Matrix Table and Summary
Matrix Table and Summary
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Northern Kentucky University
DNP 816 Analysis and Application of Health Data for APRN Practice
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DATE
DNP 618 Article Matrix and Analysis
Student Name: XXXXXXXXXXX
PICO Question: In adolescent patients seen in primary care setting (P) what is the effect of Ask Suicide Screening Question toolkit (I)compared to those not screened (C) on preventing self-harming behavior/suicide (O) in 3 months (T)
Search process: Database was searched utilizing Northern Kentucky University Library and the National Library of Medicine. The articles were peer reviewed and published within the last five years. The articles were narrowed down based on the criterial listed.
Search terms: Ask Suicide Screening Questions toolkit, suicide screening and prevention, suicide in patients, how to improve the mental health of patients or students
Databases: MEDLINE, CINHAL
Total number of articles obtained from search results: N = 1767
Number of articles initially excluded based on abstract reading: N= 30 (out of first 100 relevant)
Number of articles reviewed: N= 8
Number of articles excluded based on criteria: N= 1611
Inclusion criteria: must be in English, full text only, publishedin2017orlater, peer-reviewed articles, include adolescent, depression, and suicide as the subject, be discoverable in a reputable database
Exclusion Criteria: Article published prior to 2017, language other than English, no full text link, obtained from a non-reputable source.
Number of systematic reviews or meta-analyses used in Matrix- N = 1
| Author, year; Credentials Article #2 | Farrer, L. M. (Registered Psychologist), Gulliver, A. (Research Fellow), Katruss, N. (Research Assistant), Bennett, K. (credential not identified), Bennett, A. (credential not identified), Ali, K. (PhD research student), & Griffiths, K. M. (Emeritus Professor) (2020). Published in the British Journal of Guidance & Counselling |
| Article Focus/Title | ‘Development of the Uni Virtual Clinic: an online program for improving the mental health of university students’. |
| Research Design/Intervention (describe intervention) | A participatory research method was used for this study. There was reduced burden on university resources thanks to the implementation of evidence-based online therapies for students who were typically underserved or socially isolated. |
| Level of Evidence and model used to grade evidence | ‘Level I: (Dearholt et al., 2017)’. |
| Evaluation Tool (CASP or others- identify tool used) | The CASP for qualitative checklist 9/10 |
| Sample/# of subjects, how recruited, power analysis? | Four focus groups with undergrads (n = 5, 5, 4, 5) constituted the bulk of the qualitative methodologies used. Twenty persons participated in three sessions of prototype testing, a workshop for student leaders, and an assessment of the pilot UVC. In order to determine what kinds of resources various student groups at the university would benefit from, the project team held a number of in-person talks with representatives from those groups. |
| Data Collection Procedure | The present evidence for technologies that promoted the mental health of college students was investigated through systematic reviews. Quantitative and qualitative research approaches were used to investigate the effectiveness of peer-to-peer support interventions, as well as to collect the views and opinions of key stakeholders. Quantitative approaches included a survey of university faculty and staff who were directly involved in student instruction and supervision, and a separate poll of the students themselves. |
| Instruments and Reliability/validity of instruments | Methods including surveys and in-person conversations or focus groups were employed. The researcher can receive a clear picture of the product’s reception, as well as the customers’ real thoughts, opinions, and impressions, thanks to the use of focus groups, which are considered credible. The dependability of surveys is demonstrated by their consistently reproducing comparable results. |
| Data Analysis- id statistics, LOM, findings | Percentages were used to record all of the information gathered. Positive attitudes about involvement were evident, with all 19 positive questions having average scores above 0, suggesting agreement. |
| Results | All 19 positive questions had average values over zero, suggesting agreement, and the majority of respondents (M = 0.96, SD = 0.24) agreed with the assertion that attitudes toward involvement were typically positive. All 13 of the negative categories were rated below 0, suggesting disagreement. Ratings above 0 , showed the strongest agreement. |
| Discussion/ Significance of findings
| The needs of the UVC’s target demographic could not have been met without the use of participatory design methods during development. Universities can play an important role in creating mentally healthy environments to learn and live if UVC’s work to reduce the prevalence of mental health problems among at-risk children and the negative outcomes associated with them is successful. |
| Reliability and Validity of study, limitations | Students’ input into the design process helped the team take into account students’ changing needs, the dynamic nature of academic institutions, and the dynamic nature of web design and development approaches to e-mental health care. There were drawbacks to the study, such as the fact that it would add significant time and effort to the content creation and website development processes if end users were included in the development process. Since disagreements arose frequently concerning the nature and operation of UVC, it was challenging to reach a consensus on the final program. |
| Helpful/Reliable Compared to other articles | Validating the promise of Uni Virtual Clinic to help institutions of higher education better meet the psychiatric needs of their students. The study’s findings were straightforward and simple to comprehend. |
| Author, year; Credentials Article #3 | ‘LeCloux, M. A., Weimer, M., Culp, S. L., Bjorkgren, K., Service, S., & Campo, J. V. (2020)’. The authors credentials are not identified. Published by Elsevier Inc.” |
| Article Focus/Title | The Feasibility and Impact of a Suicide Risk Screening Program in Rural Adult Primary Care: A Pilot Test of the Ask Suicide-Screening Questions Toolkit |
| Research Design/Intervention (describe intervention) | Quasi experiment research design. Ask Suicide-Screening Questions was used to conduct a suicide screening with patients who presented for routine and sick visits; patients who tested positive for suicidal ideation were then subjected to additional screening using the same instrument. |
| Level of Evidence and model used to grade evidence | ‘Level III: Johns Hopkins’ |
| Evaluation Tool (CASP or others- identify tool used) | CASP for Qualitative checklist, score 9/10 |
| Sample/# of subjects, how recruited, power analysis? | The baseline sample included 274 patients. Patients consented electronically. A 2 phased design was used to collected date from patients who presented for routine or sick visit in a rural primary care clinic. Electronic medical records for patients 18 or older were collected, this data was logged and identified by the clinician into spread sheet.
