Date of Conferral

8-11-2026

Date of Award

August 2026

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Susan Huehn

Abstract

This organization change process evaluation addressed continued reliance on outdated no-suicide and no-harm contracts in an outpatient psychiatric setting, despite evidence that such contracts do not reduce suicide risk and may create a false sense of security. Adult outpatients with mood or psychotic disorders who express safety concerns represent a population for whom structured, collaborative safety planning is the accepted standard of care. Addressing this gap is central to patient safety and quality nursing care. The practice-focused question asked whether replacing no-suicide contracts with a structured, six-step Safety Planning Intervention would influence safety events, self-harm behaviors, and psychiatric hospitalizations among adult outpatients with major depressive disorder, bipolar disorder, or schizophrenia. Effectiveness was evaluated using deidentified data through descriptive chart review across pre- and post-implementation periods, with structured staff input. Pre-implementation review found no documented structured safety intervention in place. Following implementation, half of eligible patients completed the intervention, and outcomes among completers were favorable, with most remaining free of documented suicide attempt and self-harm. The major product was a standardized, evidence-based safety planning process. Limitations included the single-site scope and the absence of a quantified baseline rate. Implications include strengthened suicide prevention care, positive social change through improved patient safety and reduced emergency service use, and support for diversity, equity, and inclusion through an accessible, low-anxiety tool.

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