Navigating oneself through the eyes of the other - meanings of encountering ambulance clinicians while being in a suicidal process

PURPOSE

The suicidal process contains both observable and non-observable phases, and patients have described the process as characterized by loneliness and darkness. Ambulance clinicians encounter patients in all phases of the suicidal process but little is known on what meaning this encounter has to the patients. The aim of this study was to elucidate meanings of encountering ambulance clinicians while being in a suicidal process.

METHODS

Data were collected through fifteen individual interviews with eight participants who had lived experiences of encountering ambulance clinicians. Inductive design using phenomenological hermeneutical approach was used.

FINDINGS

Patients are impacted by the clinicians, both in how they find their value in the situation, but also in expected trajectory. Three themes; 'Being impacted by representatives of society', 'Being unsure of one´s own value' and 'Regaining hope in moments of togetherness' generated the main theme ´Navigating oneself through the eyes of the other´.

CONCLUSION

The way ambulance clinicians communicate impacts how patients navigate themselves in the ambivalence about living or dying, and the encounter either consolidate a feeling of being a burden, or instil hope of an endurable life. Through conversation, clinicians could support the patients in taking the first steps in the journey of recovery.

Developing a consensus of recovery from suicidal ideations and behaviours: A Delphi study with experts by experience

BACKGROUND

Understanding recovery in mental health has received significant attention and consequently, recovery has been incorporated into health policy across many countries in the Global North. In comparison, the concept of 'recovery' from suicidal thoughts and behaviours has received little attention. However, the few studies in this area appear to suggest that recovery is a complex and an idiosyncratic process with many contributing factors. This can present a challenge for clinicians and services seeking to become more recovery focused. Thus, it seems of importance to develop a consensus on how recovery from suicidal thoughts and behaviours is conceptualised.

AIM

The study aimed to use the Delphi design to establish a consensus of how recovery is defined by those with lived experience of suicidal thoughts and behaviours. The Delphi method draws on the expertise of a panel, often involving clinicians, researchers and lived experience experts to develop consensus over a topic by inviting them to rate the importance of, often a series of statements to a given topic area.

METHOD

Lived experience experts were asked to complete two rounds of questionnaires distributed online to capture their views on recovery.

RESULTS

A total of 196 individuals gave their views on the first round of the study and 97 gave their views on the second round. A final list of 110 statements was developed that 80% or more of participants defined as essential or important. Statements covered items that were important in defining, facilitation and hindering the process of recovery.

CONCLUSION

Findings are consistent with the wider literature that suggests that recovery is an idiosyncratic process, but with many commonly shared features. Here we also show that a comprehensive definition of recovery must include factors that hinder the process of recovery. Implications and recommendations for practice, policy development and future research are discussed.

Ambulance clinicians' responsibility when encountering patients in a suicidal process

BACKGROUND

Even though the traditional focus in emergency care is on life-threatening medical crisis, ambulance clinicians frequently encounter patients with mental illness, including suicidal ideation. A suicide is preceded by a complex process where most of the suicidal ideation is invisible to others. However, as most patients seek healthcare in the year before suicide, ambulance clinicians could have an important part to play in preventing suicide, as they encounter patients in different phases of the suicidal process.

AIM

The aim of this study was to describe ambulance clinicians' conceptions of responsibility when encountering patients in a suicidal process.

RESEARCH DESIGN

A qualitative inductive design using a phenomenographic approach was used.

PARTICIPANTS AND RESEARCH CONTEXT

Twenty-seven ambulance clinicians from two regions in southern Sweden were interviewed.

ETHICAL CONSIDERATIONS

The study was approved by the Swedish Ethical Review Authority.

FINDINGS

Three categories of descriptions captured a movement from responding to a biological being to responding to a social being. Conventional responsibility was perceived as a primary responsibility for emergency care. In conditional responsibility, the patient's mental illness was given only limited importance and only if certain conditions were met. Ethical responsibility was perceived to have its primary focus on the encounter with the patient and listening to the patient's life story.

CONCLUSIONS

An ethical responsibility is favourable regarding suicide prevention in ambulance care, and competence development in mental illness and conversation skills could enable ambulance clinicians to have conversations with patients about suicidal ideation.

