This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.
Suicide is a major public health problem, which affects people of all ages and ethnicities. Despite being preventable, the rates of suicide have steadily climbed (more than a third) over the past 2 decades.
Nurse practitioners (NPs) must be responsible for recognizing suicide risk and providing appropriate treatment referrals in addition to having an important role in suicide prevention. The reasons why NPs may not pursue suicide prevention training are their lack of suicide awareness and prevention, limited experiences with suicidal patients, and the stigma associated with mental illness. Before we begin to address the gaps within suicide awareness and prevention skills, we need to first examine NPs’ knowledge of and attitudes (stigma) toward suicide prevention.
This study will comprise a mixed methods approach. First, quantitative data will be collected using the
This study was funded by the Faculty Research Grants program through the Office of the Vice Chancellor for Research and Economic Development at the University of North Carolina at Charlotte. Institutional review board approval was obtained in April 2022. Recruitment occurred between summer and winter 2022. Interview conduction began in December 2022 and will conclude in March 2023. Data will be analyzed during spring and summer 2023.
The study results will add to the literature on NPs’ knowledge of and attitudes (stigma) toward suicide prevention. It represents a first step in addressing gaps within suicide awareness and prevention skills, among NPs in their respective practice settings.
PRR1-10.2196/39675
Suicide is a major public health problem, which affects people of all ages and ethnicities [
Moreover, many recovering patients with COVID-19 or those in the postacute phase experience psychosocial difficulties and such as loss of employment and financial distress. They also experience physical symptoms for an extended period [
In North Carolina, suicide is the third leading cause of death for children and young adults aged 10-34 years, the fourth cause of death in adults aged 35 to 54 years, ninth leading cause of death for those aged 55-64 years, and 17th leading cause of death for those aged 65 years and older [
Our long-term research goal is to increase suicide knowledge and awareness among NPs in the state of North Carolina. The purpose of this study is to use the Theory of Nursing Care of Patients at Risk of Suicide [
The aims of this study are to (1) explore NPs’ knowledge of and attitudes toward suicide awareness and prevention; (2) examine the differences in NPs’ suicide awareness and prevention skills based on practice specialty; (3) identify enablers and barriers to NPs’ awareness and confidence of suicide prevention skills.
Billings [
An observational mixed methods approach will be used for this study. Because the data collection questionnaires include forced choices and the prevention needs of NPs based on specialty practice have not been explored, the mixed method design is appropriate to address the objectives of the study. Descriptive statistics will be used to compute means and SDs for numerical variables and frequencies for categorical variables. Demographic and background information regarding age, gender, professional role, education, and previous suicide prevention training will be collected [
A cross-sectional survey design including a series of interviews for a small selection of nurses who have completed the survey will be used. Qualitative interviews will be audio recorded and fully transcribed removing any identifiable data to preserve participant anonymity [
First, quantitative data will be collected using the
The Suicide Knowledge and Skills Questionnaire [
Participants will report demographic data such as age, gender, specialty, education level, years of NP experience, previous suicide prevention training, and experience with suicidal patients.
The researchers will use the North Carolina Board of Nursing database for NPs registered to practice in the state. Inclusion criteria are as follows: (1) a licensed NP in the state of North Carolina and (2) able to give consent. Exclusion criteria include not being able to provide consent and not being a NP in the state of North Carolina. Our study is powered to detect the primary outcome of suicide knowledge subscale differences among nursing specialties and controlling for other demographic characteristics. Smith et al [
First, quantitative data will be collected using survey data via a questionnaire. An email will be sent to the NPs, and upon consent, they will have to access the surveys on a secure site. The quantitative component will utilize semistructured interviews via Zoom (Zoom Video Communications, Inc). An interview guide will be developed guided by the Theory of Nursing Care of Patients at Risk of Suicide [
Demographic data will be analyzed using descriptive statistics. Differences in questionnaire responses across specialists while controlling for other demographic characteristics will be analyzed with ANCOVA. These data will be analyzed using Statistics for Macintosh (version 28, IBM Corp).
Our qualitative data sampling strategy will use NPs who complete the quantitative surveys. NPs will be able to indicate if they are interested in participating in a virtual interview lasting about 50 minutes to identify facilitators and barriers to suicide knowledge and awareness. A representative sample of NPs based age, gender, ethnicity, specialty practice, and location (rural vs urban) using an address to identity (N=15 or until saturation) will be interviewed for part two of the study.
