Counseling Suicidal Patients About Access to Lethal Means: Attitudes of Emergency Nurse Leaders

Abstract

Introduction: For ED patients at risk of suicide, counseling to reduce access to lethal means (including firearms) is recommended yet not routine. To enhance practice uptake, we sought to examine the attitudes and beliefs of emergency nurse leaders concerning the acceptability and effectiveness of lethal-means counseling.

Methods: We invited a nurse leader (ED nurse manager or Chief Nursing Officer [CNO]) at each hospital-based emergency department in the 8-state Mountain West region of the United States to complete a closed-ended telephone survey. Questions assessed current practices and leaders' views on suicide prevention and lethal-means counseling. Reponses were weighted to all eligible hospitals to adjust for nonresponse.

Results: From 363 eligible hospitals, 190 emergency nurse leaders responded (overall response rate: 52%). Emergency nurse leaders thought providers at their emergency departments did an excellent job of safety counseling (74%) for suicidal patients. Most respondents believed that talking about firearms with suicidal patients is acceptable to patients (77%), supported by hospital administration (64%), effective in preventing suicide (69%), and something that providers should do (91%). However, the majority also had doubts about whether suicide is preventable (60%).

Discussion: Despite expressing high levels of support for the acceptability and effectiveness of lethal-means counseling, high proportions of emergency nurse leaders expressed skepticism regarding the preventability of suicide, a finding consistent with previous work. Our results support the need to address and modify misperceptions about prevention of suicide in any efforts for widespread implementation and dissemination of lethal-means counseling.

Keywords: Counseling; Emergency department leader; Firearm; Lethal means; Suicide prevention.

Figure 1. Perceptions of emergency nurse leaders on ED-based lethal means counseling (N=190, weighted estimates presented)

^aQuestion polarity reversed for presentation clarity; original question was “Health care professionals should not talk to patients about what to do with their firearms.” Missing data not shown. ^bQuestion response range was “very unlikely” (lightest grey), “somewhat unlikely”, “somewhat likely”, and “very likely” (black). ^cMissing/don’t know>5% (see text). Also note that greater agreement with the third question (“if someone is suicidal they will find a way…”) indicates greater skepticism about the preventability of suicide.