Date of Award

January 2022

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)


Yale University School of Nursing

First Advisor

Andree de Lisser

Second Advisor

Joanne Iennaco


Abstract Despite high rates of depression and risk factors for suicide, there is a knowledge deficit and lack of protocol surrounding the assessment of suicidal ideation in the long-term care setting. Although studies examining suicide in the long-term care setting are lacking, the prevalence of suicidal ideation is high. This DNP quality improvement project addressed this problem by creating a suicide assessment and management inservice for frontline clinical staff at a skilled nursing facility in Connecticut. The inservice integrated use of an adapted suicide assessment algorithm and a suicide screening tool, the P4 Screener. A SAMHSA toolkit was utilized as a guide for inservice creation. After a three-person expert panel unanimously validated the importance and relevance of the inservice PowerPoint content, two rounds of the inservice, including additional application content for staff authorized to complete formal assessments, was presented to twenty-eight (28) frontline staff. Evaluation of knowledge acquisition, confidence and comfortability was conducted via pre and post-test. Results of a paired samples t-test showed a significant difference in participant knowledge of suicidal ideation assessment from pre-inservice to post-inservice. Descriptive statistics were utilized to describe trends in participant comfort and confidence from pre-inservice to post-inservice. The small sample size (n=6) for the additional application content inservice limited confidence in those results showing there was not a significant difference in knowledge acquisition from pre to post-inservice. These results have implications for clinical practice in the long-term care setting by empowering the frontline assessment of suicidal ideation and collaboration with mental health services to promote accurate identification of those who are at risk and implementation of clinically appropriate interventions.


This is an Open Access Thesis.

Open Access

This Article is Open Access