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Ali, N. A. A. M., & Hussein, H. A. (2022). Effectiveness of an educational program on
nurses’ knowledge about factors contributing to suicide. International Journal of Health
Sciences, 6(S4), 3651–3659. https://doi.org/10.53730/ijhs.v6nS4.9183
International Journal of Health Sciences ISSN 2550-6978 E-ISSN 2550-696X © 2022.
Manuscript submitted: 27 March 2022, Manuscript revised: 18 May 2022, Accepted for publication: 9 June 2022
3651
Effectiveness of an educational program on
nurses’ knowledge about factors contributing to
suicide
Nada Abd Ali Mohammed Ali
PhD. Student/ Psychiatric-Mental Health Nursing Department/College of Nursing
– University of Baghdad
Corresponding author email: nada.abdali1105a@conursing.uobaghdad.edu.iq
Dr. Hassan A. Hussein
Assistant professor, Psychatric Mental Health Department, College of Nursing,
University of Baghdad, College of Nursing, Iraq
Abstract---Background: Suicide is linked to unmet needs,
hopelessness and helplessness, an ambiguous conflict between
survival and excruciating stress, a shrinking of seen options, and a
wish for escape, the suicidal person's distress signal. Material and
Method:A convenience sample was recruited from the aforementioned
hospitals. Based on an effect size of 0.25, an alpha error probability of
0.05, a power of 0.80, number of groups = 2, and 3 measurements,
the total sample size would be 72 who work in the previous mentioned
setting were selected randomly for this study. The final sample size
would be 72; 36 for the study group and 36 for the control group.A
quasi-experimental design with study and control groups was used in
this study, pretest-posttest research design was used in this study.
The study was carried out in Al-Rashad Psychiatric Teaching Hospital
and Ibn Rushd Psychiatric Teaching Hospital in Baghdad City. Data
were analyzed using the statistical package for social science (SPSS)
for windows, version 26. Results: The finding of study show that the
mean age for participants in the study group is 31.05 ± 6.68; a half
age 20-29-years (n = 18; 50.0%), followed by those who age 30-39-
years (n = 12; 33.3%), and those who age 40-49-years (n = 6; 16.7%).
For the control group, the mean of age is 34.33 ± 10.24; more than a
third age each of 20-29-years and 30-39-years (n = 13; 36.1%) for
each of them, followed by those who age each of 40-49-years and 50-
59-years (n = 5; 13.9%) for each of them. Conclusion: The student
researcher concluded that the administered educational program
positively influenced nurses’ knowledge about factors contributing to
suicide.
3652
Keywords---effectiveness, educational program, nurses’ knowledge
factors, contributing suicide.
Introduction
Suicide is linked to unmet needs, hopelessness and helplessness, an ambiguous
conflict between survival and excruciating stress, a shrinking of seen options, and
a wish for escape, the suicidal person's distress signal (1,2,3) . Psychiatric nurses
assist people in healing and recovering, as well as promoting mental health and
well-being. As a result, nurses may face interpersonal issues while trying to keep
someone alive who doesn't want to survive (4,5) . Effective nursing care provided by
psychiatric nurses can be the difference between life and death for patients. Each
suicide-related death emphasizes the need for nurses to improve and advance the
quality of nursing care they deliver, which includes developing effective prevention
technique (6,7) .
This strategy was publicly accepted by Health Ministers in all 194 WHO member
states to emphasize the importance of mental health, a significant achievement.
There are 25 nations in the WHO member states where suicide is still illegal, and
another 20 countries where suicide attempters may face jail time under Sharia
law (8,9,10) . The Action Plan outlines specific efforts targeted at improving mental
health and contributing to the achievement of a set of global goals, including (a) a
20% increase in service coverage for serious mental diseases and (b) a 10%
reduction in suicide rates in nations by 2020.
Stigmatization in society can contribute to behaviors such as isolation, a
contributing risk factor for suicidal thoughts and behaviors. Increased substance
use among the population has also been found to partially mediate the
relationship between minority stress and increased likelihood of suicidal ideation
(11,12). A case-control study found that among individuals who died by suicide,
factors related to death included rejection by family, negative feelings towards
self-related to gender and identity, and dissatisfaction with appearance (13,14,15) .
Developing a caring and inclusive environment in the health care setting is one
approach for improving cultural humility and improving care for this population
(16,17). Including educational content on developing a safe and inclusive
environment for assessment, treatment, and management of suicide risk across
diverse identities is an important dimension to address in suicide prevention
training programs to meet the needs of populations at increased risk. The Veteran
population comprises approximately 20% of deaths that occur by suicide in the
United States (18) .
The field of suicide prevention, universal strategies are approaches that target the
whole population. Conducting suicide risk assessments in the health care setting
provides a prime opportunity for health care providers to identify and intervene
with individuals at risk for suicide, even when emotional and behavioral health
diagnoses are not the primary cause for seeking health care. The diverse
population of individuals served in the health care setting and the private nature
of health concerns discussed with provider’s positions providers to assess and
3653
intervene. Previous research demonstrating high health care utilization patterns
among individuals who die by suicide in the month prior to their death (19,20,21)
supports health care settings as an avenue for assessment and intervention. One
study confirmed the feasibility of universal suicide risk screening in the
emergency department, under the conditions of adequate resources.