Lifesaving turning points: First-person accounts of recovery after suicide attempt(s)

This study explores the recovery processes of persons who had attempted suicide. Semi-structured interviews were conducted with eight persons who had attempted suicide and the data were analyzed by means of systematic text condensation. The participants described lifesaving turning points, which were connected to meaningful relationships, taking control over one's own life, and establishing a new everyday life. Suicide prevention efforts must be adapted to individual needs. First-person knowledge is important if we are to understand what is seen as helpful and should be emphasized when implementing suicide prevention work.

Valued attributes of professional support for people who repeatedly self-harm: A systematic review and meta-synthesis of first-hand accounts

Therapeutic interventions are an important adjunct to self-help strategies for people who self-harm. There is little guidance for those offering therapy on the effective components of interventions for people who self-harm. This was a systematic review aiming to identify the factors that contribute to positive experiences of therapy as described by people who have reduced or stopped self-harm. The review followed PRISMA guidelines to locate and synthesize peer-reviewed qualitative studies describing experiences of therapy among people who had reduced or stopped self-harm. Study selection, data extraction, and quality assessment were peer reviewed and conducted for at least two researchers independently. Relevant first-hand quotations were extracted from eligible studies and synthesized using a thematic analysis in collaboration with experts with personal and professional experience of self-harm. Twenty-three studies met eligibility criteria. Themes identified in the reported accounts were arranged under two meta-themes. 'Positive aspects of seeing a professional' identified aspects of professional care that were common to all encounters: the value of sharing, space to talk and reflect, and the boundaries inherent in contact with a professional. 'Positive attributes of individual professionals' depended upon individual characteristics: the ability to build reciprocal trust by being non-judgemental, showing genuine empathic concern, and being confident to talk about and respond directly to self-harm. Our review indicates that therapeutic alliance is perceived as key to effective professional help for self-harm, irrespective of underlying principles of therapy. All forms of therapy should be timely and reliable and centred around the needs of the individual and their experience of self-harm.

A call for change from impersonal risk assessment to a relational approach: professionals' reflections on the national guidelines for suicide prevention in mental health care in Norway

PURPOSE

The purpose of the study is to explore how professionals working with suicide prevention experience the influence of the national guidelines on mental healthcare, and to gather recommendations for which steps to take next.

METHODS

This is a qualitative study with an explorative design. We interviewed 22 professionals responsible for implementing suicide prevention action plans and guidelines, and/or conducting relevant research. We analysed the data by means of thematic analysis.

RESULTS

We found that the participants had an ambivalent view on risk assessment-it may be a tool, but it may also compromise other important aspects in prevention. Moreover, the possibility of liability has resulted in the need for self-protection. Instead, the participants recommended a relational approach to suicide prevention.

CONCLUSIONS

We found that the emphasis on standardized suicide risk assessment has negatively influenced suicide prevention in mental healthcare, and an approach emphasizing relational aspects is recommended. However, the prevailing objectifying concept of knowledge, the epistemological debate and the emergence of the New Public Management ideology may obstruct a fundamental emphasis on relationships. A paradigm shift in mental healthcare is called for with respect to the concept of knowledge, which forms our understandings and practices.

"Embracing is the most important thing we can do" - Caring for the family members of patients at risk of suicide

Aim

This study explores mental health personnel’s experiences in the encounter with family members of patients at risk of suicide so as to develop a deeper understanding of the content of caring.

Methodology

Data were collected using semi-structured interviews with 12 participants and were analysed and interpreted using a model inspired by the philosophical hermeneutics of Gadamer. The context was psychiatric wards.

Findings

Through a thematic analysis, four themes emerged: Acknowledgement as a premise for involving family members. Embracing with the family members’ feelings and reactions. Strengthening hope in a situation entailing a serious risk of suicide. Providing reassurance to family members in transitional situations.

Conclusion

Witnessing the family members’ suffering and needs is understood as arousing a sense of responsibility in the participants and triggering various care strategies such as listening, embracing, strengthening hope and providing reassurance.

Concerned others' help utilization and patients' alcohol treatment outcomes

BACKGROUND

This study of dyads composed of patients in treatment for alcohol use disorders (AUDs) and their Concerned Others (COs) examined (1) COs' attendance at three types of help (educational sessions, treatment sessions with the patient, and treatment sessions without the patient) during a 3-month period after patients' admission, and (2) whether COs' use of help was associated with better treatment outcomes reported by COs about patients, and patients about themselves.

