Journal of the American Psychiatric Nurses Association

 

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Journal of the American Psychiatric Nurses Association, Vol. 5, No. 1, 23-28 (1999)
DOI: 10.1177/107839039900500105

No-Suicide Contracts to Prevent Suicidal Behavior in Inpatient Psychiatric Settings

Barbara L. Drew, RN, MSN

Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Ave., Cleveland, OH 44106-4904.

BACKGROUND: Many individuals who are hospitalized on psychiatric units are at high risk of suicide. Among the strategies commonly recommended for suicide prevention is the negotiation of a no-suicide or no-harm contract. In spite of the conventional acceptance of no-suicide contracts, there is little research about this intervention.

OBJECTIVE: To describe the use of no-suicide contracts in inpatient settings including the frequency of their use, the circumstances under which they are negotiated and the form of contracts.

STUDY DESIGN: Descriptive survey.

RESULTS: No-suicide contracts were used by 79% (n = 66) of the hospitals (N = 84). Contracts were generally negotiated after suicidal ideation was expressed (83% [n = 54] of those hospitals that use contracts), after self-harm (79%, n = 51), or after a patient who made a suicidal gesture or attempt was admitted (65%/, n = 42). In all but one hos- pital, nurses negotiated contracts with patients. Contracts were usually verbal (74%/, n = 48) or handwritten (72%, n = 47) rather than preprinted (15%, n = 10). Fifty-three percent of the respondents estimated more than 10 incidents of suicidal behavior by inpatients per year.

CONCLUSIONS: Suicidal behaviors occurred in hospital settings at a rate that is clinically significant. No-suicide contracting is a common nursing practice in psychiatric inpatient settings in Ohio. Contracts are not indiscriminately used but are negotiated when high suicide risk is assessed.


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