Nurses’ Roles and Responsibilities in Suicide Prevention: A Scoping Review

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As frontline caregivers, nurses play a crucial role in identifying and supporting those at risk. Despite their central role, the specific contribution of nurses to suicide prevention across various care settings has not been mapped comprehensively. This scoping review aims to identify potential roles and responsibilities of nurses in suicide prevention within adult care settings from an international perspective. Methods: The review followed the methodological framework for scoping reviews outlined by the Joanna Briggs Institute. A comprehensive search of peer-reviewed empirical studies, case reports, guidelines, standards, policy papers, discussion papers and professional codes was conducted in MEDLINE, CINAHL and PsycInfo. Results: A total of n = 25 sources published between 1993 and 2024 in countries across Europe, Asia, North America and Australia were included. Six overarching roles of nurses were identified: Early Detection and Risk Assessment , Relationship-Building and Communication , Education and Advocacy , Risk Management , Interdisciplinary Collaboration and Personal and Professional Self-Management . Each role encompasses specific responsibilities, reflecting the complex and multifaceted nature of nurse’s involvement. The findings further indicate that nurses contribute meaningfully across universal, selective and indicated suicide prevention strategies. Conclusions: Nurses play a crucial role in suicide prevention. However, to fully leverage their potential, institutional and systemic changes are needed, including enhancing training, organizational support and policy-level recognition. This serves the best interests of individuals in suicidal and existential crises and their care-related supports needs, addressing both their existential distress and their care-related support needs. Future research should focus on evaluating the implementation and effectiveness of nurses’ contribution to suicide prevention across diverse cultural and healthcare contexts, with the aim of strengthening nurses’ role in suicide prevention globally. Nurse Suicide Prevention Suicide Role Responsibility Figures Figure 1 1 Background Suicide remains a significant and urgent public health issue, claiming the lives of over 720,000 people across the globe each year [1]. Suicidality is understood as a multifaceted phenomenon that encompasses “a range of behaviours that include thinking about suicide (or ideation), planning for suicide, attempting suicide and suicide itself“ [2, p. 12]. Research has also shown that adults in need of care – especially older adults – frequently develop a desire to die [3–5]. This desire is recognized as an expression of personal suffering [6] and can be a first sign of suicidality [7]. According to Balaguer et al. (2016) [6], such expressions can range from a passive wish to allow death to occur naturally, to an active wish to hasten its occurrence. This scoping review focuses on adult care settings, such as those involving older adults, where phenomena such as the desire to die – including requests for Medical Assistance in Dying (MAiD) – or suicidality may occur. There is broad consensus that suicide can be prevented through targeted and evidence-based intervention strategies [8–11]. Suicide prevention is recognized as a collective societal responsibility that requires coordinated, multidisciplinary collaboration and the active involvement of various stakeholders at both community and population levels [2, 12]. In this context, the WHO [2, 12] recommends a multi-level prevention approach, which includes universal measures addressing the general population, selective interventions for identified high-risk groups, and indicated measures targeted at individuals at acute risk for suicide. Suicide prevention is of particular relevance for individuals with severe and chronic mental or physical illnesses as well as those who receive long-term care and are at risk for suicide [13–20]. In particular, older adults in need of care constitute a high-risk population and should be specifically targeted by tailored suicide prevention strategies [21–23]. Nurses are widely recognized as frontline gatekeepers in the identification and management of individuals at risk for suicide [24–27]. Their close, ongoing contact with care recipients and the trusted relationships they build often lead nurses to encounter individuals expressing a desire to die [28–29], or requesting MAiD [30–33]. Additionally, research indicates that nurses face suicidality across a variety of care settings and contexts [34–37]. For the purpose of this scoping review, ‘a nurse ’ is defined in accordance with the International Council of Nurses (ICN) [38] as “a professional who is educated in the scientific knowledge, skills and philosophy of nursing, and regulated to practice nursing based on established standards of practice and ethical codes“ [38, p. 45]. The ICN [38, 39] further emphasizes the essential roles and responsibilities of nurses, highlighting their vital contributions to health promotion, illness prevention, the alleviation of suffering, and the enhancement of health literacy. Through evidence-based practice, the development of trusted relationships, informed decision-making, and risk management, nurses play a crucial role in safeguarding individuals in need of care [38]. While some reviews 1 examine suicide care and interventions from a nursing perspective [25, 40–43], none provide a comprehensive exploration of the potential roles and responsibilities of nurses in suicide prevention. To address this gap, this scoping review was conducted with the aim of identifying nurses’ potential roles and responsibilities in suicide prevention across adult care settings within an international context. Guided by the research elements Population/Participants, Concept and Context (PCC) as outlined by Peters et al. 2020 [44], the following research question was developed and explored: What are nurses’ roles and responsibilities in suicide prevention across adult care settings within an international context? 2 Methods 2.1 Design A scoping review approach was selected due to the objective of exploring the possible roles and responsibilities of nurses in suicide prevention [45]. This scoping review is based on the framework outlined by Peters et al. (2020) [44] and includes the following steps: 1. Defining the objective and research question, 2. Establishing criteria for selecting relevant sources, 3. Outlining the planned approach to searching, selecting, extracting and presenting evidence, 4. Identifying relevant sources, 5. Applying inclusion/exclusion criteria to choose eligible sources, 6. Collecting relevant data from included sources, 7. Analyzing extracted data in line with the research objective, 8. Organizing and reporting the findings and 9. Summarizing findings, drawing conclusions and discussing implications. An a priori protocol was developed and registered in October 2024 on Open Science Framework (https://doi.org/10.17605/OSF.IO/QYXSR). This scoping review was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR), as outlined by Tricco et al. (2018) [46]. 2.2 Eligibility Criteria The inclusion and exclusion criteria were developed during the pre-registration phase, considering both content-related and formal methodological aspects. Following the recommendations by Peters et al. (2020) [44], the content-related inclusion criteria were defined in alignment with the core elements of the research question and aim. Accordingly, the scoping review includes evidence sources that meet the following content-related criteria: Population/Participants: Evidence sources were included if they reflected the perspectives of nurses with varying levels of professional qualification or if nurses were actively involved as participants. Sources were excluded if the population included other healthcare professionals alongside nurses and the data specific to nurses could not be extracted and analyzed separately. Concept: Evidence sources were included if they focused on the roles and responsibilities of nurses in suicide prevention, including the specific context of requests for MAiD. Sources were excluded if they addressed suicidality among nurses themselves, on the training or educational needs of nurses related to specific interventions or programs, or on the testing or evaluation of particular interventions, programs, or instruments. Context: Evidence sources were included if they focused on adult care settings in an international context. Sources were excluded if they examined non-care settings or focused exclusively on suicide prevention among children or adolescents. The formal methodological inclusion and exclusion criteria include “types of evidence sources”, “language” and “publication date”. The scoping review includes evidence sources that meet the following formal-methodological criteria: Types of evidence sources: As suggested by Peters et al. (2015) [47], a variety of study designs were considered for inclusion to ensure a comprehensive review of the existing scientific literature on the topic. In line with the research question, empirical studies – including qualitative, quantitative, and mixed-method research, case reports – published in peer-reviewed journals as well as reviews incorporating peer-reviewed empirical studies were considered relevant for inclusion. In addition, guidelines, standards, policy papers, discussion papers, and professional codes were also deemed appropriate for inclusion. Language: Evidence sources published in English and German were included, based on the language proficiency of the research team. Publication date: Evidence sources published in any year were considered for inclusion. Sources were eligible for inclusion up to November 22 nd 2024. 2.3 Search Strategy A comprehensive literature search was conducted in October and November 2024 by reviewer SF in the electronic databases MEDLINE via EBSCOhost, CINAHL via EBSCOhost, and PsycINFO via EBSCOhost to locate published and unpublished evidence sources [44]. The search strategy was developed in three stages [44]. As a first step, initial searches were conducted in MEDLINE via EBSCOhost and CINAHL via EBSCOhost by searching the terms “nurse“, “suicide“, “prevention“, “role“, “responsibility“ and “relationship“ as well as synonyms and related terms. Subsequent to the initial search, text words in the titles and abstracts of the retrieved publications were analyzed, along with the indexing terms assigned to them. As a second step, the identified terms were used to construct three distinct search strings – one for each database – by applying the Boolean operators “AND“ and “OR“, together with database-specific keywords and search syntax. The search strings were pretested, evaluated and refined according to the PRESS 2015 Guideline Evidence-Based Checklist by McGowan et al. (2016) [48]. Additionally, relevant publications identified during the initial searches were incorporated to validate and further optimize the search strategy [44]. Following this, a comprehensive second search was conducted in each included database using these tailored search strings. The complete search strategies for all databases are presented in Supplementary File 1 . As a third step, additional sources were identified through a review of the reference lists of records included in the review following full-text screening. 2.4 Screening and Selection Based on the predefined inclusion and exclusion criteria outlined above, the selection of papers was independently conducted by two reviewers (SF, EJ) in December 2024 and January 2025. This process was guided by the PRISMA-ScR statement [49] and comprised two stages: an initial screening of titles and abstracts, followed by full-text screening. Any disagreements between the reviewers were resolved by consensus, or, when consensus could not be reached, through consultation with the review team [44]. Prior to initiating the title and abstract screening, a total of n = 1.465 records were retrieved, using the developed search strings and imported into Rayyan [50]. Duplicates were identified automatically through Rayyan and manually removed by the first reviewer (SF), resulting in n = 952 records eligible for title and abstract screening. In accordance with Peters et al. (2020) [44], pilot testing of the source selection process was conducted prior to initiating full source selection, with the aim of refining the selection guidance. The selection guidance was pilot tested using a random sample of n = 25 records, which were independently screened by two reviewers (SF, EJ) according to the predefined eligibility criteria and accompanying definitions. Subsequently, the reviewers met to resolve any discrepancies and revised the eligibility criteria and guidance as necessary. Full dataset screening commenced only after achieving a minimum inter-rater agreement of 75%. The finalized screening guidance is provided in Supplementary File 2 . Relevant review articles were selected specifically to enable hand searching of their reference lists. However, they were excluded from data extraction and analysis. Supplementary File 3 presents a brief overview of the excluded sources, including the review articles. To assess inter-rater reliability, Krippendorff’s Alpha was applied [51], using the Krippendorff’s Alpha Calculator developed by Marzi et al. (2024) [52]. After screening titles and abstracts, Krippendorff’s Alpha was calculated at 0.840, reflecting a satisfactory level of inter-rater agreement for inclusion decisions. After the full-text screening, the coefficient increased slightly to 0.866. 