"You get tired of remaining in a state of fear"- professionals' experiences of self-care facing suicidality in psychiatric wards

AIM

The aim of this study is to explore mental healthcare professionals (MHCPs) experiences related to own emotions when encountering patients at risk of suicide in psychiatric wards and their family members.

METHODOLOGY AND METHODS, PARTICIPANTS AND RESEARCH CONTEXT

This study has a qualitative explorative design. Data consist of texts from twelve in-depth interviews with MHCPs belonging to six units in two psychiatric wards. Data were interpreted using a hermeneutical approach based on Gadamer's philosophical hermeneutics.

FINDINGS

Through an interpretation process, three themes emerged: Enduring own emotions, Balancing emotional engagement and the need to rest, and Being together in the community of colleagues.

CONCLUSION

This study shows the importance of being aware of own anxiety facing suicidality. MHCPs have to work emotionally and cognitively so that care is not guided by anxiety but by collaboration with the patient and his family members. The study highlights the need for a culture in the mental health service in which the MHCP can reflect on own emotional reactions and thoughts in a collegial environment characterized by openness, generosity and collaboration.

Nursing students' experience of approaching risk for suicide behaviour through simulated environments: A content analysis study

BACKGROUND

Suicide is a major public health problem, especially among the young population. Nurses are in a unique position to prevent it due to their constant contact with patients. However, addressing suicidal behaviour can be complicated by the emotional responses it elicits. Simulation has been shown to be an effective tool to increase the self-confidence of nursing students in dealing with these sensitive situations in a safe environment prior to dealing with real patients.

AIM

To explore nursing students' perceptions, thoughts, and emotions about their performance in dealing with risk for suicidal behaviour through simulated scenarios.

DESIGN

Qualitative descriptive study.

METHODS

Students of Mental Health and Psychiatric II in the third year of the Nursing course at the University of Málaga were invited to explain their experience by answering a questionnaire of three open-ended questions following their participation in the simulated scenarios of the course.

RESULTS

A total of 72 students participated. Content analysis of the written responses identified three main themes: (i) Emotions experienced during the simulation; (ii) Self-criticism of the performance/intervention; (iii) Student evaluation of the learning experience. Most of the students indicated at some point during the clinical scenario, they had felt anxiety, proposing possible improvements in their own performance. The clinical scenario that elicited the most negative emotions was that of a person diagnosed with borderline personality disorder.

CONCLUSION

Clinical simulations contribute to a better understanding of nursing practice with mental health patients and the need for training in emotional and therapeutic communication skills among students.

The Impact Of Patient Suicide on Doctors and Nurses: A Critical Interpretive Meta-Synthesis

OBJECTIVE

To provide a conceptual overview of how medical doctors and nurses experience patient suicide.

METHOD

A systematic search identified ten qualitative papers for this interpretive meta-synthesis. Constructs were elicited and synthesized via reciprocal translational analysis.

RESULTS

Findings comprised four inter-related themes: (1) Intrinsic but taboo: patient suicide perceived as inevitable yet difficult to discuss. (2) Significant emotional impact: clinicians deeply affected, with resilience important for mitigating impact. (3) Failure and accountability: intense self-scrutiny, guilt and shame, with blame attributed differently across professions. (4) Legacy of patient suicide: opportunities for growth but lack of postvention guidance.

CONCLUSIONS

Patient suicide affects clinicians profoundly. Further research should evaluate postvention procedures to inform effective guidance and support, acknowledging professional differences.HighlightsPatient suicide profoundly affects doctors and nurses as "suicide survivors."Despite common themes, professions differed in blame attributions.Organizations must develop postvention responses to meet clinicians' pastoral needs.

Newtonian science, complexity science and suicide-critically analysing the philosophical basis for suicide research: A discussion paper

AIM

A critical discussion comparing Newtonian science and complexity science as the philosophical basis for suicide research and its impact on suicide knowledge development and clinical practice.

DESIGN

Discussion paper.

DATA SOURCES

A review of literature on suicide research and complexity science ranging from 2000 to 2022.

