Don't Ask, Won't Tell: Suicide Screening in the Pediatric Perioperative Setting

Suicide is the second leading cause of death for children and adolescents ages 10-19 in the United States. Globally, suicide is the fourth leading cause of death among adolescents and young adults ages 15-29. The World Health Organization identifies suicide prevention and promotion as a public health priority. In the United States, one of the key prevention strategies has been the recognition of the need for screening, particularly for children and adolescents. The American Academy of Pediatrics (AAP), National Institute of Mental Health (NIMH), and the Joint Commission recommend suicide risk screening for those ages 10 and older. Research has shown that children and adolescents won't disclose suicidal thoughts unless directly asked. Perioperative units in pediatric hospitals are uniquely positioned to integrate suicide screening as part of the nurses' pre-operative assessment of surgical patients. Utilizing pre-operative units for screening can identify at-risk patients who otherwise may not be screened. The purpose of this evidence-based practice (EBP) project was to determine if a one-time, educational intervention highlighting the importance of universal suicide screening in pediatric patients 10 years old or older would affect the beliefs and comfort level of pediatric perioperative nurses. The survey assessed perioperative nurses' beliefs and comforts around suicide screenings for patients ages 10 and older in the perioperative unit. Twenty-minute educational unit-based in-services were provided over a 2-week period to all current staff. The survey was then repeated to assess for changes in nurses' beliefs and comfort. Pre-educational intervention, 43.5% of participants did not believe it is important to ask patients about suicidal thoughts. Only 60.9% of participants agreed that all patients 10 years and older should be assessed for suicidal risk, regardless of behavioral health history. After the educational intervention, all perioperative nurse participants (n = 22) agreed it was important to ask patients about suicidal thoughts and to screen all patients 10 years and older for suicidal risk, not just behavioral health patients. Post-education, all participants (100%) agreed it was important to ask patients about suicidal thoughts and believed patients 10 years and older should be assessed for suicidal risk. Early detection through screening is crucial to combating this growing health crisis for children and adolescents. Educational in-services strengthened this group of perioperative nurses' understanding of the importance and feasibility of universal suicide screening in their unit. Responses from this EBI can potentially help guide the educational component of pediatric hospitals' initiatives to implement suicide screening.