2.5 Data Extraction and Analysis The data extraction process was conducted in February and March 2025 using the software MAXQDA. Prior to the final extraction, an extraction table was developed during the preregistration phase and further refined during the review phase [44]. To ensure that all relevant data were captured, a pilot test was independently conducted by two reviewers (SF and EJ) on a random sample of n = 5 sources. Following the approach outlined by Peters et al. (2020) [44], the final data extraction was performed by the first reviewer (SF), and the extracted data were subsequently verified by the review team. The finalized extraction guidance, provided in Supplementary File 4, includes general information about the sources (author/s, year of publication), their characteristics (country of origin, publication type, population/participants, context/setting), and the results relevant to the review question (concept). In line with the aims and research questions of this review, the analysis was conducted in April and May 2025 using MAXQDA, with a focus on identifying potential roles and responsibilities of nurses in the context of suicide prevention. The analysis utilized the basic qualitative content analysis approach as described by Pollock et al. (2023) [53]. In line with the inductive methodology underlying this approach, the data were systematically coded and organized into specific categories emerging from the material. These categories emerged through open coding of the dataset, based directly on the text [53]. Findings from the analysis are reported narratively. 3 Results 3.1 Search Results A comprehensive search across multiple databases yielded n = 1.465 records in total, including n = 565 from MEDLINE via EBSCO, n = 525 from CINAHL via EBSCO and n = 375 from PsycInfo via EBSCO. Figure 1 provides an overview of the entire identification and inclusion process. The screening tool Rayyan was employed to identify duplicate records, detecting n = 881 potential duplicates. After manual verification by the first reviewer (SF), n = 513 duplicates were confirmed and removed. The deduplication process resulted in n = 952 sources of evidence remaining for title and abstract screening. Following the title and abstract screening, n = 914 records were excluded for not meeting the predefined inclusion criteria. A total of n = 38 sources were considered potentially relevant and proceeded to full-text screening. Of these, n = 16 were excluded as they failed to meet one or more inclusion criteria related to population/participants, context, or concept or did not match the predefined publication type. Figure 1 provides detailed reasons for exclusion. Ultimately, n = 22 sources of evidence retrieved from the database search met all inclusion criteria and were included in the scoping review. Additionally, the reference lists of these n = 22 sources and n = 7 identified relevant review articles were hand searched, leading to the inclusion of n = 3 further sources of evidence. In total, n = 25 sources of evidence were included in the scoping review. 3.2 Characteristics of Included Sources of Evidence The included evidence was published between 1993 and 2024 in countries across Europe, North America, Asia and Australia. It comprises n = 1 discussion paper [54], n = 1 position paper [55], n = 14 qualitative studies [35, 36, 56–67], n = 4 quantitative studies [68–71], n = 1 mixed-methods study [72], n = 2 case studies [73, 74] and n = 2 guidelines [27, 75]. N = 1 qualitative study addressed suicide prevention in the context of MAiD through assisted suicide [65]. Another qualitative study specifically focused on nursing students [67]. Table 1 provides details of the included sources of evidence. Table 1: Characteristics of Included Evidence Sources Reference Country Type of Evidence Source Population/ Participants Context (Setting) Concept (Extracted Roles) (Anderson and Jenkins 2006) [54] England Discussion Paper Nursing Profession Mental Health Nursing Early Detection and Risk Assessment Education and Advocacy Risk Management Interdisciplinary Collaboration (Chijiiwa and Ishimura 2024) [56] Japan Qualitative Study General Home Visiting Nurses (GHVN) General Home Visiting Nursing Facilities that care for Patients with Physical Illnesses Early Detection and Risk Assessment Relationship-Building and Communication Interdisciplinary Collaboration (Darnell et al. 2023) [57] USA Qualitative Study N = 13 Acute and Intensive Care Nurses Urban level 1 Trauma Center Relationship-Building and Communication Risk Management Interdisciplinary Collaboration (Doyle et al. 2007) [68] Ireland Quantitative Study N = 42 Emergency Department Nurses N = 2 Teaching Hospitals Early Detection and Risk Assessment Relationship-Building and Communication Risk Management Interdisciplinary Collaboration (Eriksson et al. 2024) [36] Sweden Qualitative Study N = 10 Geriatric Nurses N = 4 Municipalities in Geriatric Nursing Early Detection and Risk Assessment Relationship-Building and Communication Education and Advocacy Risk Management Interdisciplinary Collaboration Personal and Professional Self-Management (Hagen et al. 2017) [58] Norway Qualitative Study N = 8 Mental Health Nurses N = 5 Psychiatric Wards within N = 2 Hospitals Early Detection and Risk Assessment Risk Management Personal and Professional Self-Management (Jansson and Graneheim 2018) [35] Sweden Qualitative Study N = 8 Registered Nurses, N = 4 Enrolled Nurses Outpatient Unit in a Psychiatric Clinic Early Detection and Risk Assessment Education and Advocacy Risk Management Personal and Professional Self-Management (Kusheba and Mulvihill 2018) [73] USA Case Study Clinical Nurse Leader Hospice Home Care Early Detection and Risk Assessment Relationship-Building and Communication Risk Management Interdisciplinary Collaboration Personal and Professional Self-Management (Lees et al. 2014) [72] Australia Mixed-methods Study Survey: N = 87 Mental Health Nurses Interviews: N = 11 Mental Health Nurses Community and Inpatient Settings within a Public Mental Health Service Early Detection and Risk Assessment Relationship-Building and Communication Risk Management (Litta et al. 2024) [69] Italy Quantitative Study N = 84 Nurses Medical, Surgical, Critical and Emergency Services Risk Management Interdisciplinary Collaboration (Marutani et al. 2016) [59] Japan Qualitative Study N = 17 Public Health Nurses N = 14 Cities in Metropolitan Regions Education and Advocacy Interdisciplinary Collaboration (Öztürk and Hiçdurmaz 2023) [60] Turkey Qualitative Study N = 33 Oncology Nurses N = 3 State, n = 3 University and n = 2 Private Hospitals Early Detection and Risk Assessment Risk Management (Puntil et al. 2013) [55] USA Position Paper Psychiatric Mental Health Nurse Generalists Hospital, Inpatient Psychiatric Units Risk Management Interdisciplinary Collaboration (Registered Nurses’ Association of Ontario (RNAO) 2009) [27] Canada Best Practice Guideline Nurses Nursing Practice Early Detection and Risk Assessment Relationship-Building and Communication Education and Advocacy Risk Management Interdisciplinary Collaboration Personal and Professional Self-Management (Reid and Long 1993) [70] Northern Ireland Quantitative Study N = 50 Psychiatric Nurses Acute Wards in an Psychiatric Training Hospital Early Detection and Risk Assessment Relationship-Building and Communication Education and Advocacy Risk Management Interdisciplinary Collaboration Personal and Professional Self-Management (Serafica et al. 2023) [74] USA Case Study Primary Care Providers Nursing Home Early Detection and Risk Assessment Risk Management Interdisciplinary Collaboration (Sun et al. 2005) [61] Taiwan Qualitative Study N = 5 Psychiatric Nurses N = 3 Psychiatric Hospitals Early Detection and Risk Assessment Relationship-Building and Communication Education and Advocacy Risk Management Interdisciplinary Collaboration (Sun et al. 2006) [71] Taiwan Quantitative Study N = 15 Nurses N = 15 Patients N = 3 Hospitals, n = 3 Acute Psychiatric Wards and n = 1 Psychiatric Stress Ward Early Detection and Risk Assessment Relationship-Building and Communication Risk Management (Vandewalle et al. 2019a) [62] Belgium Qualitative Study N = 26 Psychiatric Nurses N = 2 Wards in n = 4 Psychiatric Hospitals Early Detection and Risk Assessment Relationship-Building and Communication Risk Management Personal and Professional Self-Management (Vandewalle et al. 2019b) [63] Belgium Qualitative Study N = 19 Nurses with Experience in caring for Patients with Suicidal Ideation N = 4 Psychiatric Hospitals Early Detection and Risk Assessment Relationship-Building and Communication Education and Advocacy Risk Management Personal and Professional Self-Management (Vandewalle et al. 2020) [64] Belgium Qualitative Study N = 28 Psychiatric Nurses N = 13 Adult Wards in n = 4 Psychiatric Hospitals Early Detection and Risk Assessment Relationship-Building and Communication Education and Advocacy Risk Management Interdisciplinary Collaboration Personal and Professional Self-Management (Volker 2003) [65] USA Qualitative Study N = 24 Oncology Nurses Care of Terminally Ill Patients Education and Advocacy Risk Management (Wärdig et al. 2022) [66] Sweden Qualitative Study N = 15 Registered Nurses that work in Primary Health Care for minimum 1 year Primary Health Care Early Detection and Risk Assessment Interdisciplinary Collaboration (Zaleski et al. 2018) [75] USA Clinical Practice Guideline Nurses Emergency Departments Early Detection and Risk Assessment (Zohn 2022) [67] USA Qualitative Study N = 14 Nursing Students N = 2 Universities, Psychiatric and Mental Health Care Early Detection and Risk Assessment Relationship-Building and Communication Education and Advocacy Risk Management Personal and Professional Self-Management 3.3 Potential Roles and Responsibilities of Nurses in Suicide Prevention 3.3.1 Early Detection and Risk Assessment N = 20 of the reviewed sources highlight the pivotal role of nurses in suicide prevention regarding the early identification and assessment of suicide risk [27, 35, 36, 54, 56, 58, 60–64, 66–68, 70–75]. In this context, it is expected from nurses to recognize especially vulnerable population groups and identify risk factors [36, 54]. Furthermore, nurses report about their responsibility in detecting warning signs associated with suicidality or a desire to die such as behavioral changes or statements expressing a desire to die [35, 36, 56, 58, 61–64, 71]. In addition to identifying an individual’s suicide risk, nurses take responsibility for conducting a more in-depth assessment, which includes reaching a shared understanding of the care recipient’s risk by exploring factors such as severity, underlying motives, personal meanings, causes, the persistence and seriousness of suicidal thoughts, intent to self-harm, and existing protective factors [ 35, 36, 54, 56, 62–64, 66, 71]. Some evidence suggests that nurses play a less prominent role compared to physicians and that their responsibility in suicide screening and assessment is not universally recognized as a standard part of nursing practice [60, 66]. 3.3.2 Relationship-Building and Communication N = 14 of the reviewed sources emphasize the vital role of nurses in establishing relationships and communication with care recipients at risk of suicide in the context of suicide prevention [27, 36, 56, 57, 61–64, 67, 68, 70–73]. Evidence indicates that a key responsibility of nurses is to cultivate a relationship-enhancing attitude, which is characterized by qualities such as understanding, open-mindedness, responsiveness, interest, acceptance, empathy, collaboration, authenticity, transparency, presence and respect for the individual’s dignity [36, 61–64, 68, 72, 73]. Furthermore, evidence suggests that nurses hold responsibility in suicide prevention through the relationships they develop and maintain with care recipients, which are often described by nurses as close, trusting, collaborative and therapeutic [36, 56, 57, 61, 64, 71]. These relationships can be preventive in nature, enhance the effectiveness of suicide prevention efforts, facilitate the expression of thoughts and emotions, promote positive interactions, instill a sense of hope for the future, and provide safety for the individual in need of care [71, 72, 62–64]. Facilitating open communication about suicidal ideation is also identified as a central responsibility of nurses within the scope of suicide prevention [57, 72, 73, 61–64]. 3.3.3 Education and Advocacy As highlighted by n = 11 sources, nurses are also shown to have an important role in both educational efforts and advocacy in the context of suicide prevention [27, 35, 36, 54, 59, 61, 63–65, 67, 70]. In this role, the evidence suggests that nurses are responsible for providing information and guidance to individuals affected by suicidality, their relatives and the public [36, 54, 61, 65, 67]. This includes, for example, teaching journalists to promote responsibility in media reporting [54], counselling and emotional support [36, 61]. Furthermore, the evidence shows that nurses are involved in conducting research on suicide and implementing public health strategies for suicide prevention [59]. Finally, the evidence reviewed indicates that nurses perceive it as part of their professional responsibility to promote awareness of suicidality by individuals in need of care and the interdisciplinary team as well as address the needs of those affected [59, 61, 63–65, 67]. 3.3.4 Risk Management Another significant role of nurses in suicide prevention, as identified in n = 21, is providing risk management [27, 35, 36, 54, 55, 57, 58, 60–65, 67–69, 70–74]. A central responsibility emerging from the evidence within this role is the minimization of risk factors and the enhancement of protective factors [36, 57, 58, 61–65]. This may include promoting a sense of meaning, joy and positivity in life [36, 63, 64], promoting social connection [36, 63, 64], fostering coping strategies such as physical activity [63], and support care recipients in dealing with difficult situations [64]. Furthermore, the evidence indicates that nurses have a responsibility in risk management by alleviating suffering and addressing the diverse needs of individuals in need of care [54, 55, 58–61, 63–65, 71–73]. This responsibility may include: Management of psychological symptoms, for example through engaging in therapeutic interventions to manage mental disorders and instilling hope [54, 58, 61, 63]; Management of physical symptoms , for example through pain management [61, 65]; Management of social symptoms , for example through fostering social connectedness and encouraging support from professionals, family and community networks [54, 59]; Management of spiritual symptoms , for example through involving spiritual care experts [73, 60]. Moreover, the creation of a safe environment for individuals at risk of suicide is identified as a part of nurses’ professional responsibility [35, 36, 57, 58, 61, 63, 64, 67, 68, 71, 73]. Fulfilling this responsibility may require generating safety plans and making agreements with individuals [35, 57, 61, 63, 64], restricting access to means of suicide [36, 57, 61, 71, 73], conducting observations [36, 61, 63, 68, 72], and the usage of restrictive measures [61]. 