METHODS

Dyads (n = 277) were assessed when patients entered AUD treatment and 3 months later (80 %). COs rated their patient's AUD, and patients rated their own AUD, on the Brief Addiction Monitor. At 3-month follow-up, COs answered three items about help (education, treatment with patient, treatment without patient) from their patient's treatment program. Main analyses were analyses of covariance to examine associations between COs' help use and patients' outcomes.

RESULTS

At 3-month follow-up, COs who had obtained one type of help were significantly more likely to have also obtained the other two types of help. However, relatively few COs (39 %) obtained any type of help. COs who obtained help rated their patient as having more protection against future substance use. And, when COs had obtained help, patients rated themselves as having less risk of future substance use, and had attended a greater number of AA meetings, than when COs had not obtained help.

CONCLUSIONS

Findings suggest that COs' use of help can benefit patients in AUD treatment. Clinicians and researchers should increase the availability and use of help among COs.

Financial difficulties and patient-reported outcomes among patients with advanced heart failure

PURPOSE

Management of congestive heart failure (CHF) is associated with high health care costs and financial difficulties for patients. We aimed to comprehensively assess the association between financial difficulties and patients' quality of life (QOL) (physical, emotional, social and spiritual), perceived health care quality, and perception of being a burden to the family among patients with CHF; and to assess whether perceived control over stress moderated these associations.

METHODS

This was a cross-sectional study of 250 patients using the baseline data of the Singapore Cohort of Patients with Advanced Heart Failure (SCOPAH). Patients had class 3 or 4 CHF symptoms based on the New York Heart Association and were recruited between July 2017 and August 2019. We used a 3-item questionnaire to measure financial difficulties among patients. We used multivariable linear/ordered logistic regressions to test associations between financial difficulties and each dependent variable.

RESULTS

41% of participants reported financial difficulties. A higher financial difficulties score (range: 0-6, higher score indicating greater difficulty) was associated with lower QOL (emotional, social, and spiritual) and perceived health care coordination, and a higher likelihood of patients perceiving themselves to being a burden to family (all p < 0.05) CONCLUSION: Patients with financial difficulties are vulnerable to poor outcomes. Heart failure clinics should directly assess patients' financial difficulties to help guide treatment-related discussions and to identify patients vulnerable to poor QOL.

" … I felt completely stranded": liminality and recognition of personhood in the experiences of suicidal women admitted to psychiatric hospital

Purpose: The purpose of this study is to explore how patients experience their suicidality and how they experience being in a psychiatric hospital.

Methods: This is part of a field study, and the article is based on data collected in interactions with 11 women who were admitted to a psychiatric hospital and were struggling with suicidality. Data were collected through interviews, conversations, and participatory observation. We analysed the data by means of Systematic Text Condensation, followed by a deductive process where the data and preliminary findings were interpreted in light of the theory of liminality.

Results: We found that the patients’ experiences of suicidality and being a patient in a psychiatric acute ward involve “Liminality and weakened sense of personhood,” and from their perspective, “Recognition of personhood” is an important aspect of care.

Conclusion: Our study indicates that suicidality and psychiatric hospitalization involve liminality and weakened sense of personhood, aspects that are important to consider in the care of the patients. Professionals need to acknowledge more the importance of recognition of personhood in care, since this can strengthen the patient’s self-worth and empower the person. Lack of recognition may increase the patient’s suffering and suicidality.

Patients' experiences of the caring encounter in health promotion practice: a qualitative study in Swedish primary health care

BACKGROUND

Previous studies have reported that organizational structures and cultures in primary health care are obstacles to district nurses doing successful work in health promotion practice (HPP). Because organizational structures are not easily changed, Jean Watson's Attending Nurse Caring Model (ANCM) was introduced and piloted at a primary health care center in Sweden, aiming to transform HPP so as to empower district nurses and increase their work satisfaction.

AIM

To investigate patients' experiences of the caring encounter in HPP after introduction of the ANCM in Swedish primary health care, the aim being to explore the essential components of the caring encounter between patients and district nurses.

METHODS

A descriptive and qualitative research design was used. Data collection was performed using individual face-to-face interviews with twelve patients at risk for developing CVD. Data analysis consisted of both deductive content analysis, using a categorization matrix based on the ANCM and, subsequently, inductive latent content analysis.