IMPLICATIONS FOR NURSING

Suicide research based on a Newtonian worldview can have negative consequences for suicide knowledge development and can permeate nursing practice in ways that take away from addressing the complex needs of patients, their families and healthcare teams.

CONCLUSION

A Newtonian worldview as a philosophical basis for research is insufficient for the study of a phenomenon as complex as suicide. A complexity science approach is better suited to the study of suicide given the multiple, interrelated, emerging factors that can contribute to a person's decision to end their own life.

IMPACT

Suggestions are provided as to how a complexity science approach to the research of suicide can inform useful knowledge development that better meets the needs of individuals facing suicidality and their families. Researchers, healthcare administrators and nurses providing care to those struggling with suicidality can benefit from adopting a complexity science worldview in addressing this multifaceted phenomenon.

Understanding care relationships in diabetes practice: A psychodynamic interview-based exploratory study

Objective

To explore the subjective experience of physicians working in diabetic settings about their care relationships in order to find some unique clues contributing to physician professional health and capacity to manage patients’ adherence.

Research design and methods

An interview-based exploratory study has been carried out involving 18 physicians (77.8% female) with at least 3 years of clinical practice in diabetes care. In-depth interviews about the emotional experience with patients with diabetes were conducted and audio recorded. Interviews transcripts were analyzed through a computer-based text analysis which allowed the identification of thematic domains (Cluster Analysis) and latent factors (Correspondence Analysis) viewed through a psychodynamic and constructivist lens.

Results

Six thematic domains emerged respectively referring to: Concern (8.43%), Control (14.42%), Ambivalence (22.08%), Devotion (22.49%), Guilt (19.29%) and Strive for Achievement (13.30%). Moreover, three latent dimensions were taken into account, which explained 69.20% of data variance: Affect Repression (28.50%), Tendency to Repair (22.70%) and Anxiety Pattern (18.00%).

Conclusions

Overall, the results of the present study confirm the challenging nature of diabetes care. In particular, physicians ongoing effort to restore patients’ psychological integrity in chronic condition constitute the most novel finding above all. In this regard, the need for emotional labor in physicians’ education and training is suggested in order to both prevent burnout symptoms (e.g. depersonalization) and promote shared decision making in care relationships. However, findings should be treated as preliminary given the convenience nature of the sample and its reduced size.

Family expectations of inpatient mental health services for adults with suicidal ideation: a qualitative study

Involvement of family members of adults with suicidal ideation is a key area of improvement in inpatient mental health services. To support family involvement in this context, it is crucial to understand what care and treatment family members expect for their relative. This qualitative study based on grounded theory involved interviews with 14 family members, including partners, parents, adult children and siblings. The family members' expectations of care and treatment in inpatient mental health services were captured by the core element 'Struggling to remain hopeful while looking through the lens of uncertainty'. This core element interacted with four sub-elements: assuming safety as a priority, looking for a healing approach and environment, counting on continuity of care and wanting to be involved and supported. The family members fluctuated between hope and uncertainty depending on whether their expectations were met or unmet. Unmet expectations were common and underpinned by a sense of being marginalized during the admission of their relative with suicidal ideation. Mental health professionals, including nurses, can be more empathetic towards the family members and attuned to their expectations. This can underpin partnerships that help families to deal with their feelings of uncertainty and disempowerment. Such partnerships can flourish in recovery-oriented mental health services that allow meaningful family involvement.

Engagement between adults in suicidal crises and nurses in mental health wards: a qualitative study of patients' perspectives

OBJECTIVE

To understand how patients in suicidal crises perceive their engagement with nurses in mental hospitals.

METHODS

A qualitative study based on grounded theory was conducted. Semi-structured interviews were used with 11 hospitalised adults living through suicidal crises. The data were analysed by multiple researchers, using the constant comparison method, coding, and memo writing.

FINDINGS

The core process was: 'Feeling nurtured through an interpersonal engagement'. This process underpinned two categories: 'Feeling safe and cared for while struggling to trust' and 'Working toward alleviation and change of my suicidal ideation'. The patients valued nurses who integrated caring approaches of building trust, demonstrating compassion, and promoting safety, with healing approaches of helping them to express and explore their suicidal ideations, and develop new insights and ways of coping. This interpersonal engagement could nurture patients' feelings of being accepted and understood, and being hopeful and capable of overcoming their suicidal ideations.

