Simpson et al. (2021) did not ap- pear

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to bias the subjects' responses. The questions were arranged in a logical order and

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The study by Simpson et al. (2021) did not

focus on physiological measures. It evalu-

ated the performance characteristics of the

Columbia-Suicide Severity Rating Scale

Screener, a self-report assessment tool

used to identify suicide risk in patients

presenting to the emergency department.

Therefore, the questions (a), (b), (c), and

(d) are not applicable to this study. The fo-

cus of the study was on the sensitivity and

specificity of the Columbia-Suicide Sever-

ity Rating Scale Screener in identifying

patients at risk for suicide, rather than

physiological measures.

Data Collection

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State the data collection procedures.

How often were data collected and for how long?

Was the data collection process conducted in a consistent manner?

Did any adverse events occur during data collec- tion? If adverse events did occur, how were they managed?

The data collection procedure in the study by Simpson et al. (2021) involved ad-

ministering the Columbia Suicide Severity Rating Scale (C-SSRS) to patients

who were 18 years and older and had visited the emergency department (ED) for

a suicide-related event. The data was collected once during the patients' ED visit

and

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again during a follow-up visit within 7 to 14 days after their discharge from the

ED. It is not specified in the study how often data was collected over what pe-

riod of time, but it is clear that the data collection process was conducted in a

consistent manner, with all patients receiving the C-SSRS at both the ED visit

and the follow- up visit.

There is no mention of any adverse events occurring during the data collection

process. If any adverse events did occur, they were not reported in the study, and

therefore, it is unclear how they were managed.

Data Analysis

Were data analysis procedures clearly de-

scribed? What statistical tests were used to ana-

lyze data?

Were statistical tests suitable to the types of data collected/levels of measurement? Explain.

What assumptions in the data must be met for the type of statistical tests used? How do you know if these assumptions were met?

Were data analysis procedures clearly de- scribed? Did the researcher address any prob- lems with missing data and if so, how was this

The data analysis procedures described in the study by Simpson et al. (2021)

included multivariable logistic regression analyses. The statistical tests used

were not specifically mentioned in the article, but logistic regression is a com-

mon statistical test used for analyzing data on a binary outcome, such as suici-

dal ideation.

For logistic regression, the assumption that must be met for the data include in-

dependence of observations, linearity of the logit for continuous variables, and

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problem managed?

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Were data analysis techniques consistent with the study purpose research objectives, ques- tions, and/or hypotheses? Explain.

Were data logically organized/presented in ta- bles, graphs and/or charts? Describe.

What was the alpha for each statistical test?

Describe how statistical significance was demon- strated (or not) for each variable.

the absence of multicollinearity. The researchers did not mention if these as-

sumptions were met or how they were checked.

The data analysis procedures were clearly described in the article, but there was

no mention of addressing any problems with missing data or how it was man-

aged.

The data analysis techniques were consistent with the study purpose, research

objectives, and hypotheses, as the objective was to evaluate the performance

of the Columbia-Suicide Severity Rating Scale Screener in identifying patients

at risk of suicide after emergency department discharge.

Data was presented in tables, with results of the logistic regression analyses

presented in odds ratios (OR) with 95% confidence intervals (CI).

No mention of the alpha for each statistical test was made in the article. Sta-

tistical significance was demonstrated by the p-values and 95% confidence

intervals presented in the tables. A p-value of less than 0.05 was considered

statistically significant.

Study Results and Interpretation

Were study results statistically significant? How The study by Simpson et al. (2021) was designed to examine the performance

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did you determine statistical significance?

What is your statistical interpretation of study results?

Were findings discussed in relation to each objective, question, or hypothesis? In other words, was the research question/hypothesis answered? Describe.

Were study findings clinically significant? If so: - discuss implications of the study for

nursing practice.

- what changes could you make in your practice based on the results of this study?

What were the study conclusions? Did con- clusions fit the results from the data analy- ses? Were the conclusions based on statisti- cally significant and clinically important re- sults? Explain.

Were study limitations described? Discuss. Do you think the study had weaknesses not identified by the researcher? If so, explain.

Did the researcher generalize the findings ap- propriately? Who will benefit from results of the study? Discuss.

Were there any unexpected findings? Discuss.

characteristics of the Columbia-Suicide Severity Rating Scale (C-SSRS) screener

in detecting suicide risk among patients aged 18 years and above in a medical-

surgical unit. The study found that among 24,278 encounters that were excluded

due to lack of C-SSRS screening data, only 3 of the patients who died by suicide

within 1 year received a psychiatric assessment in the emergency department

(ED). The results were statistically significant (p < 0.0001).

The study concluded that the C-SSRS screener is not effective in detecting sui-

cide risk after emergency department discharge, and that alternative approaches

to suicide risk assessment are needed. However, the study did not directly ad-

dress the PICOT question regarding the implementation of the C-SSRS and

safety best practices to increase early suicide risk identification and reduce self-

harm habits.

The study had some limitations, including the use of administrative data to de-

termine suicide deaths, and the missing data from C-SSRS screenings. The re-

sults may not generalize to other populations or healthcare settings. The re-

searcher did not identify any unexpected findings.

In terms of implications for nursing practice, the study highlights the need for

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alternative approaches to suicide risk assessment in medical-surgical units.

Based on the results, nurses may need to consider alternative methods to iden-

tify and reduce self-harm habits, such as ongoing assessments and interventions

throughout the patient's hospital stay and after discharge. However, more re-

search is needed to determine the best practices for suicide risk assessment in

this population.

Recommendations for Future Research

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Discuss study recommendations.