RESULTS

The findings were abstracted into three themes: 1.'Feeling the deepest essence of being cared for': to be respected and being put at the center of the encounter; 2. 'Feeling acceptance and worth': being treated with openness and permissive attitudes, 3. 'Being in a supportive atmosphere that promotes hope': to feel trust and being trusted in the encounter, and being empowered by hope. The unifying main theme of the caring encounter was abstracted as 'Experiencing human dignity'.

CONCLUSION

The present study revealed that the essence of the caring encounter between patients and district nurses in HPP is to be unconditionally accepted in an environment that inspires hope and encouragement. The ANCM seems to be a promising model to use for strengthening the caring encounter and supporting CVD patients in making healthy lifestyle choices. However, further studies of qualitative and quantitative designs are needed to investigate what the ANCM can contribute to HPP in Swedish primary health care.

You feel it was written about you: client acceptability of a group intervention for repeat suicide attempts

BACKGROUND

Repeat attempts increase risk of death by suicide. The Psychosocial/psychoeducational Intervention for People with recurrent Suicide Attempts (PISA)/Skills for Safer Living (SfSL) is a group intervention targeting repeat attempts.

AIMS

To evaluate the acceptability of PISA/SfSL to clients and identify key model components influencing this.

METHODS

This exploratory mixed-methods study involved adults who completed PISA/SfSL (N = 16). Participants completed semi-structured interviews and a satisfaction questionnaire post-intervention, and self-report outcome measures of population specific challenges pre and post-intervention and at 6-month follow-up.

RESULTS

Qualitative themes illuminate three interrelated response processes; connection with each other and the model, taking control of life, and gaining a sense of value. Quantitative outcome measures indicated positive trends in suicidality, hopelessness, alexithymia, and problem-solving. High satisfaction levels indicated its quality, relevancy, applicability and helpfulness. Key components influencing responses were PISA/SfSL's; psychosocial group format and processes, psychoeducational and skill development content, and ethos. Results suggest PISA/SfSL was acceptable to those with repeat suicide attempts.

CONCLUSIONS

The study highlights the usefulness of group work and the importance of consistency with guidelines in suicide intervention. It supports the view that recovery in suicidality and engagement in treatment are complex processes. It adds to previous research demonstrating acceptability among facilitators.

The working alliance with people experiencing suicidal ideation: A qualitative study of nurses' perspectives

AIMS

This study aimed to enhance the conceptual understanding of the working alliance in the context of nursing care for people experiencing suicidal ideation.

DESIGN

A qualitative study based on grounded theory was conducted.

METHODS

Two authors conducted individual semi-structured interviews from September 2017-January 2019. Twenty-eight nurses in 13 wards of four psychiatric hospitals participated. The Qualitative Analysis Guide of Leuven was used to support constant data comparisons and the cyclic processes of data collection and data analysis.

FINDINGS

The nurses' perspectives revealed that the working alliance can be understood as an interpersonal and collaborative relational process. This relational process highlighted the core variable 'seeking connectedness and attunement with the person at risk of suicide'. The core variable underpinned three clusters: investing in the foundations of the working alliance, nourishing the clinical dimension of the working alliance and realizing an impact with the working alliance.

CONCLUSION

This study highlights the importance for nurses to assess, evaluate and respond to persons' suicidal ideation in harmony with a commitment to connect with them and attune to their perspective.

IMPACT

The relational process uncovered through this study offers valuable insights to support advanced nursing practice, where nurses meaningfully integrate relational elements of care with their contributions to suicide prevention and treatment.

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.

The perspectives of adults with suicidal ideation and behaviour regarding their interactions with nurses in mental health and emergency services: A systematic review

BACKGROUND

In contemporary healthcare, both community and inpatient mental health and emergency services are important help-seeking avenues for persons with suicidal ideation and behaviour. Regarding nursing practice in these services, there is a strong focus on assessing and managing suicide risk. Within this clinical context, the perspectives of persons with suicidal ideation and behaviour are often overlooked.

OBJECTIVE

To synthesise the literature examining the perceptions and experiences of persons with suicidal ideation and behaviour regarding their interactions with nurses.

DESIGN

Review of qualitative and quantitative studies within a data-based convergent synthesis design.

DATA SOURCES

A systematic search of electronic databases (until January 2020) in PubMed, Web of Science, Embase, and PsycARTICLES. Additional articles were identified through hand searching reference lists.