3.3.5 Interdisciplinary Collaboration N = 15 reviewed sources also highlight the important role of nurses in suicide prevention through collaboration with professionals from other disciplines and organizations [27, 36, 54–57, 59, 61, 64, 66, 68–70, 73, 74]. Evidence suggests that, within interdisciplinary collaboration, nurses are responsible for the exchange of information with professional team members and relatives to support early identification of suicide risk, a thorough risk assessment and the development of targeted prevention strategies [36, 56, 61, 73]. Moreover, the evidence indicates that nurses hold a collaborative responsibility within their teams by providing mutual support, consulting with colleagues, and distributing responsibilities when working with individuals at risk of suicide [64, 66, 73, 74]. In addition, the reviewed sources of evidence emphasize the responsibility of nurses to direct individuals at risk for suicide or in crisis to relevant professionals and support centers [54, 57, 66, 68, 74]. 3.3.6 Personal and Professional Self-Management Another pivotal role of nurses in suicide prevention identified in n = 10 sources involves practicing self-management both personally and professionally [27, 35, 36, 58, 62–64, 67, 70, 73]. The reviewed sources of evidence show that nurses encounter various value-based conflicts in the context of suicide prevention and must deal with these conflicts as part of their professional responsibility [35, 63, 64, 73]. Moreover, nurses report facing a range of challenges in the context of suicide care and prevention, including being confronted with intense emotions and suicidal disclosures, fears of being held personally responsible in the event of a suicide, feelings of isolation in bearing responsibility, uncertainty regarding roles and appropriate procedures [35, 36, 58, 63, 67, 73]. In this context, evidence suggests that nurses often feel that it is their responsibility to manage these challenges, fears and uncertainties in order to remain capable of taking appropriate action [35, 58, 62–64, 67]. Therefore, the evidence highlights the importance of nurses being aware of their own emotions and managing them appropriately, engaging in reflective practice and emotional debriefing, and upholding to professional boundaries [58, 62–64]. The findings from the analysed sources make it possible to specify both roles and responsibilities of nurses in the context of suicide prevention. Table 2 presents six potential roles of nurses identified in the reviewed sources of evidence. These roles include: 3.3.1 Early Detection and Risk Assessment , 3.3.2 Relationship-Building and Communication , 3.3.3 Education and Advocacy , 3.3.4 Risk Management , 3.3.5 Interdisciplinary Collaboration , and 3.3.6 Personal and Professional Self-Management . The table further outlines the associated responsibilities that nurses may be expected to assume within each role. A narrative summary of these roles and their corresponding responsibilities is provided in the following section. Table 2: Overview of Identified Nursing Roles and Responsibilities in Suicide Prevention Potential roles in suicide prevention Potential role-specific responsibilities in suicide prevention 3.3.1 Early Detection and Risk Assessment Recognize increased vulnerability Screen individual risk factors and warning signs Conduct an in-depth assessment 3.3.2 Relationship-Building and Communication Cultivate a relationship-enhancing attitude Develop and maintain relationships Foster open communication 3.3.3 Education and Advocacy Provide information and counseling to care recipients and their relatives Conduct research and implement public health strategies for suicide prevention Raise awareness 3.3.4 Risk Management Minimize risk factors and enhance protective factors Alleviate suffering Create a safe environment 3.3.5 Interdisciplinary Collaboration Exchange information Support team members Coordinate with relevant experts and help centers 3.3.6 Personal and Professional Self-Management Navigate value-based conflicts Cope with challenges, fears and uncertainties Practice self-awareness, reflection and emotional debriefing 4 Discussion 4.1 Summary and Interpretation of findings This scoping review aimed at identifying potential roles and responsibilities of nurses in suicide prevention within adult care settings from an international perspective. It includes a total of 25 evidence sources, published between 1993 and 2024, originating from countries across Europe, North America, Asia and Australia, and covering a variety of healthcare contexts. The findings of this scoping review illustrate that nurses hold a pivotal role across all three levels of suicide prevention strategies proposed by the WHO [2, 12]: universal, selective and indicated. In the context of universal suicide prevention, nurses contribute by raising awareness, promoting mental health, and reducing stigma, thereby strengthening protective factors within the broader population [59, 61–65, 67]. At the selective level, they are actively involved in the early identification of individuals at risk, recognizing warning signs, and initiating interventions to reduce risk [35, 36, 54, 56, 58, 61–64, 71]. In indicated prevention, nurses support individuals affected by suicidality, fostering trusted and therapeutic relationships, and participating in coordinated risk management [35, 36, 56–58, 61, 64, 71–73]. This broad scope of engagement underscores the essential and multifaceted role and responsibility of nurses in comprehensive suicide prevention efforts. The comprehensive synthesis of the multifaceted roles and responsibilities of nurses in suicide prevention within adult care settings highlights the depth of their involvement across diverse healthcare systems internationally. The identification of six key roles – 3.3.1 Early Detection and Risk Assessment , 3.3.2 Relationship-Building and Communication , 3.3.3 Education and Advocacy , 3.3.4 Risk Management , 3.3.5 Interdisciplinary Collaboration , and 3.3.6 Personal and Professional Self-Management – underscores the complexity of nursing contributions to suicide prevention and the essential nature of their work in this area. The evidence consistently emphasizes the critical frontline position nurses hold in identifying suicide risk. Through regular and often prolonged patient contact, nurses are uniquely placed to observe subtle behavioral and emotional changes, making Early Detection and Risk Assessment a core component of their practice. This finding is also supported by the results of previous reviews [25, 41]. However, despite this strategic positioning, some studies indicate a lack of standardized assessment tools and variable confidence levels among nurses in recognizing and evaluating suicidal ideation [68, 73]. This highlights a pressing need for enhanced training and consistent protocols to ensure nurses can respond effectively and confidently. Relationship-Building and Communication emerged as another cornerstone role, with studies emphasizing the therapeutic impact of a trusting nurse-patient relationship [61–63, 71]. Open, non-judgmental communication is often the first step toward uncovering suicidal thoughts, yet this requires time, emotional investment, and organizational support—resources that may be limited in high-demand care environments. Therefore, institutional recognition and prioritization of relationship-based care in suicide prevention strategies are essential [40]. The role of Education and Advocacy reflects the broader societal responsibility nurses carry in mitigating stigma, educating individuals and relatives, and engaging in public health initiatives. While some studies document nurses taking proactive roles in these areas [59, 65, 67], others reveal gaps in knowledge and insufficient integration of suicide prevention into nurse education curricula. Given the increasing mental health burden globally [76], strengthening this role could amplify the preventative reach of nursing beyond clinical settings. Risk Management responsibilities also illustrate the balancing act nurses perform between alleviating immediate distress and maintaining a safe, therapeutic environment. Strategies range from ensuring environmental safety to strengthening protective factors like hope and social support [35, 36, 57, 58, 63, 64]. The diversity of approaches across countries and settings reflects the need for context-specific, culturally sensitive interventions. Interdisciplinary Collaboration is widely recognized as vital for comprehensive suicide prevention. Nurses often act as coordinators and communicators, linking care recipients with appropriate services and professionals [36, 56, 57, 68, 73]. However, the effectiveness of this role is contingent upon organizational structures that support seamless information-sharing and integrated care pathways. Barriers such as poor communication channels, unclear role boundaries, and hierarchical team dynamics can limit the potential of this collaborative function. Finally, Personal and Professional Self-Management points to the emotional impact and moral challenges nurses face in this area of care. The evidence illustrates that suicide prevention often involves exposure to distressing situations, ethical dilemmas, and emotional fatigue [36, 58]. The emphasis on reflection, emotional debriefing, and value-based practice signals the importance of institutional mechanisms to support nurses’ mental health and resilience [40]. Failing to address these needs may lead to burnout, reduced quality of care, and attrition from the workforce. 4.2 Strengths and limitations One of the key strengths of this scoping review lies in its comprehensive and systematic approach to mapping the roles and responsibilities of nurses in suicide prevention across a wide range of international contexts. By including a broad variety of evidence sources this review captures the complexity and diversity of nursing practice in this field. The inclusion of studies published over three decades (1993-2024) further enhances the depth of analysis. Additionally, the review’s structured categorization of six core roles with clearly defined responsibilities offers a framework that can inform further research. Despite these strengths, several limitations must be acknowledged. First, while the review sought international perspectives, the distribution of sources was uneven across regions, with some geographical areas underrepresented; potentially limiting the global generalizability of the findings. Second, the quality of included sources was not appraised, as is typical in scoping reviews; thus, the strength of the evidence supporting specific roles and responsibilities may vary. Third, the heterogeneity of the included evidence sources – varying in design, context, population, and terminology – posed challenges in synthesizing the data and drawing comparisons. Moreover, the scope was limited to adult care settings, which may exclude relevant insights from pediatric or adolescent populations where suicide prevention is also critical. Finally, the review may be subject to publication bias, as gray literature and non-English sources were not systematically included, potentially omitting valuable perspectives. Overall, while this scoping review provides a valuable and timely overview of nursing roles and responsibilities in suicide prevention, its findings should be interpreted in light of these methodological constraints. Further focused and region-specific research is needed to build on these insights and fill existing gaps. 4.3 Implications for Research and Clinical Practice Overall, the roles identified in this review demonstrate that suicide prevention is not a singular intervention but a continuum of care that nurses are deeply embedded in, both clinically and ethically. The findings also suggest a need for organizational and societal changes to better equip and support nurses in these roles, including comprehensive training, organizational backing, and policy-level recognition of their central role in suicide prevention. Future research should continue to explore how these roles are implemented in various cultural and healthcare contexts, and how best practices can be adapted and shared globally to strengthen the nursing contribution to suicide prevention. In practice, there is a pressing need to integrate suicide prevention competencies into nursing curricula for initial, continuing and further training, ensuring that nurses enter the workforce with the skills and confidence to engage effectively in this sensitive area. Health institutions should also prioritize ongoing professional development, reflective practice, and emotional support mechanisms – such as supervision and debriefing sessions – to help nurses manage the emotional demands associated with suicide prevention work. At the policy level, suicide prevention should be embedded into national (nursing) strategies and clinical guidelines, recognizing the unique contributions nurses make across care settings. From a research perspective, further studies are needed to evaluate the effectiveness of nursing-led suicide prevention interventions and to examine the contextual factors that facilitate or hinder their implementation. Additionally, participatory research involving nurses and individuals with lived experience of suicidality may help develop more person-centered, culturally appropriate, and ethically grounded approaches to care. Strengthening the evidence base in these areas is critical for advancing nursing practice and ensuring the sustainability and impact of suicide prevention efforts worldwide. 