Material and Method
Study Design
A quasi-experimental design with study and control groups was used in this
study, pretest-posttest research design was used in this study.
Study Setting
The study was carried out in Al-Rashad Psychiatric Teaching Hospital and Ibn
Rushd Psychiatric Teaching Hospital in Baghdad City.
Study Sample
A convenience sample was recruited from the aforementioned hospitals. Based on
an effect size of 0.25, an alpha error probability of 0.05, a power of 0.80, number
of groups = 2, and 3 measurements, the total sample size would be 72 who work
in the previous mentioned setting were selected randomly for this study. The final
sample size would be 72; 36 for the study group and 36 for the control group.
Study Instrument
The study instrument consists of participants’ sociodemographic sheet (age,
gender, and marital status), employment profile (educational qualification, years
of experience in nursing, years of experience in psychiatric units, and nurse-to-
bed ratio. It also includes Nurses’ Knowledge about Suicide Prevention Scale (4
items about suicide concept) and (5 items prevalence of Suicide), (15 items
factors of suicide), (19 items psychiatric symptoms of suicide), (14 items
psychiatric diseases caused suicide), (8 items methods of suicide), (8 items ethics
of nurses to deal with suicidal person), (8 items method of suicide treatment) and
(41 items the role of nurses in suicide prevention).
Study Procedure
After obtaining the agreements from the ethical scientific committee at the College
of Nursing, the Ministry of Planning, and the Ministry of Health, the student
researcher made a baseline assessment for the knowledge about suicide
prevention for nurses in each of the study and control groups (pretest) using the
aforementioned study instrument. One week later, the student researcher will
administer the suicide prevention program for nurses in the study group
only.Three weeks later, the researcher conducted the posttest I and posttest II
three weeks after posttest I. The study was conducted in April 2021 and finished
in July 2021.
3654
Tools of the study
Pilot study
A pilot study was conducted on 10 nurses who worked at Al-Rashad Mental
Health Hospital to test the readability the study instrument, and the time
required for subjects to answer all items. The time required for answering all
items ranges between 25-30 minutes.
Data Analyses
Data were analyzed using the statistical package for social science (SPSS) for
windows, version 26. The descriptive statistical measures of frequency and
percent will be used. The inferential statistical measures of Pearson correlation,
Repeated-Measures ANOVA, Independent-Sample T-Test, and One-Way Analysis
of Variance (ANOVA) will be used.
Results
Table 1. Participants’ Sociodemographic Characteristics
Study (N = 36)
Control (N = 36)
Frequency
Percen
t
Frequenc
y
Percent
Age (Years)
20-29
30-39
40-49
50-59
18
12
6
0
50.0
33.3
16.7
0.0
13
13
5
5
36.1
36.1
13.9
13.9
Mean (SD)
31.05 ± 6.68
34.33 ± 10.24
Gender
Male
Female
12
24
33.3
66.7
16
20
44.4
55.6
Marital Status
Single
Married
Divorced
12
22
2
33.3
61.1
5.6
14
21
1
38.9
58.3
2.8
Level of Education
Nursing high school
Diploma
Bachelor's degree
Master’s degree
16
10
8
2
44.4
27.8
22.2
5.6
12
12
10
2
33.3
33.3
27.8
5.6
Table 2. Descriptive Statistics for the Values of the knowledge about factor
contributing to suicide rate over Time
Knowledge about factor contributing to suicide
Mean
Std.
Deviation
N
Study Pretest
23.63
1.97
36
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Study Posttest I
25.25
1.15
36
Study Posttest II
26.33
1.35
36
Control Pretest
23.36
1.75
36
Control Posttest I
23.44
1.66
36
Control Posttest II
23.52
1.62
36
Table 3. Multivariate Tests of the Within-subjects for the knowledge about factor
contributing to suicide
Multivariate Testsa
Effect
Value
F
Hypothe
sis df
Error
df
Sig.
Partial Eta
Squared
Factors
(Study)
Pillai's Trace
.559
21.563
b
2.000
34.000
.00
0
.559
Wilks' Lambda
.441
21.563
b
2.000
34.000
.00
0
.559
Hotelling's Trace
1.268
21.563
b
2.000
34.000
.00
0
.559
Roy's Largest
Root
1.268
21.563
b
2.000
34.000
.00
0
.559
Effect
Value
F
Hypothe
sis df
Error
df
Sig.
Partial Eta
Squared
Factors
(Control)
Pillai's Trace
.133
2.615b
2.000
34.000
.08
8
.133
Wilks' Lambda
.867
2.615b
2.000
34.000
.08
8
.133
Hotelling's Trace
.154
2.615b
2.000
34.000
.08
8
.133
Roy's Largest
Root
.154
2.615b
2.000
34.000
.08
8
.133
a. Design: Intercept Within Subjects Design: Knowledge about factors
contributing to suicide
b. Exact statistic
Table 4. Tests of Within-Subjects Effects for the knowledge about factors
contributing to suicide
Source
Type III
Sum of
Squares
df
Mean
Square
F
Sig.