REVIEW METHODS

The methodological quality was assessed using the Critical Appraisal Skills Programme for qualitative studies and the QualSyst tool for quantitative studies. Thematic analysis was used to identify the key themes and subthemes.

RESULTS

In total, 26 studies were selected for analysis. Most studies were qualitative and focused on inpatient mental health services. The studies reflected a spectrum of positive and negative perceptions and experiences of persons with suicidal ideation and behaviour regarding their interactions with nurses. Three key themes were identified: being cared for and acknowledged as a unique individual, giving voice to myself in an atmosphere of connectedness, and encountering a nurturing space to address my suicidality.

CONCLUSIONS

This systematic review provides insights that can be used to encourage nurses to contribute to suicide prevention and treatment as part of an approach in which they care for, connect, and collaborate with persons experiencing suicidal ideation and behaviour as unique individuals.

Functioning of adults in alcohol use disorder treatment: Role of concerned others

OBJECTIVE

This study examined patients in treatment for alcohol use disorders ("Patients") and their "concerned others" (COs-family and friends): (1) Did Patients' functioning differ according to COs' study participation? Among Patients with participating COs, (2) did Patients and COs agree on Patients' functioning, and (3) was Patients' functioning associated with COs' functioning and quality of CO-Patient relationships?

METHOD

Four-hundred and two Patients (mean age = 44, majority white men) and 277 COs (mean age = 52, majority white women) completed validated assessments.

RESULTS

(1) Unexpectedly, Patients who did not identify a CO for potential study participation had more protective factors against future substance use and more readiness to participate in Alcoholics Anonymous (AA) than patients who did identify a CO. (2) Patients had higher scores than COs did when rating the Patient's protective factors, viewed the Patient-CO relationship as having more resources and fewer stressors than COs did, and reported fewer incidents of violence toward the CO than the CO did. (3) Patients had higher risk factors scores when their COs binge drank, and the Patient-CO relationship had more stressors and violence. Patients had higher protective factors scores when COs had greater readiness for Al-Anon participation, and Patients had attended more AA meetings, reported more resources in their relationship with their CO, and used more negotiation tactics when in conflict with their CO.

CONCLUSIONS

Findings suggest that interventions to improve Patients' functioning should be broadened beyond COs who are spouses or partners, decrease COs' binge drinking, facilitate 12-step participation, decrease relationship stressors and conflict, and increase relationship resources.

Optimising professional communication with patients

Communication between a nurse and a patient may seem intuitive. However, communicating effectively with patients while applying the principles of person-centred care can be challenging. Patients' perceptions of suboptimal care and healthcare services may be influenced by how nurses communicate with them, since communication may be used as a quality indicator, as well as an indicator of patient experience. This article considers how nurses can communicate effectively with patients to optimise care. It explores the theoretical principles of interpersonal and professional communication, and discusses practical methods of listening and speaking to patients that nurses can apply in their clinical practice.

Conceptual Foreknowings: An Integrative Review of Hope

Hope is a universal humanuniverse living experience. To advance nursing knowledge of hope as a universal humanuniverse living experience, the scholar dwelled with printed material on hope and explored with pattern preferences. The purpose of this paper is to set forth the conceptual foreknowings arising from the integrative review of literature from diverse disciplines. Four themes arose from the review, which are elaborated here.

The Attempt Was My Own! Suicide Attempt Survivors Respond to an Australian Community-Based Suicide Exposure Survey

Those who attempt suicide have often been overlooked in the suicide prevention literature. Where stories of lived experience have been included, it is often from the perspectives of healthcare professionals who treat the physical and/or psychological impacts following an attempt, rather than firsthand accounts. Yet, the most intimate insights of suicide are lost by not including the voices of those with lived experience of suicide attempt. Through an online, community-based, non-representative survey exploring the impact of exposure to suicide, a sub-sample of 88 participants responded who reported their exposure to suicide as being their own attempt. The survey covered demographic information, questions assessing exposure to suicide attempts and death, current global psychological distress via the Kessler Psychological Distress (K10) Scale, and short qualitative responses provided by 46 participants. The qualitative data was thematically analysed resulting in three themes; the way in which individuals experienced being suicidal; who they were able, or not, to disclose these intentions to—before and after their suicide attempt; and, how these people experienced the formal and informal health care supports available to them to assist with their suicidal crisis. This paper presents important findings from a sample of participants who are highly distressed, and have previously attempted to take their own lives. This adds depth to our understanding of lived experience of suicide attempt, issues associated with seeking appropriate support after suicide attempt, and also demonstrates a willingness of participants to share their stories, even in a study that did not explicitly target those with lived experience of suicide attempt. The need for consistent and compassionate mental health care after a suicide attempt is identified as a vital component of living well after a suicide attempt.