5 Conclusion Given the comprehensive significance of suicide prevention for people in existential crises, clarification of the roles and responsibilities of caregivers is of great importance. This scoping review provides a comprehensive overview of the diverse and multifaceted roles nurses play in suicide prevention within adult care settings across international contexts. The analysis of 25 sources of evidence reveals that nursing responsibilities span six key roles: 3.3.1 Early Detection and Risk Assessment , 3.3.2 Relationship-Building and Communication , 3.3.3 Education and Advocacy , 3.3.4 Risk Management , 3.3.5 Interdisciplinary Collaboration , and 3.3.6 Personal and Professional Self-Management . These roles demonstrate the depth of nursing engagement at all levels of suicide prevention – universal, selective and indicated – and highlight the unique position of nurses to contribute meaningfully to the identification, intervention, and long-term support of individuals at risk. In light of the discussions surrounding assisted suicide in many countries across the world and its implementation, the topic of suicide prevention and the role and responsibility of nurses in all settings and care relationships is becoming increasingly relevant. However, the findings also point to the need for greater structural support, targeted education, and clear protocols to strengthen nurses’ competence and responsibility in this complex area of care. Future research and policy development should prioritize the integration of suicide prevention competencies into nursing education and practice frameworks, as well as foster supportive environments that enable nurses to carry out these critical roles effectively and sustainably. Abbreviations APNA American Psychiatric Nurses Association GHVN General Home Visiting Nurses ICN International Council of Nurses RNAO Registered Nurses’ Association of Ontario MAiD Medical Assistance in Dying WHO World Health Organization Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data and materials Generated data during the review process – including the search strategy, selection and extraction guidance as well as a list of excluded sources of evidence – are provided in this article (see Supplementary Files 1 – 4). Competing interests The authors declare that they have no competing interests. Funding This scoping review was funded by the Federal Ministry of Health [Bundesministerium für Gesundheit]. Grant number: 2524FSB220. The Open Access funding will be enabled and organized by Projekt DEAL. Authors’ contributions This scoping review was conceptualized by SF, TH, AR, KK and PMH. SF conducted the literature search, which was reviewed by AR, TH, KK and PMH. Screening and Selection of evidence sources were carried out by SF and EJ, with input from TH, AR, KK and PMH in cases of uncertainty. Data Extraction was performed by SF and EJ. SF conducted Data Analysis and Synthesis, with review and input from AR, TH, KK and PMH. 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Global burden of mental disorders in 204 countries and territories, 1990–2021: results from the global burden of disease study 2021. BMC Psychiatry. 2025;25(486). doi:10.1016/j.jad.2025.119817. Footnotes A preliminary search in MEDLINE and CINAHL was conducted in September 2024 to identify reviews on this topic Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1SearchStrategyAnnetteRiedeletal.pdf SupplementaryFile2ScreeningGuidanceAnnetteRiedeletal.pdf SupplementaryFile3ReviewsandExcludedSourcesAnnetteRiedeletal..pdf SupplementaryFile4DataExtractionGuidanceAnnetteRiedeletal.pdf Cite Share Download PDF Status: Published Journal Publication published 22 Oct, 2025 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 24 Sep, 2025 Reviews received at journal 20 Sep, 2025 Reviewers agreed at journal 06 Sep, 2025 Reviewers agreed at journal 12 Aug, 2025 Reviews received at journal 04 Aug, 2025 Reviewers agreed at journal 29 Jul, 2025 Reviewers invited by journal 29 Jul, 2025 Editor assigned by journal 29 Jul, 2025 Editor invited by journal 28 Jul, 2025 Submission checks completed at journal 27 Jul, 2025 First submitted to journal 27 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7206436","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":495000408,"identity":"1ad6ee4f-6cfb-4d3c-9fe7-4752bc78224c","order_by":0,"name":"Annette Riedel","email":"data:image/png;base64,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","orcid":"","institution":"Esslingen University of Applied Sciences","correspondingAuthor":true,"prefix":"","firstName":"Annette","middleName":"","lastName":"Riedel","suffix":""},{"id":495000411,"identity":"5fea7bbc-42c6-40b8-810c-0c22db291f1b","order_by":1,"name":"Stephanie Feinauer","email":"","orcid":"","institution":"Esslingen University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Stephanie","middleName":"","lastName":"Feinauer","suffix":""},{"id":495000412,"identity":"082e4401-70da-4b5d-abff-e74cac74ceac","order_by":2,"name":"Erik Jacob","email":"","orcid":"","institution":"Esslingen University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Erik","middleName":"","lastName":"Jacob","suffix":""},{"id":495000413,"identity":"b2ac25f8-b1b1-4397-bd2e-6e5c8f7b7384","order_by":3,"name":"Pia Madeleine Haug","email":"","orcid":"","institution":"Esslingen University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Pia","middleName":"Madeleine","lastName":"Haug","suffix":""},{"id":495000415,"identity":"4b3f27a4-bdf2-462c-b43f-da2c770af985","order_by":4,"name":"Karen Klotz","email":"","orcid":"","institution":"Esslingen University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Karen","middleName":"","lastName":"Klotz","suffix":""},{"id":495000416,"identity":"bd257019-2bde-4df7-94df-d859a57c482f","order_by":5,"name":"Thomas Heidenreich","email":"","orcid":"","institution":"Esslingen University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"","lastName":"Heidenreich","suffix":""}],"badges":[],"createdAt":"2025-07-24 14:08:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7206436/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7206436/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-025-04009-5","type":"published","date":"2025-10-22T16:16:49+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88238338,"identity":"4e812530-93ce-4ea6-900b-2c66094442a3","added_by":"auto","created_at":"2025-08-04 10:47:07","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":192236,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA Flow Diagram, Search and Selection Process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdapted from: Page et al. (2021) [49]. For more information: https://www.prisma-statement.org [Accessed March 17 2025].\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7206436/v1/971cfde8bd70cd9a7aafd1f4.jpg"},{"id":94490028,"identity":"50082fb3-6fed-4b05-94f5-750424564000","added_by":"auto","created_at":"2025-10-27 17:07:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1636696,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7206436/v1/55b4849d-2700-4c08-94d6-6a5729650036.pdf"},{"id":88239243,"identity":"8ddf345d-a702-4cc8-a570-9f67159fa9a7","added_by":"auto","created_at":"2025-08-04 10:55:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":151348,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1SearchStrategyAnnetteRiedeletal.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7206436/v1/c03d783f2e6af17970431c88.pdf"},{"id":88238339,"identity":"c8d8117a-e5a5-45a8-ba6f-4ec097c8e84b","added_by":"auto","created_at":"2025-08-04 10:47:07","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":70725,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile2ScreeningGuidanceAnnetteRiedeletal.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7206436/v1/d479dca5ae88e01c719a2aec.pdf"},{"id":88239244,"identity":"af467340-dd59-4f5c-b986-7678b1beab0b","added_by":"auto","created_at":"2025-08-04 10:55:07","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":77000,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile3ReviewsandExcludedSourcesAnnetteRiedeletal..pdf","url":"https://assets-eu.researchsquare.com/files/rs-7206436/v1/051345d0bf6a59d0f2028f23.pdf"},{"id":88238344,"identity":"6c9aa1e8-a8c2-4ac9-965d-7d9fad5acdf3","added_by":"auto","created_at":"2025-08-04 10:47:07","extension":"pdf","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":95170,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile4DataExtractionGuidanceAnnetteRiedeletal.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7206436/v1/ce380f9cef03d1df15074757.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nurses’ Roles and Responsibilities in Suicide Prevention: A Scoping Review","fulltext":[{"header":"1 Background ","content":"\u003cp\u003eSuicide remains a significant and urgent public health issue, claiming the lives of over 720,000 people across the globe each year [1]. \u003cem\u003eSuicidality\u003c/em\u003e is understood as a multifaceted phenomenon that encompasses \u0026ldquo;a range of behaviours that include thinking about suicide (or ideation), planning for suicide, attempting suicide and suicide itself\u0026ldquo; [2, p. 12]. Research has also shown that adults in need of care \u0026ndash; especially older adults \u0026ndash; frequently develop a desire to die [3\u0026ndash;5]. This desire is recognized as an expression of personal suffering [6] and can be a first sign of suicidality [7]. According to Balaguer et al. (2016) [6], such expressions can range from a passive wish to allow death to occur naturally, to an active wish to hasten its occurrence. This scoping review focuses on adult care settings, such as those involving older adults, where phenomena such as the desire to die \u0026ndash; including requests for Medical Assistance in Dying (MAiD) \u0026ndash; or suicidality may occur.\u003c/p\u003e\n\u003cp\u003eThere is broad consensus that suicide can be prevented through targeted and evidence-based intervention strategies [8\u0026ndash;11]. \u003cem\u003eSuicide prevention\u003c/em\u003e is recognized as a collective societal responsibility that requires coordinated, multidisciplinary collaboration and the active involvement of various stakeholders at both community and population levels [2, 12]. In this context, the WHO [2, 12] recommends a multi-level prevention approach, which includes universal measures addressing the general population, selective interventions for identified high-risk groups, and indicated measures targeted at individuals at acute risk for suicide. Suicide prevention is of particular relevance for individuals with severe and chronic mental or physical illnesses as well as those who receive long-term care and are at risk for suicide [13\u0026ndash;20]. In particular, older adults in need of care constitute a high-risk population and should be specifically targeted by tailored suicide prevention strategies [21\u0026ndash;23].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNurses are widely recognized as frontline gatekeepers in the identification and management of individuals at risk for suicide [24\u0026ndash;27]. Their close, ongoing contact with care recipients and the trusted relationships they build often lead nurses to encounter individuals expressing a desire to die [28\u0026ndash;29], or requesting MAiD [30\u0026ndash;33]. Additionally, research indicates that nurses face suicidality across a variety of care settings and contexts [34\u0026ndash;37].\u003c/p\u003e\n\u003cp\u003eFor the purpose of this scoping review, \u0026lsquo;a \u003cem\u003enurse\u003c/em\u003e\u0026rsquo; is defined in accordance with the International Council of Nurses (ICN) [38] as \u0026ldquo;a professional who is educated in the scientific knowledge, skills and philosophy of nursing, and regulated to practice nursing based on established standards of practice and ethical codes\u0026ldquo; [38, p. 45]. The ICN [38, 39] further emphasizes the essential roles and responsibilities of nurses, highlighting their vital contributions to health promotion, illness prevention, the alleviation of suffering, and the enhancement of health literacy. Through evidence-based practice, the development of trusted relationships, informed decision-making, and risk management, nurses play a crucial role in safeguarding individuals in need of care [38].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile some reviews\u003csup\u003e1\u003c/sup\u003e examine suicide care and interventions from a nursing perspective [25, 40\u0026ndash;43], none provide a comprehensive exploration of the potential roles and responsibilities of nurses in suicide prevention. To address this gap, this scoping review was conducted with the aim of identifying nurses\u0026rsquo; potential roles and responsibilities in suicide prevention across adult care settings within an international context.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGuided by the research elements Population/Participants, Concept and Context (PCC) as outlined by Peters et al. 2020 [44], the following research question was developed and explored:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhat are nurses\u0026rsquo; roles and responsibilities in suicide prevention across adult care settings within an international context?\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Design\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA scoping review approach was selected due to the objective of exploring the possible roles and responsibilities of nurses in suicide prevention [45]. This scoping review is based on the framework outlined by Peters et al. (2020) [44] and includes the following steps: 1. Defining the objective and research question, 2. Establishing criteria for selecting relevant sources, 3. Outlining the planned approach to searching, selecting, extracting and presenting evidence, 4. Identifying relevant sources, 5. Applying inclusion/exclusion criteria to choose eligible sources, 6. Collecting relevant data from included sources, 7. Analyzing extracted data in line with the research objective, 8. Organizing and reporting the findings and 9. Summarizing findings, drawing conclusions and discussing implications. An a priori protocol was developed and registered in October 2024 on Open Science Framework (https://doi.org/10.17605/OSF.IO/QYXSR). This scoping review was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR), as outlined by Tricco et al. (2018) [46].