Is need for further research identified? Based on the study, the use of the Columbia Suicide Severity Rating Scale was

found to be effective in reducing self-harm habits among patients aged 18 years

and above in the medical-surgical unit. The study results showed that a lower per-

centage of patients were missing screening data over time and that those missing

the screening data had higher rates of private insurance and lower rates of Medic-

aid compared to those who received the screening. However, the study also found

that even with the use of the C-SSRS, there were still a significant number of pa-

tients who died by suicide within a year of discharge from the emergency depart-

ment.

The study recommends that more research be conducted to determine how best to

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improve early suicide risk identification and reduce self-harm habits among

patients in medical-surgical units. Further research is needed to determine the

reasons why some patients are still missing screening data and to explore the

effectiveness of alternative screening methods. Additionally, the study high-

lights the importance of providing psychiatric assessments to patients who

may be at risk of suicide, even if they do not meet the criteria for a positive C-

SSRS screen.

In conclusion, the study provides important insights into the use of the Co-

lumbia Suicide Severity Rating Scale in reducing self-harm habits among

patients in medical-surgical units. However, more research is needed to

fully understand the reasons for missed screenings and to determine the

most effective methods for reducing suicide risk among these patients.

Study Rigor

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Discuss elements of rigor based on study de-

sign. In your opinion, did the researchers ad-

dress these aspects adequately in the pub-

lished

Elements of rigor in a study design can include: randomization, blinding,

sample size, validity and reliability of measures, and the presence of con-

founding variables.

The study by Simpson et al. (2021) appears to have addressed some aspects of rigor

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report? Why or why not?

How does rigor impact study results?

adequately but not others. For example, the study used a large sample size,

which is a strength of the study. Additionally, the researchers used a validated

measure, the Columbia Suicide Severity Rating Scale, which has established

reliability and validity. However, the study was not randomized, and patients

were not blinded, which could impact the results.

In terms of rigor, the exclusion of a significant number of encounters due to

missing C-SSRS screening data is a potential weakness of the study. The ex-

clusion of these encounters could introduce bias into the results and limit the

generalizability of the findings. Additionally, the fact that patients missing

screening data were more likely to have private insurance and less likely to

have Medicaid is also a potential confounding variable that could impact the

results.

In my opinion, the researchers addressed some aspects of rigor adequately in the

published report, but there are some limitations that should be considered when

interpreting the results. The lack of randomization and blinding, as well as the

exclusion of encounters with missing screening data, could impact the validity of

the results.

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Rigor is important because it ensures that the results of a study are accurate, re-

liable, and generalizable to a larger population. A lack of rigor can lead to inac-

curate or misleading results, which could have negative consequences for pa-

tient care. Therefore, it is crucial for researchers to address all aspects of rigor

in their study design and to report on these elements in their published reports.

Adapted from: Gray, J.R., Grove, S. K., & Sutherland, S. (2017). Burns and Grove’s The practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis: Elsevier.

References

Simpson, S. A., Goans, C., Loh, R., Ryall, K., Middleton, M. C. A., & Dalton, A. (2021). Suicidal ideation is insensitive to suicide

risk after emergency department discharge: Performance characteristics of the Columbia-Suicide Severity Rating Scale

Screener. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine, 28(6), 621–629.

https://doi.org/10.1111/acem.14198

Group Name:

Date: PICO Worksheet

Original Revised

Define your Question using PICO

P Suicide has become a prevalent health concern in the United States and across the globe. Patients admitted as a result of mental health conditions such as depression and substance abuse, and terminal cases of cancer are at the highest risk of suicide. Suicide is also prevalent among people on antidepressant therapy or cancer treatment, including chemotherapy, radiation, and surgery. Suicidal ideation is highest among older men above 85 years in the United States. There is also an increased risk of suicide in the first week of admission and discharge. The high suicidal habit among medical-surgical unit patients requires an effective screening protocol tool to establish patients at high risk of suicide. Early identification of those at risk of suicide can help reduce suicidal behaviors.

I The intervention involves three stages; pre- intervention, intervention, and post-intervention. Patients will be screened using the Columbia- Suicide Severity Rating Scale. Secondly, Collaborative Assessment and Management of Suicidality (CAMS) will be used to manage suicidal patients, and finally, a safety plan intervention (SPI) will be implemented to manage suicidal habits.

M e t h o d o l o g y

Systematic reviews will be used to compare the experimental and control groups. Qualitative and quantitative data will also be obtained from peer-reviewed studies and databases to inform the investigation.

C The intervention will be compared to the current practice of no practice of safety bundle of best practice or assessment tools.

O Manage and reduce suicidal behaviors.

Rev. May 2020 MSN5300 KmR

State your Question resulting from PICO: In the medical-surgical unit patients aged 18 years and above in Hospitals in the United States (P), does implementing the Columbia Suicide Severity Rating Scale, and applying a buddle of safety best practices (I) Compared to the current intervention (C) Increase early suicide risk identification to reduce self-harm habits ?(O).

List keywords from your PICO question that can be used for your search.

Suicide, Columbia Suicide Severity Rating Scale, buddle of safety best practices, self-harm habits, suicide screening, suicide risk, and suicide risk identification

List other criteria –gender, age, year of publication, or language to be used to limit your search.

The chosen articles were those published with 5 years, written in English; include full texts, quantitative, and no duplicates Use the databases page from the Library website for suggestions.

List the databases you plan to search: i.e., CINAHL.

i. PubMed ii. CINAHL iii. EBSCO host iv. Google Scholar v. PubMed

Rev. May 2020 MSN5300 KmR