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| Data Collection Procedure | As part of an online survey, patients were asked to complete both the ASQ and a shorter, 5-item Screening Opinions Questionnaire. The primary care physician conducted a brief suicide risk assessment using the BSSA as a guide, and then provided disposition planning for patients who screened positive for suicide risk. The patient’s risk profile was then documented in their electronic medical record. In this study, the researcher accessed the EMR to collect data. |
| Instruments and Reliability/validity of instruments | Ask Suicide-Screening Questions (ASQ) questionnaires were utilized. In young and adult inpatients, it has shown both high sensitivity and strong specificity. |
| Data Analysis- id statistics, LOM, findings | All data was uploaded to SPSS 26 for analysis. Descriptive statistics were utilized to evaluate the aforementioned viability markers. Chi-square analysis followed by Fisher’s exact test was utilized to evaluate the two time periods’ client testing and suicide risk assessment procedure rates. |
| Results | Intervention period reports of suicide risk screening were significantly higher than baseline period reports ( P 0.001). In addition, 6.2% of cases showed signs of suicidal ideation throughout the intervention phase, whereas only 0.7% did so during the baseline phase ( P 0.001). |
| Discussion/ Significance of findings
| Preliminary results from this study indicate that the ASQ and BSSA can be helpful in identifying persons in rural areas who are at risk for suicide and are seeking primary care. Rural primary care settings are ideal for implementing suicide risk screening programs. |
| Reliability and Validity of study, limitations | Before beginning the study, the university obtained complete permission from its institutional oversight board for all study methods. The ASQ Toolkit has been found to increase the rate of risk identification in adults receiving primary care, while maintaining the validity and reliability of the research. Pilot in nature, with participants being of the same race seeing the same rural primary care doctor, the study had several inherent limitations. As this was a two-part study, there were additional variations between the study’s initial and final stages. |
| Helpful/Reliable Compared to other articles | These results are comparable with those of earlier empirical research, which have shown that suicide risk screening is possible and acceptable to most patients. |
| Author, year; Credentials Article #5 | Lindstrom, A. C. (DNP, APRN), & Earle, M. (DNP, RN) (2021). Published in the Journal of Doctoral Nursing Practice |
| Article Focus/Title | ‘Improving Suicidal Ideation Screening and Suicide Prevention Strategies on Adult nonbehavioral Health Units’. |
| Research Design/Intervention (describe intervention) | Randomized control trial. Targeted intervention that includes nursing education, easier electronic medical record (EMR) workflow for documentation of suicide screening, was needed to improve identification and provide safety of patients at risk for suicidal. |
| Level of Evidence and model used to grade evidence | “Level I: ( Dearholt et al., 2017)’ |
| Evaluation Tool (CASP or others- identify tool used) | CASP for qualitative checklist score 8/10 |
| Sample/# of subjects, how recruited, power analysis? | In total, 6,229 adults were admitted to the hospital for treatment of non-behavioral health issues. A total of 6,210 people were screened for suicidal ideation. Patients were chosen at random.. |
| Data Collection Procedure | An examination of the literature on the early deployment of suicide screening and the results of focus groups with key stakeholders, such as bedside nurses, guided the development of interventions. |
| Instruments and Reliability/validity of instruments | The electronic medical record was modified by adding an additional answer to the suicide screening question and mandating its documentation following focus group discussions, the development of nursing protocols, data on compliance monitoring, nursing education, pre- and post-nursing assessments, and other interventions. The project was greenlit by the IRB, the issue was identified and quantified, potential solutions were evaluated and executed, and a control plan was created to assure the initiative’s long-term viability. |
| Data Analysis- id statistics, LOM, findings | Patient records were audited to ensure accurate order entry and screening procedures. The audit found that within 24 hours of admission, 76.2% of patients had gotten assistance from a clinician and 82.5% of patients had taken safety actions that were documented. |
| Results | With 91.5% of all registered nurses having completed the program, and with 89.2% of the pretest questions properly answered, it is evident that the trainees entered the program with a solid grounding in the subject matter. Between the two tests, there was a 2.9% improvement in accuracy, with 92.1% accurate answers on the second test. 20.6% more people were screened. |
| Discussion/ Significance of findings
| The nurses’ training was extensive, covering everything from patient intake through discharge. In order to improve universal suicide ideation screening and thereby boost patient safety, nurses need access to clear policies, standardized protocols, and education.. |
| Reliability and Validity of study, limitations | The researchers in this study identified several elements at the medical center where the research was done that contributed to a culture of compliance. Results cannot be generalized to other areas because this study was conducted in only one. What’s more, the study began two months before the hospital encountered the COVID-19 outbreak. |
| Helpful/Reliable Compared to other articles | In addition to being a legitimate study, the study’s usefulness stems from the fact that no literature was located on how to enhance screening compliance once a method had been devised. |
Summary
Suicide is a significant health problem in the world. The percentage of teenagers experiencing major depressive disorder (MDD) symptoms has nearly doubled, from 8.3% in 2008 to 14.4% in 2018 (Sekharet al., 2021). Thus, screening for suicide risk and suicidal behavior is an essential first step toward preventing suicide in young people. High-risk groups in optimal settings are the focus of effective screening programs. This research focuses on screening for suicide risk in medical settings because of its importance. Although there are a number of tools used to assess whether or not a patient is at risk for suicide ideation or behavior, the Ask Suicide-Screening Questions (ASQ) kit was developed with this particular context in mind.