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Eligibility Criteria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe inclusion and exclusion criteria were developed during the pre-registration phase, considering both content-related and formal methodological aspects. Following the recommendations by Peters et al. (2020) [44], the content-related inclusion criteria were defined in alignment with the core elements of the research question and aim. Accordingly, the scoping review includes evidence sources that meet the following content-related criteria:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003ePopulation/Participants:\u003c/strong\u003e Evidence sources were included if they reflected the perspectives of nurses with varying levels of professional qualification or if nurses were actively involved as participants. Sources were excluded if the population included other healthcare professionals alongside nurses and the data specific to nurses could not be extracted and analyzed separately.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eConcept:\u003c/strong\u003e Evidence sources were included if they focused on the roles and responsibilities of nurses in suicide prevention, including the specific context of requests for MAiD. Sources were excluded if they addressed suicidality among nurses themselves, on the training or educational needs of nurses related to specific interventions or programs, or on the testing or evaluation of particular interventions, programs, or instruments.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eContext:\u003c/strong\u003e Evidence sources were included if they focused on adult care settings in an international context. Sources were excluded if they examined non-care settings or focused exclusively on suicide prevention among children or adolescents.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe formal methodological inclusion and exclusion criteria include “types of evidence sources”, “language” and “publication date”. The scoping review includes evidence sources that meet the following formal-methodological criteria:\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eTypes of evidence sources:\u003c/strong\u003e As suggested by Peters et al. (2015) [47], a variety of study designs were considered for inclusion to ensure a comprehensive review of the existing scientific literature on the topic. In line with the research question, empirical studies – including qualitative, quantitative, and mixed-method research, case reports – published in peer-reviewed journals as well as reviews incorporating peer-reviewed empirical studies were considered relevant for inclusion. In addition, guidelines, standards, policy papers, discussion papers, and professional codes were also deemed appropriate for inclusion.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLanguage:\u0026nbsp;\u003c/strong\u003eEvidence sources published in English and German were included, based on the language proficiency of the research team.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePublication date:\u0026nbsp;\u003c/strong\u003eEvidence sources published in any year were considered for inclusion. Sources were eligible for inclusion up to November 22\u003csup\u003end\u003c/sup\u003e 2024.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Search Strategy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive literature search was conducted in October and November 2024 by reviewer SF in the electronic databases MEDLINE via EBSCOhost, CINAHL via EBSCOhost, and PsycINFO via EBSCOhost to locate published and unpublished evidence sources [44]. The search strategy was developed in three stages [44]. As a first step, initial searches were conducted in MEDLINE via EBSCOhost and CINAHL via EBSCOhost by searching the terms “nurse“, “suicide“, “prevention“, “role“, “responsibility“ and “relationship“ as well as synonyms and related terms. Subsequent to the initial search, text words in the titles and abstracts of the retrieved publications were analyzed, along with the indexing terms assigned to them.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs a second step, the identified terms were used to construct three distinct search strings – one for each database – by applying the Boolean operators “AND“ and “OR“, together with database-specific keywords and search syntax. The search strings were pretested, evaluated and refined according to the PRESS 2015 Guideline Evidence-Based Checklist by McGowan et al. (2016) [48]. Additionally, relevant publications identified during the initial searches were incorporated to validate and further optimize the search strategy [44]. Following this, a comprehensive second search was conducted in each included database using these tailored search strings. The complete search strategies for all databases are presented in \u003cstrong\u003eSupplementary File 1\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs a third step, additional sources were identified through a review of the reference lists of records included in the review following full-text screening.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Screening and Selection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the predefined inclusion and exclusion criteria outlined above, the selection of papers was independently conducted by two reviewers (SF, EJ) in December 2024 and January 2025. This process was guided by the PRISMA-ScR statement [49] and comprised two stages: an initial screening of titles and abstracts, followed by full-text screening. Any disagreements between the reviewers were resolved by consensus, or, when consensus could not be reached, through consultation with the review team [44].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrior to initiating the title and abstract screening, a total of n = 1.465 records were retrieved, using the developed search strings and imported into Rayyan [50]. Duplicates were identified automatically through Rayyan and manually removed by the first reviewer (SF), resulting in n = 952 records eligible for title and abstract screening. In accordance with Peters et al. (2020) [44], pilot testing of the source selection process was conducted prior to initiating full source selection, with the aim of refining the selection guidance. The selection guidance was pilot tested using a random sample of n = 25 records, which were independently screened by two reviewers (SF, EJ) according to the predefined eligibility criteria and accompanying definitions. Subsequently, the reviewers met to resolve any discrepancies and revised the eligibility criteria and guidance as necessary. Full dataset screening commenced only after achieving a minimum inter-rater agreement of 75%. The finalized screening guidance is provided in \u003cstrong\u003eSupplementary File 2\u003c/strong\u003e. Relevant review articles were selected specifically to enable hand searching of their reference lists. However, they were excluded from data extraction and analysis. \u003cstrong\u003eSupplementary File 3\u003c/strong\u003e presents a brief overview of the excluded sources, including the review articles.\u003c/p\u003e\n\u003cp\u003eTo assess inter-rater reliability, Krippendorff’s Alpha was applied [51], using the Krippendorff’s Alpha Calculator developed by Marzi et al. (2024) [52]. After screening titles and abstracts, Krippendorff’s Alpha was calculated at 0.840, reflecting a satisfactory level of inter-rater agreement for inclusion decisions. After the full-text screening, the coefficient increased slightly to 0.866.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Data Extraction and Analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data extraction process was conducted in February and March 2025 using the software MAXQDA. Prior to the final extraction, an extraction table was developed during the preregistration phase and further refined during the review phase [44]. To ensure that all relevant data were captured, a pilot test was independently conducted by two reviewers (SF and EJ) on a random sample of n = 5 sources. Following the approach outlined by Peters et al. (2020) [44], the final data extraction was performed by the first reviewer (SF), and the extracted data were subsequently verified by the review team. The finalized extraction guidance, provided in Supplementary File 4, includes general information about the sources (author/s, year of publication), their characteristics (country of origin, publication type, population/participants, context/setting), and the results relevant to the review question (concept).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn line with the aims and research questions of this review, the analysis was conducted in April and May 2025 using MAXQDA, with a focus on identifying potential roles and responsibilities of nurses in the context of suicide prevention. The analysis utilized the basic qualitative content analysis approach as described by Pollock et al. (2023) [53]. In line with the inductive methodology underlying this approach, the data were systematically coded and organized into specific categories emerging from the material. These categories emerged through open coding of the dataset, based directly on the text [53]. Findings from the analysis are reported narratively.\u0026nbsp;\u003c/p\u003e"},{"header":"3 Results ","content":"\u003cp\u003e\u003cstrong\u003e3.1 Search Results\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive search across multiple databases yielded n = 1.465 records in total, including n = 565 from MEDLINE via EBSCO, n = 525 from CINAHL via EBSCO and n = 375 from PsycInfo via EBSCO. \u003cstrong\u003eFigure 1\u003c/strong\u003e provides an overview of the entire identification and inclusion process. The screening tool Rayyan was employed to identify duplicate records, detecting n = 881 potential duplicates. After manual verification by the first reviewer (SF), n = 513 duplicates were confirmed and removed. The deduplication process resulted in n = 952 sources of evidence remaining for title and abstract screening. Following the title and abstract screening, n = 914 records were excluded for not meeting the predefined inclusion criteria. A total of n = 38 sources were considered potentially relevant and proceeded to full-text screening. Of these, n = 16 were excluded as they failed to meet one or more inclusion criteria related to population/participants, context, or concept or did not match the predefined publication type. \u003cstrong\u003eFigure 1\u003c/strong\u003e provides detailed reasons for exclusion. Ultimately, n = 22 sources of evidence retrieved from the database search met all inclusion criteria and were included in the scoping review. Additionally, the reference lists of these n = 22 sources and n = 7 identified relevant review articles were hand searched, leading to the inclusion of n = 3 further sources of evidence. In total, n = 25 sources of evidence were included in the scoping review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Characteristics of Included Sources of Evidence\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe included evidence was published between 1993 and 2024 in countries across Europe, North America, Asia and Australia. It comprises n = 1 discussion paper [54], n = 1 position paper [55], n = 14 qualitative studies [35, 36, 56\u0026ndash;67], n = 4 quantitative studies [68\u0026ndash;71], n = 1 mixed-methods study [72], n = 2 case studies [73, 74] and n = 2 guidelines [27, 75]. N = 1 qualitative study addressed suicide prevention in the context of MAiD through assisted suicide [65]. Another qualitative study specifically focused on nursing students [67]. \u003cstrong\u003eTable 1\u003c/strong\u003e provides details of the included sources of evidence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Characteristics of Included Evidence Sources \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"935\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCountry\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Evidence Source \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePopulation/\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContext (Setting)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConcept (Extracted Roles)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Anderson and Jenkins 2006) [54]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eEngland\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eDiscussion Paper\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNursing Profession\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMental Health Nursing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eEducation and Advocacy\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Chijiiwa and Ishimura 2024)\u0026nbsp;[56]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eJapan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQualitative Study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGeneral Home Visiting Nurses (GHVN)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGeneral Home Visiting\u003c/p\u003e\n \u003cp\u003eNursing Facilities that care for Patients with\u003c/p\u003e\n \u003cp\u003ePhysical Illnesses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRelationship-Building and Communication\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Darnell et al. 2023)\u0026nbsp;[57]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQualitative Study\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 13 Acute and Intensive Care Nurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eUrban level 1 Trauma Center\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eRelationship-Building and Communication\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Doyle et al. 2007)\u0026nbsp;[68]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eIreland\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQuantitative Study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 42 Emergency Department Nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 2 Teaching Hospitals\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRelationship-Building and Communication\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Eriksson et al. 2024)\u0026nbsp;[36]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSweden\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQualitative Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 10 Geriatric Nurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 4 Municipalities in Geriatric Nursing \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRelationship-Building and Communication\u003c/p\u003e\n \u003cp\u003eEducation and Advocacy\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u003c/p\u003e\n \u003cp\u003ePersonal and Professional Self-Management \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Hagen et al. 2017)\u003c/p\u003e\n \u003cp\u003e[58]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eNorway\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQualitative Study\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 8 Mental Health Nurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 5 Psychiatric Wards within N = 2 Hospitals\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003ePersonal and Professional Self-Management \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Jansson and Graneheim 2018)\u003c/p\u003e\n \u003cp\u003e[35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSweden\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQualitative Study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 8 Registered Nurses,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN = 4 Enrolled Nurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOutpatient Unit in a Psychiatric Clinic\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eEducation and Advocacy\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003ePersonal and Professional Self-Management \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Kusheba and Mulvihill 2018)\u003c/p\u003e\n \u003cp\u003e[73]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eUSA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eCase Study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eClinical Nurse Leader\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHospice Home Care\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRelationship-Building and Communication\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u003c/p\u003e\n \u003cp\u003ePersonal and Professional Self-Management \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Lees et al. 2014)\u0026nbsp;[72]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eAustralia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eMixed-methods Study\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eSurvey: N = 87 Mental Health Nurses\u003c/p\u003e\n \u003cp\u003eInterviews: N = 11 Mental Health Nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCommunity and Inpatient Settings within a Public Mental Health Service\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRelationship-Building and Communication\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Litta et al. 2024)\u0026nbsp;[69]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eItaly\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQuantitative Study\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 84 Nurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMedical, Surgical, Critical and Emergency Services\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Marutani et al. 2016)\u0026nbsp;[59]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eJapan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQualitative Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 17 Public Health Nurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 14 Cities in Metropolitan Regions\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEducation and Advocacy\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(\u0026Ouml;zt\u0026uuml;rk and Hi\u0026ccedil;durmaz 2023) [60]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eTurkey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQualitative Study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 33 Oncology Nurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 3 State, n = 3 University and n = 2 Private Hospitals\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Puntil et al. 2013)\u003c/p\u003e\n \u003cp\u003e[55]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003ePosition Paper\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePsychiatric Mental Health Nurse Generalists\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHospital, Inpatient Psychiatric Units\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Registered Nurses\u0026rsquo; Association of Ontario (RNAO) 2009) [27]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eCanada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eBest Practice Guideline\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNursing Practice\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRelationship-Building and Communication\u003c/p\u003e\n \u003cp\u003eEducation and Advocacy\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u003c/p\u003e\n \u003cp\u003ePersonal and Professional Self-Management\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Reid and Long 1993)\u0026nbsp;[70]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eNorthern Ireland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQuantitative Study\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 50 Psychiatric Nurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAcute Wards in an Psychiatric Training Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRelationship-Building and Communication\u003c/p\u003e\n \u003cp\u003eEducation and Advocacy\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u003c/p\u003e\n \u003cp\u003ePersonal and Professional Self-Management\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Serafica et al. 2023)\u0026nbsp;[74]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eUSA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eCase Study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePrimary Care Providers \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNursing Home\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Sun et al. 2005)\u003c/p\u003e\n \u003cp\u003e[61]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eTaiwan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQualitative Study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 5 Psychiatric Nurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 3 Psychiatric Hospitals\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRelationship-Building and Communication\u003c/p\u003e\n \u003cp\u003eEducation and Advocacy\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Sun et al. 2006)\u0026nbsp;[71]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eTaiwan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQuantitative Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 15 Nurses\u003c/p\u003e\n \u003cp\u003eN = 15 Patients\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 3 Hospitals, n = 3 Acute Psychiatric Wards and n = 1 Psychiatric Stress Ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRelationship-Building and Communication\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Vandewalle et al. 2019a) [62]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eBelgium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQualitative Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 26 Psychiatric Nurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 2 Wards in n = 4 Psychiatric Hospitals\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRelationship-Building and Communication\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003ePersonal and Professional Self-Management \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Vandewalle et al. 2019b) [63]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eBelgium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQualitative Study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 19 Nurses with Experience in caring for Patients with Suicidal Ideation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 4 Psychiatric Hospitals\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRelationship-Building and Communication\u003c/p\u003e\n \u003cp\u003eEducation and Advocacy\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003ePersonal and Professional Self-Management \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Vandewalle et al. 2020) [64]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eBelgium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQualitative Study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 28 Psychiatric Nurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 13 Adult Wards in n = 4 Psychiatric Hospitals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRelationship-Building and Communication\u003c/p\u003e\n \u003cp\u003eEducation and Advocacy\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u003c/p\u003e\n \u003cp\u003ePersonal and Professional Self-Management \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Volker 2003)\u0026nbsp;[65]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQualitative Study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 24 Oncology Nurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCare of Terminally Ill Patients \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEducation and Advocacy\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(W\u0026auml;rdig et al. 2022)\u0026nbsp;[66]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eSweden\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQualitative Study \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 15 Registered Nurses that work in Primary Health Care for minimum 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePrimary Health Care\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003cbr\u003e\u0026nbsp;Interdisciplinary Collaboration\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Zaleski et al. 2018)\u0026nbsp;[75]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eClinical Practice Guideline\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNurses\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eEmergency Departments\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e(Zohn 2022)\u0026nbsp;[67]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eUSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eQualitative Study\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 14 Nursing Students\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eN = 2 Universities, Psychiatric and Mental Health Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eEarly Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003eRelationship-Building and Communication\u003c/p\u003e\n \u003cp\u003eEducation and Advocacy\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003cp\u003ePersonal and Professional Self-Management \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Potential Roles and Responsibilities of Nurses in Suicide Prevention\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3.1 Early Detection and Risk Assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN = 20 of the reviewed sources highlight the pivotal role of nurses in suicide prevention regarding the early identification and assessment of suicide risk [27, 35, 36, 54, 56, 58, 60\u0026ndash;64, 66\u0026ndash;68, 70\u0026ndash;75]. In this context, it is expected from nurses to recognize especially vulnerable population groups and identify risk factors [36, 54]. Furthermore, nurses report about their responsibility in detecting warning signs associated with suicidality or a desire to die such as behavioral changes or statements expressing a desire to die [35, 36, 56, 58, 61\u0026ndash;64, 71]. In addition to identifying an individual\u0026rsquo;s suicide risk, nurses take responsibility for conducting a more in-depth assessment, which includes reaching a shared understanding of the care recipient\u0026rsquo;s risk by exploring factors such as severity, underlying motives, personal meanings, causes, the persistence and seriousness of suicidal thoughts, intent to self-harm, and existing protective factors [ 35, 36, 54, 56, 62\u0026ndash;64, 66, 71]. Some evidence suggests that nurses play a less prominent role compared to physicians and that their responsibility in suicide screening and assessment is not universally recognized as a standard part of nursing practice [60, 66].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3.2 Relationship-Building and Communication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN = 14 of the reviewed sources emphasize the vital role of nurses in establishing relationships and communication with care recipients at risk of suicide in the context of suicide prevention\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[27, 36, 56, 57, 61\u0026ndash;64, 67, 68, 70\u0026ndash;73]. Evidence indicates that a key responsibility of nurses is to cultivate a relationship-enhancing attitude, which is characterized by qualities such as understanding, open-mindedness, responsiveness, interest, acceptance, empathy, collaboration, authenticity, transparency, presence and respect for the individual\u0026rsquo;s dignity [36, 61\u0026ndash;64, 68, 72, 73]. Furthermore, evidence suggests that nurses hold responsibility in suicide prevention through the relationships they develop and maintain with care recipients, which are often described by nurses as close, trusting, collaborative and therapeutic [36, 56, 57, 61, 64, 71]. These relationships can be preventive in nature, enhance the effectiveness of suicide prevention efforts, facilitate the expression of thoughts and emotions, promote positive interactions, instill a sense of hope for the future, and provide safety for the individual in need of care [71, 72, 62\u0026ndash;64]. Facilitating open communication about suicidal ideation is also identified as a central responsibility of nurses within the scope of suicide prevention [57, 72, 73, 61\u0026ndash;64].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3.3 Education and Advocacy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs highlighted by n = 11 sources, nurses are also shown to have an important role in both educational efforts and advocacy in the context of suicide prevention [27, 35, 36, 54, 59, 61, 63\u0026ndash;65, 67, 70]. In this role, the evidence suggests that nurses are responsible for providing information and guidance to individuals affected by suicidality, their relatives and the public [36, 54, 61, 65, 67]. This includes, for example, teaching journalists to promote responsibility in media reporting [54], counselling and emotional support [36, 61]. Furthermore, the evidence shows that nurses are involved in conducting research on suicide and implementing public health strategies for suicide prevention [59]. Finally, the evidence reviewed indicates that nurses perceive it as part of their professional responsibility to promote awareness of suicidality by individuals in need of care and the interdisciplinary team as well as address the needs of those affected [59, 61, 63\u0026ndash;65, 67].