Document Type

Doctoral Project

Publication Date



Suicide is a worldwide problem that claims over 800,000 lives annually (NIMH, 2017; WHO, 2017). Almost one third of mental health professionals feel they have received inadequate training on suicide prevention (Jahn, Quinnett, & Ries, 2016). Asking mental health clients to agree to a no-suicide contract is a widely-used practice in the inpatient mental health care setting but lacks efficacy and can have ethical implications (Bryan et al., 2017). The NGASR was selected from a variety of suicide risk assessment tools for incorporation into a public inpatient mental health hospital unit in the Midwestern U.S.A. The NGASR is unique in that it describes evidence-based variables known to increase a person’s suicide risk, does not coerce mental health clients, and attempts to help nurses improve their clinical judgment when assessing suicide risk (Cutcliffe & Barker, 2004). The EBPI model was used to guide this DNP project, which asked “Among nurses working with mental health clients in the inpatient mental health hospital setting (P) how does the use of the NGASR (I) compared to the use of a no-suicide contract (C) impact nursing practice and the quality of care for mental health clients (O) over a four-month period of time? (T).”

Twenty-two out of sixty nurses (36.7%) completed the survey at the end of the DNP project. Nurses felt the process of changing to the NGASR was neutral (31.82%) to negative (50%) with statements that the NGASR was more “time-consuming” and screened more mental health clients as a “high risk” for suicide than the no-suicide contract. Nurses provided neutral (13.64%) to positive (59.09%) responses when asked how the NGASR changed their practice and mental health client care. Nurses reported the NGASR increased critical thinking, awareness, and insight into the mental health clients’ problems and history. During the two months of NGASR incorporation the use and cost of safety sitters decreased by 44.44% and vi 76.76% ($10,897.71) respectively. It is recommended the NGASR undergo further incorporation and study on inpatient mental health hospital units to determine if utilizing the EHR is able to mitigate nurses’ perception of increased workload.