Trajectory of suicide as a transformation in obscurity-As told by the deceased's next of kin

There is a collective call from the field of suicide research for studies on the individual dynamics of suicidality in order to understand the deadliness of the suicidal process. This study examines the deceased next of kin's ('survivor's) experience of the suicidal process in order to gain perspectives that can be used in the preventive care of suicidal patients. The aim of this study was to explore the suicide process through the suicide survivor's experience. The study is designed and conducted through a phenomenological, reflective lifeworld approach. Twelve in-depth interviews concerning lived experiences of a suicide were conducted. The suicide process is described as the emerging of an obscured transformation of self, and an aligning to this changing understanding of self that forms a unique suicidal death course. This death course contains the co-occurrence of life and death orientations. Survivors' collected knowledge of a suicidal trajectory helps us understand the life conditions of a suicidal person that has ended their life. Life orientation and experiences of self-governance are critical parts of a suicidal trajectory and can have great preventive potential for care and assessments during suicidality. The Consolidated Criteria for Reporting Qualitative Research (COREQ) were used for the reporting structure of this article.

Don´t set us aside!Experiences of families of people with BPD who have access to Brief admission:a phenomenological perspective

AIM

To highlight the experiences of family members of people with borderline personality disorder (BPD) and self-harming behaviour who have access to brief admission.

METHODS

To understand the families lived experience a phenomenological lifeworld perspective was adopted to this study. Twelve in-depht interviews were performed in November and December 2021 with family members of people with BPD and self-harming behaviour who have accessed BA. The phenomenological life-world perspective guided the analysis.

RESULTS

Families' life-world was characterized by anxiety and constant protection of their loved one. They live with constant fear of how their loved ones are feeling and whether they will injure themselves. When access to BA was available this gave hope and provided conditions for families to maintain everyday routines and also enhanced relationships among family members. When families' loved ones were denied BA, they felt betrayed which contributed to negative feelings towards the medical profession, and the families lost confidence in psychiatry.

CONCLUSION

By interviewing families of people with BPD and self-harming behaviour who had access to BA, it emerged they possess valuable knowledge. BA can be developed if the needs of families are taken into consideration, and if families are given the opportunity to share emotions and the high burden of responsibility with staff or families in similar situations. If health care staff gives family members a more central role in care and makes their shared life-world visible it could thereby hopefully increase well-being and benefits for the whole family.

Relatives' experiences of brief admission in borderline personality disorder and self-harming behaviour

AIM

The aim of this study is to describe experiences of brief admission (BA) of people with borderline personality disorder and self-harming behaviour, from the perspective of their relatives.

DESIGN

A descriptive qualitative design was chosen.

METHODS

Twelve relatives of people with borderline personality disorder and self-harming behaviour who had access to BA were interviewed. Data were analysed with qualitative conventional content analysis.

RESULTS

One overarching category: Hope for the future and three categories occurred: Breathing space, Personal responsibility and Structure. BA created hope for the future and the relatives appreciated that BA is a freer and easily accessible form of care that enables help at an early stage, compared with usual care. When BA functions, the structure and pre-determined days of care give relatives a breathing space, and the uncertainty diminishes for the children, as the parent can still be present during inpatient care. The lack of places was described as a disadvantage of BA.

Nurses' experiences of suicide attempts in palliative care

OBJECTIVES

To describe nurses' experiences of caring for individuals who have attempted suicide in specialized palliative care and to describe if the care of these individuals changed after the suicide attempt.

METHODS

A qualitative, descriptive study was conducted. Nine nurses working in specialized palliative care units were interviewed following a semi-structured interview guide. Conventional content analysis was used in the analysis process.

RESULTS

The results are presented in 3 categories: "A suicide attempt evokes strong emotions," "Health-care efforts changed after the suicide attempt," and "Experiences for the rest of working life." Suicide attempts aroused emotions in nurses such as frustration, compassion, and feelings of being manipulated. The relationship between the nurse and the individual was strengthened after the suicide attempt, and their conversations became deeper and changed in nature. Health-care efforts relating to the individual increased after the suicide attempt.

SIGNIFICANCE OF RESULTS

The results of the study can create an awareness that the palliative process also includes the risk of suicide and can be used to create conditions for nurses to be able to handle questions about suicide without fear. The results of the study can be used as an "eye opener" to the fact that suicidality occurs in palliative care. In summary, there is a critical need for nursing education in suicide risk assessment and continued follow-up care for patients at risk of suicide within palliative care.

Forced to move on: An interview study with survivors who have lost a relative to suicide

PURPOSE

To explore the loss of a relative due to suicide.

DESIGN AND METHODS

Ten survivors of relatives who had taken their lives were interviewed. Data was analyzed from a phenomenological perspective.

FINDINGS

The survivors described how they witnessed the darkness that took over their relative's lifeworld. During the time before and after the suicide, the survivor felt barred from having a role in the relative's care.

PRACTICE IMPLICATIONS

Understanding and exploring implicit dynamics, such as "a feeling of darkness taking over," "a sense of relief," or "putting on a mask" could be important for developing person-centered suicide care.

Conceptualizing patient participation in psychiatry: A survey describing the voice of patients in outpatient care

Background

While increasingly discussed in somatic care, the concept of patient participation remains unsettled in psychiatric care, potentially impeding person‐centred experiences.

Objective

To describe outpatient psychiatric care patients’ conceptualization of patient participation.

Design

An exploratory survey.

Setting and participants

Patients in four psychiatric outpatient care units.