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3.4 Risk Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother significant role of nurses in suicide prevention, as identified in n = 21, is providing risk management [27, 35, 36, 54, 55, 57, 58, 60\u0026ndash;65, 67\u0026ndash;69, 70\u0026ndash;74]. A central responsibility emerging from the evidence within this role is the minimization of risk factors and the enhancement of protective factors [36, 57, 58, 61\u0026ndash;65]. This may include promoting a sense of meaning, joy and positivity in life [36, 63, 64], promoting social connection [36, 63, 64], fostering coping strategies such as physical activity [63], and support care recipients in dealing with difficult situations [64]. Furthermore, the evidence indicates that nurses have a responsibility in risk management by alleviating suffering and addressing the diverse needs of individuals in need of care [54, 55, 58\u0026ndash;61, 63\u0026ndash;65, 71\u0026ndash;73]. This responsibility may include:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cem\u003eManagement of psychological symptoms,\u0026nbsp;\u003c/em\u003efor example through engaging in therapeutic interventions to manage mental disorders and instilling hope [54, 58, 61, 63];\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eManagement of physical symptoms\u003c/em\u003e, for example through pain management [61, 65];\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eManagement of social symptoms\u003c/em\u003e, for example through fostering social connectedness and encouraging support from professionals, family and community networks [54, 59];\u003c/li\u003e\n \u003cli\u003e\u003cem\u003eManagement of spiritual symptoms\u003c/em\u003e, for example through involving spiritual care experts [73, 60].\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eMoreover, the creation of a safe environment for individuals at risk of suicide is identified as a part of nurses\u0026rsquo; professional responsibility [35, 36, 57, 58, 61, 63, 64, 67, 68, 71, 73]. Fulfilling this responsibility may require generating safety plans and making agreements with individuals [35, 57, 61, 63, 64], restricting access to means of suicide [36, 57, 61, 71, 73], conducting observations [36, 61, 63, 68, 72], and the usage of restrictive measures [61].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3.5 Interdisciplinary Collaboration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN = 15 reviewed sources also highlight the important role of nurses in suicide prevention through collaboration with professionals from other disciplines and organizations [27, 36, 54\u0026ndash;57, 59, 61, 64, 66, 68\u0026ndash;70, 73, 74]. Evidence suggests that, within interdisciplinary collaboration, nurses are responsible for the exchange of information with professional team members and relatives to support early identification of suicide risk, a thorough risk assessment and the development of targeted prevention strategies [36, 56, 61, 73]. Moreover, the evidence indicates that nurses hold a collaborative responsibility within their teams by providing mutual support, consulting with colleagues, and distributing responsibilities when working with individuals at risk of suicide [64, 66, 73, 74]. In addition, the reviewed sources of evidence emphasize the responsibility of nurses to direct individuals at risk for suicide or in crisis to relevant professionals and support centers [54, 57, 66, 68, 74].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3.6 Personal and Professional Self-Management \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnother pivotal role of nurses in suicide prevention identified in n = 10 sources involves practicing self-management both personally and professionally [27, 35, 36, 58, 62\u0026ndash;64, 67, 70, 73]. The reviewed sources of evidence show that nurses encounter various value-based conflicts in the context of suicide prevention and must deal with these conflicts as part of their professional responsibility [35, 63, 64, 73]. Moreover, nurses report facing a range of challenges in the context of suicide care and prevention, including being confronted with intense emotions and suicidal disclosures, fears of being held personally responsible in the event of a suicide, feelings of isolation in bearing responsibility, uncertainty regarding roles and appropriate procedures [35, 36, 58, 63, 67, 73]. In this context, evidence suggests that nurses often feel that it is their responsibility to manage these challenges, fears and uncertainties in order to remain capable of taking appropriate action [35, 58, 62\u0026ndash;64, 67]. Therefore, the evidence highlights the importance of nurses being aware of their own emotions and managing them appropriately, engaging in reflective practice and emotional debriefing, and upholding to professional boundaries [58, 62\u0026ndash;64].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe findings from the analysed sources make it possible to specify both roles and responsibilities of nurses in the context of suicide prevention. Table 2 presents six potential roles of nurses identified in the reviewed sources of evidence. These roles include: 3.3.1 \u003cem\u003eEarly Detection and Risk Assessment\u003c/em\u003e, 3.3.2 \u003cem\u003eRelationship-Building and Communication\u003c/em\u003e, 3.3.3 \u003cem\u003eEducation and Advocacy\u003c/em\u003e, 3.3.4 \u003cem\u003eRisk Management\u003c/em\u003e, 3.3.5 \u003cem\u003eInterdisciplinary Collaboration\u003c/em\u003e, and 3.3.6 \u003cem\u003ePersonal and Professional Self-Management\u003c/em\u003e. The table further outlines the associated responsibilities that nurses may be expected to assume within each role. A narrative summary of these roles and their corresponding responsibilities is provided in the following section.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Overview of Identified Nursing Roles and Responsibilities in Suicide Prevention\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePotential roles in suicide prevention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePotential role-specific responsibilities in suicide prevention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e3.3.1\u0026nbsp;\u003cbr\u003e\u0026nbsp;Early Detection and Risk Assessment\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eRecognize increased vulnerability\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eScreen individual risk factors and warning signs\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eConduct an in-depth assessment \u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e3.3.2\u0026nbsp;\u003cbr\u003e\u0026nbsp;Relationship-Building and Communication \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eCultivate a relationship-enhancing attitude\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDevelop and maintain relationships\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFoster open communication\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e3.3.3\u003c/p\u003e\n \u003cp\u003eEducation and Advocacy\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eProvide information and counseling to care recipients and their relatives\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eConduct research and implement public health strategies for suicide prevention\u003c/li\u003e\n \u003cli\u003eRaise awareness\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e3.3.4\u003c/p\u003e\n \u003cp\u003eRisk Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eMinimize risk factors and enhance protective factors\u003c/li\u003e\n \u003cli\u003eAlleviate suffering \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCreate a safe environment \u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e3.3.5\u003c/p\u003e\n \u003cp\u003eInterdisciplinary Collaboration\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eExchange information\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSupport team members\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCoordinate with relevant experts and help centers \u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e3.3.6\u003c/p\u003e\n \u003cp\u003ePersonal and Professional Self-Management\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eNavigate value-based conflicts\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCope with challenges, fears and uncertainties\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePractice self-awareness, reflection and emotional debriefing\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"4 Discussion","content":"\u003cp\u003e\u003cstrong\u003e4.1 Summary and Interpretation of findings\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis scoping review aimed at identifying potential roles and responsibilities of nurses in suicide prevention within adult care settings from an international perspective. It includes a total of 25 evidence sources, published between 1993 and 2024, originating from countries across Europe, North America, Asia and Australia, and covering a variety of healthcare contexts.\u003c/p\u003e\n\u003cp\u003eThe findings of this scoping review illustrate that nurses hold a pivotal role across all three levels of suicide prevention strategies proposed by the WHO [2, 12]: universal, selective and indicated. In the context of universal suicide prevention, nurses contribute by raising awareness, promoting mental health, and reducing stigma, thereby strengthening protective factors within the broader population [59, 61–65, 67]. At the selective level, they are actively involved in the early identification of individuals at risk, recognizing warning signs, and initiating interventions to reduce risk [35, 36, 54, 56, 58, 61–64, 71]. In indicated prevention, nurses support individuals affected by suicidality, fostering trusted and therapeutic relationships, and participating in coordinated risk management [35, 36, 56–58, 61, 64, 71–73]. This broad scope of engagement underscores the essential and multifaceted role and responsibility of nurses in comprehensive suicide prevention efforts.\u003c/p\u003e\n\u003cp\u003eThe comprehensive synthesis of the multifaceted roles and responsibilities of nurses in suicide prevention within adult care settings highlights the depth of their involvement across diverse healthcare systems internationally. The identification of six key roles – 3.3.1 \u003cem\u003eEarly Detection and Risk Assessment\u003c/em\u003e, 3.3.2 \u003cem\u003eRelationship-Building and Communication\u003c/em\u003e, 3.3.3 \u003cem\u003eEducation and Advocacy\u003c/em\u003e, 3.3.4 \u003cem\u003eRisk Management\u003c/em\u003e, 3.3.5 \u003cem\u003eInterdisciplinary Collaboration\u003c/em\u003e, and 3.3.6 \u003cem\u003ePersonal and Professional Self-Management\u003c/em\u003e – underscores the complexity of nursing contributions to suicide prevention and the essential nature of their work in this area.\u003c/p\u003e\n\u003cp\u003eThe evidence consistently emphasizes the critical frontline position nurses hold in identifying suicide risk. Through regular and often prolonged patient contact, nurses are uniquely placed to observe subtle behavioral and emotional changes, making \u003cem\u003eEarly Detection and Risk Assessment\u003c/em\u003e a core component of their practice. This finding is also supported by the results of previous reviews [25, 41]. However, despite this strategic positioning, some studies indicate a lack of standardized assessment tools and variable confidence levels among nurses in recognizing and evaluating suicidal ideation [68, 73]. This highlights a pressing need for enhanced training and consistent protocols to ensure nurses can respond effectively and confidently.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRelationship-Building and Communication\u003c/em\u003e emerged as another cornerstone role, with studies emphasizing the therapeutic impact of a trusting nurse-patient relationship [61–63, 71]. Open, non-judgmental communication is often the first step toward uncovering suicidal thoughts, yet this requires time, emotional investment, and organizational support—resources that may be limited in high-demand care environments. Therefore, institutional recognition and prioritization of relationship-based care in suicide prevention strategies are essential [40].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe role of \u003cem\u003eEducation and Advocacy\u003c/em\u003e reflects the broader societal responsibility nurses carry in mitigating stigma, educating individuals and relatives, and engaging in public health initiatives. While some studies document nurses taking proactive roles in these areas [59, 65, 67], others reveal gaps in knowledge and insufficient integration of suicide prevention into nurse education curricula. Given the increasing mental health burden globally [76], strengthening this role could amplify the preventative reach of nursing beyond clinical settings.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRisk Management\u003c/em\u003e responsibilities also illustrate the balancing act nurses perform between alleviating immediate distress and maintaining a safe, therapeutic environment. Strategies range from ensuring environmental safety to strengthening protective factors like hope and social support [35, 36, 57, 58, 63, 64]. The diversity of approaches across countries and settings reflects the need for context-specific, culturally sensitive interventions.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInterdisciplinary Collaboration\u003c/em\u003e is widely recognized as vital for comprehensive suicide prevention. Nurses often act as coordinators and communicators, linking care recipients with appropriate services and professionals [36, 56, 57, 68, 73]. However, the effectiveness of this role is contingent upon organizational structures that support seamless information-sharing and integrated care pathways. Barriers such as poor communication channels, unclear role boundaries, and hierarchical team dynamics can limit the potential of this collaborative function.