Alan LeFollow

Date of Submission

Spring 4-23-2021

Document Type


Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Dr. Trinette Radasa

Second Advisor

Dr. Alexa Curtis


Background: Environmental hazards are a factor in the bulk of inpatient suicide cases, which disproportionately impact psychiatric patients. Current measures to minimize suicide risk include process-oriented solutions and environmental safeguards such as breakaway structures.

Aims: To perform a review of the literature that identifies environmental suicide hazards and interventions implemented to abate hazards and reduce suicide risk.

Methods: Electronic databases were searched using relevant keywords. Inclusion criteria consisted of articles published 2009-2020 that identified environmental suicide hazards or examined efficacy of interventions implemented to abate hazards. The Johns Hopkins Research and Non-Research Evidence Appraisal Tools were used for critical appraisal.

Results: Final article yield consisted of one level V-B literature review, one level II-B quasi experimental research study, and five level III-B non-experimental descriptive studies. Checklists and structural interventions demonstrated statistically significant reductions in inpatient suicides. The most common environmental hazards were ligatures (sheets/bedding) and ligature points (door fixtures) used in hanging.

Conclusions: Findings have valuable clinical implications, such as providing guidance in the systematic elimination of more commonly occurring hazards and support the use of structural and checklist interventions alongside existing suicide prevention measures. However, additional research is needed on efficacy in different settings.