Date of Award

Spring 4-3-2021

Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Dr Sheri Jacobson, PhD, RN

Second Advisor

Dr Rebekah L. Powers, DNP, RN-BC, CMSRN, CSPHA, CHTS-CP


Practice Problem: Suicide is a public health condition that affects people globally. The increased suicidal behaviors of patients in a medical-surgical unit demanded an effective screening protocol to identify high-risk patients.

PICOT: In patients 18 years and older on a medical-surgical unit, does the implementation of the Columbia Suicide Severity Rating Scale (C-SSRS) tool and application of a Safety Bundle of Best Practices (SBBP) increase early identification of suicide risk with decreased patient self-harm behaviors, compared to the current standard practice of no assessment tool or safety bundle of best practices within 12 weeks?

Evidence: Ten studies served as evidence that assessment of early suicidal-risk behaviors decreased patient self-harm. The evidence supported the implementation of the C-SSRS tool and application of the Safety Bundle of Best Practices for the project intervention.

Intervention: The intervention consisted of three phases (pre-intervention, intervention, and post-intervention): a) patients were screened with the Columbia-Suicide Severity Rating Scale (C-SSRS); b) suicidal patients were managed with Collaborative Assessment and Management of Suicidality (CAMS); and c) a Safety Plan Intervention (SPI) was employed to manage suicidal behaviors.

Outcome: At the start of the assessment period, pre-intervention data yielded a C-SSRS risk score mean of 0.81; following the eight-week implementation period, post-intervention data yielded a C-SSRS risk score mean of 0.75. There was a marginally significant difference between the means at pre- and post-intervention, showing a lower suicidal risk at post-intervention, p = 0 .07, t-test result (31) = 1.87.

Conclusion: The decrease in patient self-harm behaviors with the implementation of the C-SSRS tool and application of SBBP was not statistically significant (SBBP). However, the decrease did indicate a clinically meaningful improvement in suicidal behavior outcomes after implementation of the intervention.


Scholarly project submitted to the University of St. Augustine for Health Sciences in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice

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