Assessment and Care of Adults at Risk for Suicidal ...

1 Nursing Best Practice GuidelineShaping the Future of NursingAssessment and Care of Adults at Risk for Suicidal Ideationand BehaviourJanuary 2009 Greetings fromDoris Grinspun Executive DirectorRegistered Nurses Association of Ontario It is with great excitement that the Registered Nurses Association of Ontario (RNAO)presents this guideline, Assessment and Care of Adults at Risk for Suicidal Ideation andBehaviour,to the health care community. Evidence-based practice supports theexcellence in service that nurses are committed to delivering in our day-to-day is delighted to provide this key resource to you. RNAO offers its heartfelt thanks to the many individuals and institutions that are making our vision forNursing Best Practice Guidelines (BPGs) a reality: the Government of Ontario for recognizing our ability tolead the program and providing multi-year funding; Irmajean Bajnok, Director, RNAO International Affairsand Best Practice Guidelines (IABPG) Programs, for her expertise and leadership in advancing theproduction of the BPGs; each and every Team Leader involved, and for this BPG in particular Elaine for her superb stewardship, commitment and, above all, exquisite expertise.

2 Also thanks to SamathaMayo, RNAO s IABPG Program Coordinator, for her intense work to see that this BPG moved from conceptto reality. A special thanks to the BPG Panel we respect and value your expertise and volunteer work. To all,we could not have done this without you!The nursing community, with its commitment and passion for excellence in nursing care, is providing theknowledge and countless hours essential to the development, implementation, evaluation and revision ofeach guideline. Employers have responded enthusiastically by nominating best practice champions,implementating and evaluating the guidelines and working towards a culture of evidence-based practice. Successful uptake of these guidelines requires a concerted effort from nurse clinicians and their health carecolleagues from other disciplines, from nurse educators in academic and practice settings and fromemployers.

3 After lodging these guidelines into their minds and hearts, knowledgeable and skillful nursesand nursing students need healthy and supportive work environments to help bring these guidelines topractice actions. We ask that you share this guideline with members of the interdisciplinary team as there is much to learnfrom one another. Together, we can ensure that the public receives the best possible care every time theycome in contact with us. Let s make them the real winners in this important effort!Doris Grinspun, RN, MScN, PhD(c), O. DirectorRegistered Nurses Association of Ontario1 Nursing Best Practice GuidelineDisclaimerThese guidelines are not binding on nurses or the organizations thatemploy them. The use of these guidelines should be flexible based onindividual needs and local circumstances.

4 They neither constitute aliability nor discharge from liability. While every effort has been made toensure the accuracy of the contents at the time of publication, neither theauthors nor the Registered Nurses Association of Ontario (RNAO) giveany guarantee as to the accuracy of the information contained in themnor accept any liability, with respect to loss, damage, injury or expensearising from any such errors or omission in the contents of this work. CopyrightWith the exception of those portions of this document for which a specificprohibition or limitation against copying appears, the balance of thisdocument may be produced, reproduced and published in its entirety,without modification, in any form, including in electronic form, foreducational or non-commercial purposes. Should any adaptation of thematerial be required for any reason, RNAO written permission must beobtained.

5 Appropriate credit or citation must appear on all copiedmaterials as follows:Registered Nurses Association of Ontario.(2008) Assessment and Care ofAdults at Risk for Suicidal Ideation and , Nurses Association of and Care of Adults at Risk for Suicidal Ideation and BehaviourRegistered Nurses Association of OntarioNursing Best Practice Guidelines Program158 Pearl StreetToronto, Ontario M5H 1L3 Website: Santa Mina (Sta. Mina), RN, BA, BAAN,MSc, PhD, CPMHN(C)Team LeaderAssociate ProfessorDaphne Cockwell School of NursingRyerson UniversityToronto, OntarioShuan S. Boo, MAProgram DirectorCrisis Response ServiceCanadian Mental Health Association Thunder Bay BranchThunder Bay, OntarioAmy Brown, RNStaff NursePsychiatric Emergency ServiceSt. Michael s HospitalToronto, OntarioLisa Clements, RNCommunity Mental Health NurseAssertive Community Treatment Team IINortheast Mental Health CentreNorth Bay, OntarioKarin Doan, RN, MScN, CPMHN(C)Advanced Practice NurseGeneral Psychiatry Program/CATSC entre for Addiction and Mental HealthToronto, OntarioBeth Hamer, RN, BA, BSN, MS, CPMHN(C)Nurse Educator/Practice LeaderMental Health Centre PenetanguishenePenetanguishene, OntarioKristine Lorbergs, RN, BA, MN, CPMHN(C)

