Archives of Psychiatric Nursing 31 (2017) 31–37
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Archives of Psychiatric Nursing
journal homepage: www.elsevier.com/locate/apnu
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 investigate mental 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. Interview data of eight mental health nurses were 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.
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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 particular moment. In Norway, 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 identify warning 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: [email protected] (J. Hagen).
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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 is moved 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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