Barriers to suicide risk management in clinical practice: a national survey of oncology nurses.

Abstract

Standards of practice identify the nurse's pivotal role in risk detection, assessment, intervention, and management of suicidal patients, but scant research explores the barriers that hinder this role. This study describes the analysis of barriers to suicide risk management from a survey of a random sample of members of a national organization, the Oncology Nursing Society (n = 1200), who participated in a descriptive study exploring nurses' knowledge and attitudes about suicide. The 454 (37%) respondents included respondents from the United States, Canada, and Puerto Rico. Instruments included a demographic inventory, the Suicide Opinion Questionnaire (SOQ), a suicide attitude measure (SUIATT), and a vignette of a suicidal patient. Nurses knew an average of 4.8 out of 9 suicide risk factors and 49.4% miscalculated the risk of suicide. In contrast with their moderate to high ratings of suicide risk, they indicated minimal interventions. Barriers to management of suicidal patients included deficits in skill, knowledge, referrals, patient teaching, advocacy, or consultation as well as participants' and religious/other values, uncomfortable feelings, personal experiences, and the weight of professional responsibility. Strategies for intervention include: suicide prevention education, consultation, values clarification, ethical analysis, and conflict resolution and psychosocial support to reduce barriers. Nurses are not alone in their request for more education about suicide prevention; this study confirms earlier research of psychologists and psychiatrists who report they need more education in suicide risk management.