6 Clinical Nurse SpecialistMental Health SystemTrillium Health CentreMississauga, OntarioJosephine Muxlow, RN, MScNClinical Nurse Specialist Adult Mental HealthAdjunct ProfessorDalhousie University School of NursingHalifax, Nova ScotiaJim Natis, BA, BSW, MSW, RSWC oncurrent Disorders ClinicianUniversity Health Network, Toronto WesternHospital DivisionAddictions Program, Department of PsychiatryToronto, OntarioElizabeth (Billie) Pryer, RN, MN, CPMH(C) Advanced Practice NurseChamplain District Regional First EpisodePsychosis ProgramThe Ottawa HospitalOttawa, OntarioAssessment and Care of Adults at Risk for Suicidal Ideation and Behaviour 2 Development Panel Members3 Nursing Best Practice GuidelineVictoria Smye, RN, BA, MHSc, PhDAssistant ProfessorSchool of NursingUniversity of British Columbia Vancouver, British ColumbiaKim M. Watson, RN, DPHN, MScNBoard of DirectorsOntario Suicide Prevention NetworkStaff NurseEmergency DepartmentHotel-Dieu Grace HospitalWindsor, OntarioSamantha Mayo, RN, MNProgram CoordinatorNursing Best Practice Guidelines ProgramRegistered Nurses Association of OntarioToronto, OntarioErica Kumar, BSc, GC, DipHlthPromProgram AssistantNursing Best Practice Guidelines ProgramRegistered Nurses Association of OntarioToronto, OntarioThe RNAO would also like to acknowledge Salima Ladak, RN, MN-ACPN,Research Assistant, for her contributionto the quality appraisal of the literature and preparation of evidence of interest and confidentiality were requested from all members of the guideline development details are available from the Registered Nurses Association of Edward Connors, PhDPsychologistOnkwatenro shon.

7 A Health Planners Orillia, OntarioHelen Fatum, RN, BScN, MScN(c), ETEnterostomal Therapist, Patient EducatorNorth Bay General HospitalNorth Bay, OntarioDr. Ruth Gallop, RN, PhDProfessor EmeritusLawrence S. Bloomberg Faculty of NursingUniversity of TorontoToronto, OntarioAdrian HillConsumerSuicide prevention and bereavement communityToronto, OntarioDr. Paul Links, MD, MSc, FRCPCA rthur Sommer Rotenberg Chair of Suicide StudiesUniversity of TorontoToronto, OntarioB. L. Murray, RN, BSN, MN, PhD(c)Associate Professor, College of NursingUniversity of SaskatchewanSaskatoon, SaskatchewanNegin Pearl Shalchi, RPN Staff NurseNorth York General HospitalNorth York, OntarioElizabeth McCay, RN, PhDAssociate Professor and Associate DirectorDaphne Cockwell School or NursingRyerson UniversityToronto, OntarioJanie Houle, PhDPostdoctoral fellowCentre de recherche du Centre hospitalier de l Universit de Montr alMichelle Y.