The semistructured interviews will be recorded and transcribed verbatim. The data will be managed using NVivo software (QSR International) for content analysis and analyzed for points of convergence and divergence.
Participants will be informed that safeguards have been put in place to protect confidentiality and anonymity. All study-related information and spreadsheets will be stored in a locked office and file cabinet. All participant information will be coded by identification number to maintain confidentiality. We will protect confidentiality by removing all identifiers. Only members of the research team will have access to the data, and only aggregate data will be presented for publication.
Approval from the University of North Carolina at Charlotte institutional review board (IRB-22-0925) was required since the protocol is categorized as a research study [
The instruments and the reliability and validity values to be used in our pilot study are shown in
Instruments and reliability values of this study.
Study outcome | Instrument | Reliability values |
Demographic survey: participants will report demographic data such as age, gender, specialty, education level, years of nurse practitioner experience, previous suicide prevention training, and experience with suicidal patients. | Demographic survey | N/Aa |
Nurse practitioner knowledge and skills-Suicide | Suicide Knowledge and Skills Questionnaire [ |
Cronbach α score of .84 |
Nurse practitioner stigma-suicide | Suicide Stigma Scale (Brief version) [ |
Cronbach α score of .98 |
aN/A: not available.
The project can be completed within 12 months. We anticipate no problems in recruiting subjects for the proposed study. The timeline for this study is shown in
Research tasks timeline.
Research tasks | Jan-Apr 2022 | May-Dec 2022 | Dec-Feb 2023 | Feb-May 2023 |
Obtain institutional review board approval, send surveys, and email reminders | ✓ | —a | — | — |
Recruit for qualitative interviews and analyze quantitative data | — | ✓ | — | — |
Conduct interviews and analyze data | — | — | ✓ | — |
Interpret and compare data and disseminate findings | — | — | — | ✓ |
Apply for funding | — | — | — | ✓ |
aNot applicable.
In this pilot feasibility study, we will have a sample of convenience, which may result in response bias. We are recruiting participants who are NPs in the state of North Carolina. Hence, the findings may be different from those who are MDs or PAs. For future research, we may consider the inclusion of additional clinicians like MDs or PAs. The strengths include the capacity to reach all registered NPs in the state of North Carolina.
The institutional review board’s approval was obtained in April 2022. Recruitment occurred between summer and winter 2022. Data analysis is to be completed by the second quarter of 2023. Our study is expected to conclude in the second quarter of 2023. We will submit a manuscript for publication consideration by the third quarter of 2023.
We hypothesize that NPs will endorse self-efficacy working with suicidal clients, familiarity using evidence-based assessment procedures, and identifying best practices for suicide prevention [
In this study, we describe a protocol for examining NPs’ knowledge of and attitudes (stigma) toward suicide prevention. This represents a first step in addressing gaps within suicide awareness and prevention skills, among NPs in their respective practice settings or sites. Telepsychiatry interventions and digital tools (eg, mobile apps, internet chatbots, and videoconferencing) have proliferated rapidly in response to the COVID-19 emergency [
We have developed a strategic dissemination plan. The research process and our findings will be shared with university colleagues and clinical providers, in a peer-reviewed journal, and at a research conference.
This study will close the gap in identifying NPs’ knowledge of and attitudes toward suicide awareness and prevention. In addition, the results with help to examine differences in NPs’ suicide awareness and prevention skills based on practice specialty. Finally, we expect our results to identify enablers and barriers to NPs’ awareness and confidence in suicide prevention skills. The study’s findings will add to the current literature on NPs’ knowledge of and attitudes (stigma) toward suicide prevention. Our study results may inform practice, policy, further research, and training. The results may shape how members of the health care system respond to people who are at risk of suicide and their families [
Interview guide.
analysis of covariance model
emergency department
interpretative phenomenological analysis
medical doctor
nurse practitioner
physician assistant
Suicide Opinions Questionnaire
This project is funded by the Faculty Research Grants program through the Office of the Vice Chancellor for Research and Economic Development at the University of North Carolina at Charlotte.
The data sets generated during or analyzed during this study are not publicly available but are available from the corresponding author on reasonable request.
None declared.