Caring For Suicidal Patients; Mental Health Nurses

Archives of Psychiatric Nursing 31 (2017) 31–37

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Archives of Psychiatric Nursing

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Mental Health Nurses’ Experiences of Caring for Suicidal Patients in

Psychiatric Wards: An Emotional Endeavor
Julia Hagen a,b,⁎, Birthe Loa Knizek a, Heidi Hjelmeland b a Department of Applied Social Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway b Department of Social Work and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

a b s t r a c t

The purpose of the study is to investigatemental health nurses’ experiences of recognizing and responding to sui- cidal behavior/self-harm and dealing with the emotional challenges in the care of potentially suicidal inpatients. Interviewdata of eightmental health nurseswere analyzed by systematic text condensation. The participants re- ported alertness to patients’ suicidal cues, relieving psychological pain and inspiring hope. Various emotions are evoked by suicidal behavior. Mental health nurses seem to regulate their emotions and emotional expressions, and balance involvement and distance to provide good care of patients and themselves. Mental health nurses have an important role and should receive sufficient formal support.

Caring for patients with suicidal behavior is one of the most chal- lenging tasks for mental health nurses in psychiatric wards, and preventing suicidal acts may be difficult. Suicide prevention in mental health services involves suicide risk assessments that should not only be based on standard risk factors (Cassells, Paterson, Dowding, & Morrison, 2005; Paterson et al., 2008), but warning signs; ‘what is my patient doing (observable signs) or saying (expressed symptoms) that elevates his or her risk to die by suicide…’(Rudd, 2008, p. 88). The latter requires more involvement with the patient, exploring aspects relevant to the individual’s suicide risk at that particularmoment. InNorway, it is the therapist (psychiatrist/psychologist) who has the main responsibil- ity for performing and documenting assessments of inpatients’ suicide risk (National guidelines for Prevention of Suicide in Mental Health Care, Norwegian Directorate of Health and Social Affairs, 2008). Howev- er, nurses provide most of the direct care of the patients and have the opportunity to identifywarning signs of suicide and prevent suicidal be- havior (Bolster, Holliday, Oneal, & Shaw, 2015; Cutcliffe & Barker, 2002). According to Sun, Long, Boore, and Tsao (2005); Sun, Long, Boore, and Tsao (2006), nurses assessed patients’ suicide risk through vigilant ob- servation, recognizing warning signs, using their interviewing skills and gathering information about cues to suicide. Assessing the patients continuously throughout the hospital stay seems important to capture the patient’s changing state of mind (Aflague & Ferszt, 2010; Sun et al., 2005). However, some nurses are not properly educated and trained in suicide assessments (Bolster et al., 2015).

⁎ Corresponding Author: Julia Hagen, Rn, MHSc, PhD candidate in Health Science, De- partment of Applied Social Science, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway.

E-mail address: julia.hagen@ntnu.no (J. Hagen).

The recognition of patients’ suicide risk should lead to meaningful in- terventions (Cutcliffe & Stevenson, 2007, 2008a). The literature has point- ed to the importance of nurses engaging in a close relationship with the suicidal patient (Cutcliffe & Barker, 2002; Cutcliffe & Stevenson, 2008b; Gilje & Talseth, 2014), where the patient feels confirmed as a significant human being (Samuelsson,Wiklander, Åsberg, & Saveman, 2000; Talseth, Lindseth, Jacobsson, &Norberg, 1999; Vatne&Nåden, 2014) and ismoved from a ‘death-oriented’ position to a ‘life-oriented’ position through the process of ‘re-connecting with humanity’ (Cutcliffe & Stevenson, 2007; Cutcliffe, Stevenson, Jackson, & Smith, 2006). However, patients have reported that experiences of not being sufficiently cared for (e.g. lack of confirmation, not being seen) have led to increased suicidal behavior while hospitalized (Talseth et al., 1999; Samuelsson et al., 2000).

Caring for suicidal patients is emotionally demanding (Cutcliffe & Barker, 2002; Cutcliffe & Stevenson, 2008a, 2008b), and suicide/suicide attempt/self-harm evoke painful feelings in the professionals (Bohan & Doyle et al., 2008; Castelli-Dransart et al., 2014; Joyce & Wallbridge, 2003; Séguin, Bordeleau, Drouin, Castelli-Dransart, & Giasson, 2014; Takahashi et al., 2011; Valente & Saunders, 2002; Wilstrand, Lindgren, Gilje, & Olofsson, 2007; Wurst et al., 2010). It has been suggested that nurses may distance themselves in meetings with suicidal patients to protect themselves from emotional discomfort (Carlén & Bengtsson, 2007; Talseth, Lindseth, Jacobsson, & Norberg, 1997). To cope with the challenges involved in the care of potentially suicidal patients the literature has emphasized sufficient education, training, supervision and support (Bohan & Doyle, 2008; Cutcliffe & Barker, 2002; Cutcliffe & Stevenson, 2008a; Gilje & Talseth, 2014; Takahashi et al., 2011; Talseth & Gilje, 2011; Wilstrand et al., 2007).

The aim of this study is to extend the existing literature and develop further the knowledge of how mental health nurses deal with the vari- ety of demands in the care of potentially suicidal patients in psychiatric

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32 J. Hagen et al. / Archives of Psychiatric Nursing 31 (2017) 31–37

wards: How do they experience their skills with regard to recognizing and responding to suicidal behavior/self-harm among patients? How do they react to suicide and suicidal acts, and deal with the emotional challenges in the care of patients at risk of suicide?Weuse the term ‘sui- cidal patient’with an awareness of the diversity and complexity of each person’s suicidality and related problems.

MATERIALS AND METHODS

Participants

A purposive sample of eight mental health nurses (seven women, one man) aged 43–60 years working in two different hospitals and five different psychiatric wards in Norway participated in the study. The lack of gender difference largely reflects the situation in many psy- chiatricwardswhere themajority ofmental health nurses are female. In addition, the units’ management assisted in recruiting mental health nurses with experience of caring for suicidal patients in psychiatric wards, thus, clinical experience and willingness to participate was em- phasized regardless of gender. Thereby, the strategy for selecting the study subjects (purposefully) was influenced by homogenous sampling (in terms of professional background and clinical experience) and con- venience sampling (Patton, 1990). Their professional experience in psy- chiatric hospital ranged from 5–25 years. Seven nurses had 15 years of experience or more. Five of the nurses worked in an acute ward, one in an acute/crisis unit, one in a specializedward and oneworked in a re- habilitation ward.

Interview Procedure

The first author conducted the interviews. Seven of the nurses were interviewed at their respectiveworking places (available office/meeting room in or outside the ward, one interview was conducted in a vacant patient room), and one of the participantswas interviewed in ameeting room not located at the hospital. The interviews lasted from 48minutes to 1 hour and 22 minutes. A semi-structured interview guide was used as a tool to obtain detailed descriptions of the nurses’ caring experi- ences, including both good interactions with suicidal patients and chal- lenging experiences involving suicidal acts and suicide among patients. Main questions were: How do you experience working in a psychiatric ward? How do you experience meetings with suicidal patients? Can you describe a situation where you did/did not achieve a good relation- ship with a suicidal patient? Have you experienced that a patient have attempted suicide or taken his/her life? Can you describe your experi- enceswith regard to that? All interviewswere recorded and transcribed verbatim.

DO MY NURSING ESSAY

Caring For Suicidal Patients; Mental Health Nurses