Partial Eta
Squared
Factors
(Study)
Sphericity
Assumed
132.352
2
66.176
31.37
4
.000
.473
Greenhouse-
Geisser
132.352
1.612
82.112
31.37
4
.000
.473
Huynh-Feldt
132.352
1.678
78.873
31.37
4
.000
.473
Lower-bound
132.352
1.000
132.352
31.37
4
.000
.473
Error
Sphericity
147.648
70
2.109
3656
(Factors
Study)
Assumed
Greenhouse-
Geisser
147.648
56.41
4
2.617
Huynh-Feldt
147.648
58.73
1
2.514
Lower-bound
147.648
35.00
0
4.219
Source
Type III
Sum of
Squares
df
Mean
Square
F
Sig.
Partial Eta
Squared
Factors
(Control)
Sphericity
Assumed
.500
2
.250
3.621
.032
.094
Greenhouse-
Geisser
.500
1.590
.315
3.621
.043
.094
Huynh-Feldt
.500
1.653
.302
3.621
.041
.094
Lower-bound
.500
1.000
.500
3.621
.065
.094
Error
(Factors
Control)
Sphericity
Assumed
4.833
70
.069
Greenhouse-
Geisser
4.833
55.64
3
.087
Huynh-Feldt
4.833
57.86
1
.084
Lower-bound
4.833
35.00
0
.138
Discussion
Table(1)show that the mean age for participants in the study group is 31.05 ±
6.68; a half age 20-29-years (n = 18; 50.0%), followed by those who age 30-39-
years (n = 12; 33.3%), and those who age 40-49-years (n = 6; 16.7%). For the
control group, the mean of age is 34.33 ± 10.24; more than a third age each of 20-
29-years and 30-39-years (n = 13; 36.1%) for each of them, followed by those who
age each of 40-49-years and 50-59-years (n = 5; 13.9%) for each of them.
Concerning gender, most in the study group are females (n = 24; 66.7%)
compared to males (n = 12; 31.4%). For the control group, most are females (n =
20; 55.6%) compared to males (n = 16; 44.4%). Regarding the marital status, most
in the study group are married (n = 22; 61.1%), followed by those who are singles
(n = 12; 33.3%), and those who are divorced (n = 2; 5.6%). For the control group,
most are married (n = 21; 58.3%), followed by those who are singles (n = 14;
44.4%), and one who is divorced (n = 1; 2.8%).With respect to the level of
education, more than two-fifth in the study group are nursing high school
graduates (n = 16; 44.4%), followed by those who hold a diploma degree (n = 10;
27.8%), those who hold a bachelor’s degree (n = 8; 22.2%), and those who hold a
master’s degree (n = 2; 5.6%).For the control group, a third are both nursing high
school graduates and hold a diploma degree (n = 12; 33.3%) for each of them,
followed by those who hold a bachelor’s degree (n = 10; 27.8%), and those who
hold a master’s degree (n = 2; 5.6%).Table(2)This table demonstrated that the
values of the nurses’ knowledge about factor contributing to suicide for the study
group noticeably increase by time compared to the control group (Pretest = 23.63
3657
vs. 23.36, Posttest II = 25.25 vs. 23.44, Posttest II = 26.33 vs. 23.52) respectively.
Higher score means better knowledge. Table(3) There are significant differences in
the values of knowledge about factors contributing to suicide over time for
participants in the study group (F = 21.563, df = 2, p < .05). Finally Table (4)
There was a (a priori p = 0.01) significant difference (F (1.612, 56.414) = 31.374, p
= 0.01) in the knowledge about factors contributing to suicide over time for
participants in the study group. The omnibus effect (measure of association) for
this analysis is .473, which indicates that approximately 47% of the total variance
in the value of knowledge about suicide rate is accounted for by the variance in
the administered intervention.For the control group, there was a (a priori p =
0.05) significant difference (F (1.590, 55.643) = 3.621, p = 0.05) in the knowledge
about factors contributing to suicide over time for participants in the study group.
The omnibus effect (measure of association) for this analysis is .094, which
indicates that approximately 0.9% of the total variance in the value of knowledge
about factors contributing to suicide is accounted for by the chance .In the study
group in the pretest time statistically differ from such knowledge in the posttest I
and posttest II. Such a knowledge in the posttest I statistically differs from that in
the pretest time and posttest II. Such knowledge in the posttest II statistically
differs from that in the pretest time and that in the posttest I and posttest I.
These findings reflect the positive effect of the administered educational program
in enhancing nurses’ knowledge about the nurses’ overall knowledge and the
consistency of the administered educational program in enhancing such a
knowledge. These findings are supported by (22) who concluded that there are
significant increases in the values of subjects’ knowledge about suicide from
pretest to posttest. These findings almost go in line with these of (23,24) who
concluded that there was a significant improvement in intervention participants
in terms of perceived knowledge of/willingness to help suicidal patients
immediately after training and when compared with the control participants 3
months later (25,26,27).
Conclusion
The student researcher concluded that the administered educational program
positively influenced nurses’ knowledge about factors contributing to suicide.
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