The borderline between life and death

A systematic review and thematic synthesis of inpatient nursing staff experiences of working with high-risk patient behaviours

INTRODUCTION

Nursing staff are frequently exposed to high-risk patient behaviours within inpatient health services, yet staff commonly report a lack of training and support in managing these behaviours.

AIM

The aim of the study was to examine nursing staff experiences of high-risk behaviours in inpatient mental health settings.

METHODS

Four electronic databases (CINAHL, Medline, PsycINFO, EMBASE) were searched. The protocol for this review was prospectively registered in PROSPERO (Ref: CRD42022334739). A meta-synthesis of nursing staff's experiences of high-risk behaviours in inpatient mental health settings was conducted.

RESULTS

We identified 30 eligible studies. Six themes were constructed from the meta-synthesis: the social contract of care; the function of risk behaviours; the expectation of risk; risk as a relational concept; navigating contradictions in care; the aftermath.

DISCUSSION

Nursing staff conceptualize risk as a meaningful behaviour shaped by patient, staff and environmental factors. Managing risk is an ethical dilemma for nursing staff and they require more training and support in ethical risk decision-making.

IMPLICATIONS FOR PRACTICE

Inpatient mental healthcare services should formulate and manage risk as a relational concept comprising staff, patient and environmental factors. Future research and clinical practice should place further consideration on the varied experiences of different types of risk behaviours.

RELEVANCE STATEMENT

Nursing staff are frequently exposed to high-risk patient behaviours within inpatient health services, yet staff commonly report a lack of training and support in managing these behaviours. This systematic review offers insights into how high-risk behaviours are experienced by nursing staff and makes recommendations about how to improve the understanding and management of them. Inpatient mental healthcare services should formulate and manage risk as a relational concept comprising staff, patient and environmental factors. Future research and clinical practice should place further consideration on the varied experiences of different types of risk behaviours.

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.

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.

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.

Impact of suicide on health professionals in psychiatric care mental healthcare professionals' perceptions of suicide during ongoing psychiatric care and its impacts on their continued care work

People who attempt suicide as well as those who actually take their own life often have communicated their suicidal thoughts and feelings to healthcare professionals in some form. Suicidality is one of the most challenging caring situations and the impacts of suicide care affect both the professional and personal lives of healthcare professionals. This study investigates how mental health professionals perceive suicide while providing psychiatric care and how this perception impacts their continued care work. This qualitative exploratory study includes 19 mental health professionals in psychiatry who had provided care for patients who had taken their own life. Analysis followed the principle of phenomenography. The findings reveal that these healthcare professionals experienced an internal conflict that affected them both personally and professionally. In response to these conflicts, the healthcare professionals developed strategies that involved a safety zone and increased vigilance. Those who were able to commute and balance a safe spot and learning to be more vigilant seem to have developed as a result of patient's suicide. These findings have the potential to help establish a post-suicide caring process where healthcare professionals learn to make better suicide assessments, become more open to talking about death with patients, and develop a humbler approach to understanding a patient's suicide.