CONCLUSION

The conceptual insights can inform strategies to reframe overly instrumental approaches to prevent suicide and treat suicidal ideation, and instead promote an interpersonal orientation in nursing practice that integrates caring-healing approaches.

Telling a Complicated Grief: A Psychodynamic Study on Mental Health Nurses' Countertransference Reactions to Patients' Suicidal Behavior

A key element of suicide education, training and clinical supervision is enhancing emotional awareness about mental health professionals' countertransference reactions, as emotional responses to patients' suicidal behavior (SB) that may be unbeneficial to care. This study aimed to explore emotional responses to patients' SB in mental health nurses (MHNs) according to a psychodynamic perspective. Twenty-eight Italian MHNs (61% females, Mage = 52 years) were interviewed to examine their deep feelings about attempted suicides or deaths by suicide of patients with mental illness. Computer-aided thematic analysis was performed on the verbatim transcribed interviews, adopting Emotional Text Analysis (ETA) as a research framework to explore affective symbolizations underlying narratives, beyond intentional and explicitly reported contents. Some statistical multidimensional techniques were carried out, allowing th.e detection of shared symbolic domains (Cluster Analysis) and latent factors organizing the contraposition between them (Multiple Correspondence Analysis). Five symbolic domains emerged which were respectively referred to as: hyper-vigilance (21.97% of the overall textual corpus), resentment (17.86%), rationalization (34.50%), resignation (5.54%) and mourning (20.12%). Four latent factors explained the overall data variance: strive for reparation (F1), lack of control (F2), ambivalence toward care (F3) and complicated grief (F4). Some clinical recommendations were derived suggesting to balance issues of risk assessment/management and staff's reflective practice, to work on the subjective sense of hopelessness resulting from turning against oneself the hostility evoked by patients, to consider rationalization processes and implicit beliefs leading to risk underestimation and to address some basic conflicts contributing to a complicated grief in mourning suicidal events.

"When my worse fear happened": Mental health nurses' responses to the death of a client through suicide

WHAT IS KNOWN ON THE SUBJECT?: The death of a client to suicide evokes a range of grief responses for mental health nurses (MHNs), which vary in intensity according to the nature of the therapeutic relationship with the deceased client. There are limited qualitative studies on the experiences of nurses working in the community and the personal or professional strategies used by nurses to cope with the death of a client by suicide. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Following a client suicide, MHNs were often left to carry the burden of grief alone and to care for themselves with the support of their family and colleagues. While all participants perceived the need for support following the death of a client by suicide, they were offered minimal support beyond the debriefing meetings, with their grief experience being largely unacknowledged and disenfranchised. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: MHNs and services need to establish and promote a culture of openness in which suicide is anticipated as a possible outcome, even with excellent standards of care and wherein all staff are supported and encouraged to discuss and reflect on their concerns and fears during the aftermath of a client suicide. As MHNs are often left to carry the burden of grief alone, services need to recognize the emotional cost of embodied engagement with clients and families and provide the necessary supports. ABSTRACT: Introduction Experiencing a client's death through suicide is complex and challenging, yet limited research exists on how MHNs might deal with its aftermath. Aim This study aimed to explore the impact and responses of MHNs to a client suicide. Method The study design is a secondary analysis of an existing data set involving semi-structured interview with 33 MHNs that were analysed using the principles of grounded theory. To answer the secondary question on the impact and responses of MHNs to the death of a client by suicide a subset of the data from 10 participants who experienced the death of a client by suicide were re-analysed using thematic analysis. Ethical approval was granted by the university ethics committee. Findings The findings identified five themes: "Hearing the news," "Experiencing the impact of grief," "Grieving privately" "Searching for meaning" and "Questioning practice." Discussion Findings highlighted that although participants perceived the need for support, they were offered minimal support beyond the debriefing meetings, with their grief experience being largely unacknowledged and disenfranchised. Implications for practice MHN services need to promote a culture of openness wherein all MHNs are supported and encouraged to discuss their concerns and fears during the aftermath of a client suicide.