Variables

Patients conceptualized patient participation by completing a semi‐structured questionnaire, including optional attributes and free text. Data were analysed using statistics for ordinal data and content analysis for free text.

Results

In total, 137 patients (69% of potential respondents) completed the questionnaire. The discrete items were favoured for conceptualizing patient participation, indicating a primary connotation that participation means being listened to, being in a reciprocal dialogue, learning about one's health care and managing one's symptoms. Additional free‐text responses acknowledged the attributes previously recognized, and provided supplementary notions, including that patient participation is about mutual respect and shared trust.

Discussion

What patient participation is and how it can be facilitated needs to be agreed in order to enable preference‐based patient participation. Patients in outpatient psychiatric care conceptualize participation in terms of both sharing of and sharing in, including taking part in joint and solo activities, such as a reciprocal dialogue and managing symptoms by yourself.

Conclusion

While being a patient in psychiatric care has been associated with a lack of voice, an increased understanding of patient participation enables person‐centred care, with the benefits of collaboration, co‐production and enhanced quality of care.

Patient contribution

Patients provided their conceptualization of patient participation in accordance with their lived experience.

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.

Healthcare staff's evaluation of a walk-in centre at a healthcare centre in an immigrant-dense area

AIMS AND OBJECTIVES

To evaluate a walk-in centre at a healthcare centre in an immigrant-dense area where a high proportion of the patients have limited language ability in Swedish, from the perspective of healthcare personnel.

BACKGROUND

Increased global migration results in higher vulnerability in migrants, with the risk of increased morbidity and mortality. Migrants' health often deteriorates, which can be attributed to an increased level of stress and adaptation to a new lifestyle. Therefore, immigrants are at higher risk of being affected by, for example, cardiovascular diseases and diabetes. This requires access to good health care.

DESIGN

A qualitative exploratory study was conducted, using semi-structured interviews. Content analysis was used in the analysis process.

METHODS

Semi-structured interviews were held with 15 purposively sampled doctors and nurses, working at a healthcare centre in Sweden. Data were collected during autumn 2017. The study was performed in accordance with COREQ.

RESULTS

Working at the walk-in centre involved caring for everything from basic to advanced health problems and meant a high pace that required stress-resistant personnel. The walk-in centre was described as both promoting and threatening patient safety. The personnel had several ideas on how to develop the walk-in centre.

CONCLUSIONS

A walk-in centre can be seen as a necessity related to issues of ensuring patient safety and delivering care for everyone in an immigrant-dense area. However, it cannot be the only form of care offered, as it seems not be adapted to certain groups, such as people with disabilities and the elderly.

RELEVANCE TO CLINICAL PRACTICE

The findings emphasise that a walk-in centre is a way to increase accessibility for the entire population and offer equal care for all, even if it involves challenges that need to be addressed.

Health-related quality of life and metabolic risk in patients with psychosis

Improved Health-related quality of life (HRQoL) is an alternative treatment goal for individuals with psychosis, who have up to two times greater prevalence of type 2 diabetes, hypertension and obesity than the general population.

AIM

to compare HRQoL in patients with psychosis, especially schizophrenia, with a reference sample and explore the relationship between HRQoL and metabolic risk factors in these patients.

METHODS

a prospective cohort study was carried out in specialized psychiatric outpatient departments in Sweden. The patients were invited consecutively. A prospective population-based study of public health in the south-east of Sweden served as reference group. Patients were assessed with psychiatric questionnaires that included Global Assessment of Functioning (GAF). Health-related quality of life was assessed using the questionnaire EQ5D, both for patients and the population, and several other health status outcomes were used.

RESULTS

At 73%, schizophrenia and schizoaffective disorder were the most common diagnoses in the patient group. The results in patients (n=903) and population (n=7238) showed significant differences in lower EQ5D among patients. According to the definition by the International Diabetes Federation (IDF), elevated blood pressure was the only metabolic risk associated with lower HRQoL in patients. Raised LDL-cholesterol levels were also significantly related to lower HRQoL.

CONCLUSION

patients suffering from psychosis had significantly lower HRQoL regarding all components in EQ5D, except for the pain/discomfort component. Almost half of the patient group met the criteria for metabolic syndrome. According to the IDF criteria, elevated blood pressure was the only metabolic risk factor that had an impact on HRQoL.

Preventing the development of metabolic syndrome in people with psychotic disorders--difficult, but possible: experiences of staff working in psychosis outpatient care in Sweden

The aim of this study was to explore mental health staffs' experiences of assisting people with psychotic disorders to implement lifestyle changes in an effort to prevent metabolic syndrome. Qualitative interviews were conducted with 12 health care professionals working in psychosis outpatient care in Sweden. Data were analysed using a qualitative content analysis. The results illustrate that implementation of lifestyle changes among people with psychotic disorders was experienced as difficult, but possible. The greatest obstacles experienced in this work were difficulties due to the reduction of cognitive functions associated with the disease. Guidelines available to staff in order to help them identify and prevent physical health problems in the group were not always followed and the content was not always relevant. Staff further described feelings of uncertainty about having to motivate people to take anti-psychotic medication while simultaneously being aware of the risks of metabolic deviations. Nursing interventions focusing on organising daily routines before conducting a more active prevention of metabolic syndrome, including information and practical support, were experienced as necessary. The importance of healthy eating and physical activity needs to be communicated in such a way that it is adjusted to the person's cognitive ability, and should be repeated over time, both verbally and in writing. Such efforts, in combination with empathic and seriously committed community-based social support, were experienced as having the best effect over time. Permanent lifestyle changes were experienced as having to be carried out on the patient's terms and in his or her home environment.