8 E. Lee, RN, MScN, PhD (student)Registered NurseUniversity of TorontoToronto, Ontario Don Rose, RN, BScN, MN, PhDAssociate ProfessorDaphne Cockwell School of NursingRyerson UniversityToronto, OntarioAssessment and Care of Adults at Risk for Suicidal Ideation and Behaviour 4 Advisory Panel MembersAdvisory Panel Members representing diverse perspectives were solicited for their feedback, and theRegistered Nurses Association of Ontario wish to acknowledge the following for their contribution to thedevelopment of this nursing best practice guideline:External Stakeholder Review PanelAn expert Review Panel was convened to review the final guideline prior to publication. The RegisteredNurses Association of Ontario wishes to acknowledge the following for their contribution in reviewing thisbest practice guideline and providing feedback:5 Nursing Best Practice GuidelineShelly Archibald, RN, BSNP ublic Health NurseFirst Nations and InuitHealth Branch, Health CanadaSioux Lookout, OntarioLisa Crawley Beames, RN, BSN, CPMHN(C)Clinical Leader ManagerDepartment of Family and CommunityMedicine, Withdrawal Management ServicesSt.

9 Michael's HospitalToronto, OntarioYvonne Bergmans, BA(Hons), BEd.,BSW, MSW, RSWS uicide Intervention ConsultantSuicide Studies Unit, Arthur Sommer RotenbergChair in Suicide StudiesToronto, OntarioJacqueline Candlish, RN, BScNPublic Health Nurse, Public Health ServicesHamilton, OntarioBrock Cooper, RN, BScN, CPMHN(C) CandidateStaff NurseCentre for Addiction and Mental HealthToronto, OntarioYvonne Craig, BSc, BN, RN, CPMHN(C)Nurse ClinicianRoyal Ottawa Mental Health CentreOttawa, OntarioPatrick Cuaresma, RPN Research AssistantRyerson UniversityToronto, OntarioHiltrud Dawson, RN, BTech (specialty nursing),IBCLCH ealth Promotion ConsultantBest Start Resource CentreToronto, OntarioFrancine DeMarchi, RDH, BADental HygienistNiagara CollegeWelland, Ontario Cheryl Evans, RN, MScNNursing Professional Practice ConsultantSt. Joseph s Healthcare HamiltonHamilton, OntarioStakeholder AcknowledgementStakeholders representing diverse perspectives were solicited for their feedback and the Registered Nurses Association of Ontario wish to acknowledge the following for their contribution in reviewing this nursingbest practice guideline:Christine Garinger, RNCrisis Counsellor/Case ManagerLondon Mental Health Crisis ServiceLondon,OntarioLisebeth Gatkowski, RN, BScN, CMPHN(C)Nurse Educator, St.

10 Joseph s HospitalCentre for Mountain Health ServicesHamilton, OntarioJoan Graham, RNCharge NurseCommunity Crisis CareNiagara Health SystemSt. Catharines, OntarioJohanne Hayes, RN, BScN, MN (student)Nurse EducatorSt. Joseph s Healthcare HamiltonHamilton, OntarioJoanne Jones, RN, BScN, CPMHN(C)Clinical Education LeaderWhitby Mental Health CentreWhitby, OntarioVictoria KehoeExecutive DirectorDistress Centre DurhamOshawa, OntarioTamara Leniew, BAFamily and Community Coordinator,Schizophrenia Society of Ontario Hamilton/Niagara and Master Trainer ( )Hamilton, OntarioMarie A. Lochhead, , RDHD ental HygienistSt. Catharines, OntarioKristy Lojewski, RPNC ertified ReflexologistStaff NurseRegional Mental Health Care LondonLondon, OntarioElizabeth Mathewson, RN, BScN, MPH,COHN, CRSPN ursing ProfessorSir Sandford Fleming CollegePeterborough, OntarioAssessment and Care of Adults at Risk for Suicidal Ideation and Behaviour 67 Margaret McArthur, BA (Hons), RN, MHScNNurse Clinician/EducatorMental Health and Addictions ProgramSudbury Regional HospitalSudbury, OntarioLisa Murata, RN, BScN, MEd, CSFTC linical Nurse EducatorRoyal Ottawa Mental Health CentreOttawa, OntarioHeather Ochalski, BSocSc(c)Community Liaison OfficerAjunnginiq CentreNational Aboriginal Health Organization Ottawa, OntarioLisa Ostrom, RN, BScNStaff NurseCrisis Intervention TeamSt.