The articles reviewed in this matrix include two level IV evidence, two-level I evidence, and one level III evidence articles.The two cross sectional studies were valid according to the JBI checklist for cross sectional studies. The quasi and randomized control trials were valid according to CASP checklist. Questionnaires were used in three of the articles and past records were used in two of the articles. Four of the results of the study were reliable. One study was done in before months before Covid 19 and All articles utilized showed suicidal screening is feasible and helps improve patient safety, and more importantly several articles showed utilization of the Ask Suicide-Screening Questions Toolkit has potential to improve suicide risk assessment (LeCloux et al., 2020).
The articles have improved my knowledge on my chosen topic. There is no change been considered at this time. I was able to find sufficient literature, government information, and education on the screening tool I have chosen. However, future studies measuring the impact of suicide risk screening with youth in outpatient specialty and primary care clinics on outcomes such as linkage with mental health services and future suicidal behavior are warranted (Aguinaldo et al., 2021). Gaps in screening of patients with suicidal thoughts exist because of lack of education, clear policies, and protocols for screening in these settings.
References
Aguinaldo, L. D., Sullivant, S., Lanzillo, E. C., Ross, A., He, J. P., Bradley-Ewing, A., Bridge, J. A., Horowitz, L. M., & Wharff, E. A. (2021). Validation of the ask suicide-screening questions (ASQ) with youth in outpatient specialty and primary care clinics. General hospital psychiatry, 68, 52–58. https://doi.org/10.1016/j.genhosppsych.2020.11.006
https://doi.org/10.1016/j.genhosppsych.2020.11.00
Dearholt, S., Dang, D., & Sigma Theta Tau International. (2012). Johns Hopkins nursing evidence-based practice: Models and
guidelines. https://libguides.ohsu.edu/ld.php?content_id=16277844
Farrer, L. M., Gulliver, A., Katruss, N., Fassnacht, D. B., Kyrios, M., & Batterham, P. J. (2019). A novel multi-component online intervention to improve the mental health of university students: Randomized controlled trial of the Uni Virtual Clinic. Internet interventions, 18, 100276. https://doi.org/10.1016/j.invent.2019.100276
LeCloux, M. A., Weimer, M., Culp, S. L., Bjorkgren, K., Service, S., & Campo, J. V. (2020). The Feasibility and Impact of a Suicide Risk Screening Program in Rural Adult Primary Care: A Pilot Test of the Ask Suicide-Screening Questions Toolkit. Psychosomatics, 61(6), 698–706. https://doi.org/10.1016/j.psym.2020.05.002
Lindstrom, A. C., & Earle, M. (2021). Improving Suicidal Ideation Screening and Suicide Prevention Strategies on Adult Nonbehavioral Health Units. Journal of doctoral nursing practice, JDNP-D-20-00049. https://doi.org/10.1891/JDNP-D-20-00049
Men, V. Y., Emery, C. R., & Yip, P. S. F. (2021). Characteristics of cancer patients who died by suicide: A quantitative study of 15-year coronial records. Psycho-oncology, 30(7), 1051–1058. https://doi.org/10.1002/pon.5634
Sekhar, D. L., Schaefer, E. W., Waxmonsky, J. G., Walker-Harding, L. R., Pattison, K. L., Molinari, A., Rosen, P., & Kraschnewski, J. L. (2021). Screening in High Schools to Identify, Evaluate, and Lower Depression Among Adolescents: A Randomized Clinical Trial. JAMA network open, 4(11), e2131836. https://doi.org/10.1001/jamanetworkopen.2021.31836
Fall 10.2020