Suicide care from the nursing perspective: A meta-synthesis of qualitative studies

AIMS

To explore nurses' experiences of suicide care and to identify and synthesize the most suitable interventions for the care of people with suicidal behaviour from a nursing perspective.

DESIGN

Qualitative meta-synthesis.

DATA SOURCES

Comprehensive search of five electronic databases for qualitative studies published between January 2015 and June 2019.

REVIEW METHODS

The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso's method.

RESULTS

Seventeen articles met the inclusion criteria. The data analysis revealed 13 subcategories from which four main categories emerged: 'Understanding suicidal behaviour as a consequence of suffering', 'Nurses' personal distress in suicide care', 'The presence of the nurse as the axis of suicide care' and, 'Improving nurses' relational competences for a better therapeutic environment'.

CONCLUSION

Further training of nurses on the therapeutic relationship, particularly in non-mental health care work settings, and monitoring of the emotional impact on nurses in relation to suicide is required to promote more effective prevention and care.

IMPACT

This review provides new insights on how suicide is interpreted, the associated emotions, the way suicide is approached and proposals for improving clinical practice from the point of view of nurses. The results demonstrate that the nurse-patient relationship, ongoing assessment, and the promotion of a sense of security and hope are critical in nursing care for patients who exhibit suicidal behaviour. Consequently, to promote an effective nursing care of suicide, nurses should be provided with further training on the therapeutic relationship. Thus, health institutions do not only provide the time and space to conduct an adequate therapeutic relationship, but also, through their managers, they should supervise and address the emotional impact that is generated in nurses caring for patients who exhibit suicidal behaviour.

To Identify and Support Youths Who Struggle with Living-Nurses' Suicide Prevention in Psychiatric Outpatient Care

Nurses working in psychiatric care daily encounter youths who are struggling with living. Despite this, nurses' suicide-prevention work is seldom addressed in research or in recommendations for care. The overall aim of this paper is to discuss how nurses, with their caring science perspective, may contribute to suicide prevention. The paper presents how nurses in psychiatric outpatient care may identify and support suicidal youths, according to experts in suicide prevention. The interviews with six experts in suicide prevention resulted in three themes: Engagement necessary but demanding, Acknowledgement of warnings signs and Supportive relationship. The respondents elaborated on how suicide-risk can be assessed. A good rapport with the youths was stressed and the recommended act of care included: to listen openheartedly without interrupting as well as to listen after risk- and protective factors to emphasize or to penetrate. To ask about suicidality as well as to let the person elaborate on what's important for him or her. To endure in the patients' suffering as well as steering the conversations toward hope. The paper also presents warning signs that need to be noticed according to the experts and the literature consensus. Our findings suggest that communication in suicide-prevention is an "art and act" that cannot be reduced to a method or simple guidelines. We argue that the recommended acts of care demand sensitivity and skills and that nurses as well as the domain of caring science may contribute to this competence.

'Promoting and preserving safety and a life-oriented perspective': A qualitative study of nurses' interactions with patients experiencing suicidal ideation

Suicide prevention is an important imperative in psychiatric hospitals, where nurses have a crucial role in and make essential contributions to suicide prevention and promoting the recovery of patients experiencing suicidal ideation. The present qualitative grounded theory study aimed to uncover and understand the actions and aims of nurses in psychiatric hospitals during their interactions with patients experiencing suicidal ideation. Interviews were conducted with 26 nurses employed on 12 wards in four psychiatric hospitals. The data analysis was inspired by the Qualitative Analysis Guide of Leuven. The findings show that nurses' actions and aims in their interactions with patients experiencing suicidal ideation are captured in the core element 'promoting and preserving safety and a life-oriented perspective'. This core element represents the three interconnected elements 'managing the risk of suicide', 'guiding patients away from suicidal ideation', and 'searching for balance in the minefield'. The enhanced understanding of nurses' actions and aims can inform concrete strategies for nursing practice and education. These strategies should aim to challenge overly controlling and directing nursing approaches and support nurses' capacity and ability to connect and collaborate with patients experiencing suicidal ideation.