Exploring nurses' and patients' perceptions of hope and hope-engendering nurse interventions in an eating disorder facility: A descriptive cross-sectional study

WHAT IS KNOWN ON THE SUBJECT?: Individuals with eating disorders (EDs) experience hopelessness, suicidal thoughts and behaviours at elevated rates compared to the general population. Current knowledge of recovery from EDs does not address nurse engendered hope. This study aimed to explore differences between patients' and nurses' perceptions of hope-engendering nurse actions and the relationship actions have with patients' perception of hope. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study to explore differences between patients' and nurses' perceptions of hope-engendering nurse actions in an inpatient ED facility and find significant differences; nurses' scores were higher than patients' scores. The study explored the relationship perceived self-reported nurse hope-engendering actions have with patients' and nurses' perception of hope. There were no significant relationships. This study provides additional evidence to support that there are common patient needs for nurse hope-engendering practices such as caring and providing for patients; supporting and encouraging patients' connection to others; facilitating patients' adaptive belief systems; and helping to set goals and attain resources for patients. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Nurses who work with patients who have EDs should be prepared to work with patients who are feeling hopeless about their future. Thus, nursing continuing education should focus on strategies that enable nurses to deliver care that reduces hopelessness, improves connection, and inspires hope in those who are recovering from EDs. The results revealed that nurses perceived that they offered patients with EDs hope-engendering actions more often and effectively than patients believed; this finding pinpoints a future direction for research that may improve care for patients. Patient feedback identified ways nurses may improve care to engender hope: providing an open caring environment, nurse presence, comfort/pain relief, and involving patients in their care. Actions by nurses aimed to enhance interpersonal connection and nurse presence could facilitate hope in patients with ED. ABSTRACT: Introduction Individuals with eating disorders (EDs) experience suicidal thoughts and behaviours at elevated rates compared to the general population. Hope-engendering nursing actions may increase patients' levels of hope for the future, improve coping self-efficacy, and possibly reduce suicidality. Although nursing staff are integral ED treatment team members, little is known about nursing actions targeting hopefulness. Aim Explore differences between patients' and nurses' perceptions of hope-engendering nurse actions and the relationship actions have with patients' perception of hope. Methods Descriptive, cross-sectional, comparative, correlational research design was used. Responses for 97 ED patients and 10 nurses were entered into analysis. Hope-engendering nurse intervention and hope questionnaires were administered and analysed. Results Nurses' total hope-engendering nurse intervention and hope scores were higher than patients' scores. Discussion Patients reported that the most effective nursing actions were providing an open caring environment, comfort/pain relief, and involving patients in their care and treatment. Nurses perceived that they offered patients hope-engendering actions more often and effectively than the patients believed. Implications for Practice Findings indicate that patients with EDs have low levels of hope. Nursing educators should further develop strategies that enable nurses to deliver care that inspires hope and improves connectedness in those who have EDs.

Responses of persons at risk of suicide: A critical interpretive synthesis

AIM

Several nursing studies focus on suicidal persons; yet, a synthesis of such research is unavailable. The aim of this review was to give an inclusive understanding of responses of persons at risk for suicide that guides clinical nursing practice and research.

DESIGN

A reflexive and iterative study design was used in this study.

METHOD

A qualitative content analysis and a systematic review of literature guided the six-phase Critical Interpretive Synthesis . A sample consisting of 24 nursing studies published during 1994-2017 were included in this study.

RESULTS

Key concepts found were "Disengaged while fraught with affliction"; "Readiness to engage in life"; and "Engaging through caring and confirming humanity." Contextually, there are gaps in global nursing knowledge. Conceptually, three key concepts can guide the nursing practice and give an impetus for the research. Methodologically, the Critical Interpretive Synthesis served as a helpful way to summarize and synthesize a small sample size into an aggregate body of knowledge. An evidenced-based understanding of responses of persons at risk for suicide can guide nurses to ensure safety, promote hopeful recovery, and foster resilience.