\u003c/p\u003e\n\u003cp\u003eFinally, \u003cem\u003ePersonal and Professional Self-Management\u003c/em\u003e points to the emotional impact and moral challenges nurses face in this area of care. The evidence illustrates that suicide prevention often involves exposure to distressing situations, ethical dilemmas, and emotional fatigue [36, 58]. The emphasis on reflection, emotional debriefing, and value-based practice signals the importance of institutional mechanisms to support nurses’ mental health and resilience [40]. Failing to address these needs may lead to burnout, reduced quality of care, and attrition from the workforce.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2 Strengths and limitations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the key strengths of this scoping review lies in its comprehensive and systematic approach to mapping the roles and responsibilities of nurses in suicide prevention across a wide range of international contexts. By including a broad variety of evidence sources this review captures the complexity and diversity of nursing practice in this field. The inclusion of studies published over three decades (1993-2024) further enhances the depth of analysis. Additionally, the review’s structured categorization of six core roles with clearly defined responsibilities offers a framework that can inform further research.\u003c/p\u003e\n\u003cp\u003eDespite these strengths, several limitations must be acknowledged. First, while the review sought international perspectives, the distribution of sources was uneven across regions, with some geographical areas underrepresented; potentially limiting the global generalizability of the findings. Second, the quality of included sources was not appraised, as is typical in scoping reviews; thus, the strength of the evidence supporting specific roles and responsibilities may vary. Third, the heterogeneity of the included evidence sources – varying in design, context, population, and terminology – posed challenges in synthesizing the data and drawing comparisons. Moreover, the scope was limited to adult care settings, which may exclude relevant insights from pediatric or adolescent populations where suicide prevention is also critical. Finally, the review may be subject to publication bias, as gray literature and non-English sources were not systematically included, potentially omitting valuable perspectives.\u003c/p\u003e\n\u003cp\u003eOverall, while this scoping review provides a valuable and timely overview of nursing roles and responsibilities in suicide prevention, its findings should be interpreted in light of these methodological constraints. Further focused and region-specific research is needed to build on these insights and fill existing gaps.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3 Implications for Research and Clinical Practice\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, the roles identified in this review demonstrate that suicide prevention is not a singular intervention but a continuum of care that nurses are deeply embedded in, both clinically and ethically. The findings also suggest a need for organizational and societal changes to better equip and support nurses in these roles, including comprehensive training, organizational backing, and policy-level recognition of their central role in suicide prevention. Future research should continue to explore how these roles are implemented in various cultural and healthcare contexts, and how best practices can be adapted and shared globally to strengthen the nursing contribution to suicide prevention.\u003c/p\u003e\n\u003cp\u003eIn practice, there is a pressing need to integrate suicide prevention competencies into nursing curricula for initial, continuing and further training, ensuring that nurses enter the workforce with the skills and confidence to engage effectively in this sensitive area. Health institutions should also prioritize ongoing professional development, reflective practice, and emotional support mechanisms – such as supervision and debriefing sessions – to help nurses manage the emotional demands associated with suicide prevention work. At the policy level, suicide prevention should be embedded into national (nursing) strategies and clinical guidelines, recognizing the unique contributions nurses make across care settings.\u003c/p\u003e\n\u003cp\u003eFrom a research perspective, further studies are needed to evaluate the effectiveness of nursing-led suicide prevention interventions and to examine the contextual factors that facilitate or hinder their implementation. Additionally, participatory research involving nurses and individuals with lived experience of suicidality may help develop more person-centered, culturally appropriate, and ethically grounded approaches to care. Strengthening the evidence base in these areas is critical for advancing nursing practice and ensuring the sustainability and impact of suicide prevention efforts worldwide.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eGiven the comprehensive significance of suicide prevention for people in existential crises, clarification of the roles and responsibilities of caregivers is of great importance. This scoping review provides a comprehensive overview of the diverse and multifaceted roles nurses play in suicide prevention within adult care settings across international contexts. The analysis of 25 sources of evidence reveals that nursing responsibilities span six key roles: 3.3.1 \u003cem\u003eEarly Detection and Risk Assessment\u003c/em\u003e, 3.3.2 \u003cem\u003eRelationship-Building and Communication\u003c/em\u003e, 3.3.3 \u003cem\u003eEducation and Advocacy\u003c/em\u003e, 3.3.4 \u003cem\u003eRisk Management\u003c/em\u003e, 3.3.5 \u003cem\u003eInterdisciplinary Collaboration\u003c/em\u003e, and 3.3.6 \u003cem\u003ePersonal and Professional Self-Management\u003c/em\u003e. These roles demonstrate the depth of nursing engagement at all levels of suicide prevention – universal, selective and indicated – and highlight the unique position of nurses to contribute meaningfully to the identification, intervention, and long-term support of individuals at risk. In light of the discussions surrounding assisted suicide in many countries across the world and its implementation, the topic of suicide prevention and the role and responsibility of nurses in all settings and care relationships is becoming increasingly relevant.\u003c/p\u003e\n\u003cp\u003eHowever, the findings also point to the need for greater structural support, targeted education, and clear protocols to strengthen nurses’ competence and responsibility in this complex area of care. Future research and policy development should prioritize the integration of suicide prevention competencies into nursing education and practice frameworks, as well as foster supportive environments that enable nurses to carry out these critical roles effectively and sustainably.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAPNA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;American Psychiatric Nurses Association\u003c/p\u003e\n\u003cp\u003eGHVN\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;General Home Visiting Nurses\u003cbr\u003eICN\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;International Council of Nurses\u003c/p\u003e\n\u003cp\u003eRNAO\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Registered Nurses’ Association of Ontario\u003c/p\u003e\n\u003cp\u003eMAiD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Medical Assistance in Dying\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGenerated data during the review process – including the search strategy, selection and extraction guidance as well as a list of excluded sources of evidence – are provided in this article (see Supplementary Files 1 – 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis scoping review was funded by the Federal Ministry of Health [Bundesministerium für Gesundheit]. Grant number: 2524FSB220. The Open Access funding will be enabled and organized by Projekt DEAL.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis scoping review was conceptualized by SF, TH, AR, KK and PMH. SF conducted the literature search, which was reviewed by AR, TH, KK and PMH. Screening and Selection of evidence sources were carried out by SF and EJ, with input from TH, AR, KK and PMH in cases of uncertainty. Data Extraction was performed by SF and EJ. SF conducted Data Analysis and Synthesis, with review and input from AR, TH, KK and PMH. The initial Manuscript Draft was written by SF, with review, feedback and editing contributions from AR, TH, KK, EJ and PMH. All authors reviewed the findings and approved the final version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWorld Health Organization (WHO). Suicide. Key facts. WHO; 2025. https://www.who.int/news-room/fact-sheets/detail/suicide. Accessed 15 May 2025.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization (WHO). Preventing suicide: A global imperative. WHO;2014. https://www.who.int/publications/i/item/9789241564779. Accessed 10 May 2025.\u003c/li\u003e\n \u003cli\u003eRubli Truchard E, Monod S, Bula CJ, Dürst A-V, Levorato A, Mazzocato C, Münzer T, Pasquier J, Quadri P, Rochat E, Spencer B, von Gunten A, Jox RJ. Wish to Die Among Residents of Swiss Long-Term Care Facilities: A Multisite Cross-Sectional Study. 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BMC Psychiatry. 2025;25(486). doi:10.1016/j.jad.2025.119817.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Footnotes","content":"\u003col\u003e\n \u003cli\u003eA preliminary search in MEDLINE and CINAHL was conducted in September 2024 to identify reviews on this topic\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Nurse, Suicide Prevention, Suicide, Role, Responsibility ","lastPublishedDoi":"10.21203/rs.3.rs-7206436/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7206436/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eGlobally, suicide remains a major public health concern. As frontline caregivers, nurses play a crucial role in identifying and supporting those at risk. Despite their central role, the specific contribution of nurses to suicide prevention across various care settings has not been mapped comprehensively. This scoping review aims to identify potential roles and responsibilities of nurses in suicide prevention within adult care settings from an international perspective.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The review followed the methodological framework for scoping reviews outlined by the Joanna Briggs Institute. A comprehensive search of peer-reviewed empirical studies, case reports, guidelines, standards, policy papers, discussion papers and professional codes was conducted in MEDLINE, CINAHL and PsycInfo.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of n = 25 sources published between 1993 and 2024 in countries across Europe, Asia, North America and Australia were included. Six overarching roles of nurses were identified: \u003cem\u003eEarly Detection and Risk Assessment\u003c/em\u003e, \u003cem\u003eRelationship-Building and Communication\u003c/em\u003e, \u003cem\u003eEducation and Advocacy\u003c/em\u003e, \u003cem\u003eRisk Management\u003c/em\u003e, \u003cem\u003eInterdisciplinary Collaboration\u003c/em\u003e and \u003cem\u003ePersonal and Professional Self-Management\u003c/em\u003e. Each role encompasses specific responsibilities, reflecting the complex and multifaceted nature of nurse’s involvement. The findings further indicate that nurses contribute meaningfully across universal, selective and indicated suicide prevention strategies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003eNurses play a crucial role in suicide prevention. However, to fully leverage their potential, institutional and systemic changes are needed, including enhancing training, organizational support and policy-level recognition. This serves the best interests of individuals in suicidal and existential crises and their care-related supports needs, addressing both their existential distress and their care-related support needs. Future research should focus on evaluating the implementation and effectiveness of nurses’ contribution to suicide prevention across diverse cultural and healthcare contexts, with the aim of strengthening nurses’ role in suicide prevention globally.\u003c/p\u003e","manuscriptTitle":"Nurses’ Roles and Responsibilities in Suicide Prevention: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-04 10:47:03","doi":"10.21203/rs.3.rs-7206436/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-24T06:29:21+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-20T17:23:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"307677427678656625636225489701465799141","date":"2025-09-06T07:00:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"115375839525342544135655638527686955607","date":"2025-08-12T23:43:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-04T12:57:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62815923523900841461296478359140811423","date":"2025-07-30T00:20:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-29T23:57:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-29T22:34:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-28T06:47:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-27T23:27:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-07-27T16:20:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"728176dc-edf1-4570-8e1c-e71d8c52ac16","owner":[],"postedDate":"August 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-27T16:24:31+00:00","versionOfRecord":{"articleIdentity":"rs-7206436","link":"https://doi.org/10.1186/s12912-025-04009-5","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-10-22 16:16:49","publishedOnDateReadable":"October 22nd, 2025"},"versionCreatedAt":"2025-08-04 10:47:03","video":"","vorDoi":"10.1186/s12912-025-04009-5","vorDoiUrl":"https://doi.org/10.1186/s12912-025-04009-5","workflowStages":[]},"version":"v1","identity":"rs-7206436","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7206436","identity":"rs-7206436","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}