Engagement between adults living through suicidal crisis and nurses in mental health wards
Background: The interpersonal relationship between a patient and a nurse is considered the cornerstone of care for people in a suicidal crisis. It is important for patients to engage in meaningful relationships with nurses in which they have timely, ongoing and supportive contact. However, nurses may perceive interactions with patients in a suicidal crisis as complex, demanding and anxiety-provoking and, as a result, may refrain from interacting. This can lead to patients feeling that their suffering and suicidality are not recognised or responded to. Therefore, nurses need a more thorough understanding of the impact their engagement has on patients’ well-being.
Objective: To explore and understand how patients in suicidal crisis perceive their engagement with nurses in mental health hospitals
Methods: A qualitative study based on grounded theory was conducted. Semistructured interviews were used with 11 hospitalised adults living through suicidal crisis. The data were analyzed by multiple researchers, using the constant comparison method, coding, and memo writing.
Findings: The core process was: ‘Feeling nurtured through an interpersonal engagement’. This process underpinned two categories: ‘Feeling safe and cared for while struggling to trust’ and ‘Working toward alleviation and change of my suicidal ideation’. The patients valued nurses who integrated caring approaches of building trust, demonstrating compassion, and promoting safety, with healing approaches of helping them to express and explore their suicidal ideations, and develop new insights and ways of coping. This interpersonal engagement could nurture patients’ feelings of being accepted and understood, and being hopeful and capable of overcoming their suicidal ideations. However, patients perceived that some nurses lacked the capacity to promote their healing or tried to interrogate or reframe their suicidal ideations without caring for them. Such interactions could perpetuate their suffering, reinforce negative self-perceptions, and trigger distrust. The findings can be framed in an international literature review that highlights the importance for nurses to care for and recognise individuals with suicidal thoughts and behaviours as unique individuals, to engage and collaborate with them, and to be attentive to their multiple needs.
Conclusion: The conceptual insights help to identify the impact of interpersonal engagement for patients in suicidal crisis. Simultaneously, these insights can inform strategies to reframe overly instrumental approaches to prevent suicide and treat suicidal ideation, and instead promote an interpersonal orientation in nursing practice that integrates caring-healing approaches. In such contexts, patients will be increasingly able to access nurses who care for them as unique individuals, while being enabled to explore and reflect on their suicidal experiences in open and sensitive ways.
Caressa Van Hoe (MSc, RN) has been employed as a nurse in the mental health hospital Onze-Lieve-Vrouw in Bruges (Belgium) since 2014. She works on a ward where the interdisciplinary team offers long-term and intensive treatment to people with severe and persistent mental illnesses. The focus of treatment is on relieving the patients’ symptoms and improving their quality of life. However, there are still patients who struggle with suicidal ideation or who make a suicide attempt, for example, because they no longer consider themselves to be part of society, their symptoms are too heavy to bear, or voices instruct them to harm themselves. Recently, she started working as a research assistant at Palliatieve Zorg Vlaanderen where she is conducting research on oyster care (crustatieve zorg) as a model of care for people with severe and persistent mental illnesses.
She completed the Master of Nursing and Midwifery programme in 2020 and her master’s thesis led to the writing of the article “Engagement between adults living through suicidal crisis and nurses in mental health wards: a qualitative study”. Her own experiences with and research on people in a suicidal crisis makes her eager to exchange experiences and discuss the topic “Suicide and it’s prevention” during the conference.
Van Hoe, C., Vandewalle, J., Debyser, B., Deproost, E. & Verhaeghe, S. (2021). Engagement between adults living through suicidal crisis and nurses in mental health wards: a qualitative study. Archives of Psychiatric Nursing, 35, 541-548. doi: 10.1016/j.apnu.2021.07.011