New! This article has been updated August 9, 2016 to include more information about the scoring and links to useful tools to accompany.
The Nurses’ Global Assessment of Suicide Risk (NGASR) is a tool that nurses can utilize to assess for suicide risk in a clinical, inpatient environment. The tool was originally developed to assist nurses in a UK hospital where suicide risk assessments were originally completed by an intake nurse, without any backup or support to ensure they were done properly.
Suicide risk assessment takes a lot of experience and practice, and the NGASR is one tool that can provide assistance while nurses develop these critical skills.
Indicators of Suicide Risk
The NGASR explored the following indicators. In brackets is the point value if the item is present, which allows you to assess the suicide risk using the score found below.
- Feelings of hopelessness (3)
- Recent stressful events (1)
- Persecutory hallucinations (1)
- Depression (3)
- Withdrawal from social interactions (1)
- Verbalization of suicidal intent (1)
- Evidence of a specific plan (6)
- Family history of mental illness or suicide (1)
- Recent bereavement or relationship breakdown (3)
- History of psychosis (1)
- Widow/widower (1)
- Prior suicide attempt (3)
- History of socio-economic deprivation (1)
- History of substance use (1)
- Terminally ill (1)
It’s important to note that these elements cover the CPR Risk Assessment elements, starting with the verbalization of suicide intent and following on with:
- Current Plan (Evidence of a specific plan)
- Previous Exposure to Suicide (family history of mental illness or suicide; recent bereavement; prior suicide attempt)
- Resources (withdrawal from social interactions)
Each of the variables identified above for the NGASR are assigned a weighting based on the ones most likely to lead to suicide, with five being assigned a score of 3 (for high-risk) and the others being assigned a score of 1.
The following scoring system has been developed by Cutcliffe & Barker (2004):
- 0-5 – Low Risk, Level Four
- 6-8 – Intermediate Risk, Level Three
- 9-11 – High Risk, Level Two
- 12+ – Very High Risk, Level One
These supervision levels from Barker & Buchanan-Barker (2005) and reproduced in the RNAO guide.
- Level Four: Engagement on a structured daily basis (such as by having nurses available to speak with and providing regular programming)
- Level Three: Formal engagement at least three times per day – morning, afternoon and evening (such as by having nurses perform suicide assessments and check in with patients)
- Level Two: Regular support (e.g. approximately every 15 minutes, varying between 10 and 20 minutes) from the nursing team throughout the day or night (This is the most common level of “high risk” or “suicide watch” supervision and can help prevent inpatient suicide)
- Level One: Constant access to a nurse, or other professional for support (This is for imminent risk situations while a patient is being stabilized, or during transition points such as moving to a higher or lower level of care.)
You can download the NGASR at the RNAO website (see page two.)
Barker, P. & Buchanan-Barker, P. (2005). The Tidal Model: A Guide for Mental Health Professionals. New York, NY: Routledge.
Cutcliffe, J.R., Barker, P. (2004) “The Nurses’ Global Assessment of Suicide Risk (NGSAR): developing a tool for clinical practice.” Journal of Psychiatric and Mental Health Nursing. 11. 393-400