N682 Module 6 assignment: high-risk behavior paper, a full sample

Four Questions and the Next Hour: The School Nurse's Response to Adolescent Suicide Risk

Student Name

Master of Science in Nursing Program, Aspen University

N682: School Nursing

Instructor Name

Month Day, Year

Four Questions and the Next Hour: The School Nurse's Response to Adolescent Suicide Risk

Suicide is among the leading causes of death for adolescents in the United States, and many young people who die by suicide had contact with a health professional in the months before. School nurses see students every day, often for complaints such as headaches, stomachaches or sleep problems that can accompany depression. That makes the health office one of the places where risk can be recognized. This paper describes the scope of the problem, a brief screening approach suitable for the health office, the steps a school nurse takes after a positive screen, and the nurse's role when a student returns to school after a crisis, using a composite suburban high school of 1,650 students as its setting.

The Scope of the Problem

The most recent national survey of high school students found that 39.7% had experienced persistent feelings of sadness or hopelessness during the past year, 20.4% had seriously considered attempting suicide and 9.5% had attempted suicide, with rates differing by sex, sexual identity, grade, and race and ethnicity. Every protective factor examined, including feeling connected to school and to adults at school, was associated with lower prevalence of one or more risk indicators (Verlenden et al., 2024). Applied to the composite high school, those figures suggest that more than 300 students have seriously considered suicide in the past year, far more than the counseling staff will ever learn about through referrals alone. The finding about school connectedness also suggests that the relationships students have with adults at school, including the nurse, are part of prevention.

Screening in the Health Office

Screening works only if it is brief, validated and followed by a clear response. The Ask Suicide-Screening Questions tool was developed in pediatric emergency departments for patients aged 10 to 21. In its development study of 524 young people, four questions, asking about recent wishes to be dead, feeling that the family would be better off without the patient, recent thoughts of suicide and any past attempt, identified those at elevated risk with a sensitivity of 96.9% and a specificity of 87.6% (Horowitz et al., 2012). A fifth question, asked when any answer is yes, asks about current thoughts of suicide and determines whether the situation is urgent.

The composite school's nurses use the tool in two ways. They ask the questions of any student whose visit suggests possible depression, such as repeated somatic complaints, a disclosure of stress or a teacher's concern, and of every student seen after self-harm or substance use. They ask in private, explain that they ask many students these questions, and do not ask in front of friends. The tool was developed in emergency departments rather than schools, so the district's mental health team reviews its use each year, and a positive screen always leads to a full assessment by a qualified mental health professional rather than a decision by the nurse alone.

Nurses also prepare for the moment a student answers yes. Each nurse practices the conversation in a role play with the school psychologist at the start of the year, including how to thank the student for being honest, how to explain what will happen next, and how to stay calm. Students notice when an adult is frightened by their answer, and a steady response makes it more likely that they will keep talking.

The Next Hour

What happens after a positive screen matters more than the screen. The district protocol sets out steps for the next hour. The student is never left alone and is not sent back to class or to the bathroom unaccompanied. If the student answers yes to current thoughts of suicide, the nurse calls the school's crisis team immediately and, if the student has a plan or means at hand, calls emergency services. For a non-urgent positive screen, the nurse contacts the school counselor or psychologist, who completes a risk assessment the same day. The parent or guardian is contacted unless there is reason to believe that contact would increase danger, in which case child protective services are involved. The nurse documents the screen, the actions taken and the times.

Before the student leaves, the counselor and student complete a safety plan: a short written list of the student's warning signs, coping strategies the student can use alone, people and places that provide distraction, people to ask for help, professionals and crisis lines, and steps to make the environment safer, especially limiting access to firearms and medications (Stanley & Brown, 2012). The nurse's contribution is to talk with the parent about safe storage of medications at home and to make sure the student and family know how to reach the crisis line.

Returning to School

Students who have been hospitalized after a suicide attempt or crisis return to a school that may feel overwhelming: missed work, questions from peers and the anxiety of being watched. The composite school holds a reentry meeting before the student returns, with the student, family, counselor, nurse and an administrator, and with the hospital's discharge recommendations if the family agrees to share them. The plan sets a gradual return if needed, adjusted workload, a trusted adult the student can go to during the day and a quiet place to go when overwhelmed. The nurse's role includes managing any new medications at school, watching for side effects, and serving as one of the daily points of contact, since students may find it easier to visit the health office than the counseling office.

Over the following weeks, the nurse, counselor and family keep in touch, and the plan is reviewed after two weeks and again after a month. The nurse documents health office visits and shares patterns, such as a return of frequent visits, with the counselor.

Conclusion

Suicide risk among adolescents is common enough that every high school health office will encounter it. School nurses can recognize risk with four brief, validated questions, respond in the next hour with a protocol that keeps the student safe and connects them to mental health professionals and family, contribute to safety planning, and support students when they return from a crisis. Because connection to caring adults at school protects students, the nurse's daily relationships with students are part of prevention as well as response.

References

Horowitz, L. M., Bridge, J. A., Teach, S. J., Ballard, E., Klima, J., Rosenstein, D. L., Wharff, E. A., Ginnis, K., Cannon, E., Joshi, P., & Pao, M. (2012). Ask Suicide-Screening Questions (ASQ): A brief instrument for the pediatric emergency department. Archives of Pediatrics & Adolescent Medicine, 166(12), 1170-1176. https://doi.org/10.1001/archpediatrics.2012.1276

Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264. https://doi.org/10.1016/j.cbpra.2011.01.001

Verlenden, J. V., Fodeman, A., Wilkins, N., Jones, S. E., Moore, S., Cornett, K., Sims, V., Saelee, R., & Brener, N. D. (2024). Mental health and suicide risk among high school students and protective factors: Youth Risk Behavior Survey, United States, 2023. MMWR Supplements, 73(4), 79-86. https://doi.org/10.15585/mmwr.su7304a9