Nursing Care of the Suicidal Patient
Suicide risk assessment needs to be a crisis intervention explored together with the person in care. The crisis intervention needs to start at the first encounter with healthcare and should be salient in all ensuing encounters and actions taken during the care. A caring approach which involves qualities like being welcoming, nonjudgmental, open-minded, and respectful can alleviate suffering and is crucial for assessment and forthcoming care, while an uncaring approach may cause the person to hide his or her needs, flee in affect, or refrain from seeking help during forthcoming suicide crises. Despite this, the competence required to connect and listen to another person is all too often neglected in hospital-based suicide prevention.
Nurses have an important role to play in suicide risk prevention, since they frequently encounter patients in suicidal crises. Furthermore, nurses’ competence involves both the biomedical and philosophical perspective on the person’s health and care which is needed for assessment and care. Recommendations for care stress the interpersonal relationships with the person’s narrative as essential. However, components often described as person-centered care, such as establishing a therapeutic relationship, showing trust and respect, facilitating communication, getting to know the person, sharing power and responsibility, and empowering the person, require systematic education, training, and implementation. This chapter provides examples on how communication skills and rapport can be developed and applied in acts of care. The chapter also describes an approach for suicide prevention and crisis intervention that synthesizes teachings from caring science with contemporary suicide prevention.
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Nursing Care of the Suicidal Patient
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References
- Jobes DA, Chalker SA. One size does not fit all: a comprehensive clinical approach to reducing suicidal ideation, attempts, and deaths. Int J Environ Res Public Health. 2019;16(19):3606. https://doi.org/10.3390/ijerph16193606. PMID: 31561488; PMCID: PMC6801408. ArticlePubMed CentralGoogle Scholar
- National Collaborating Centre for Mental Health, Health Education England. Self-harm and suicide prevention competence framework: adults and older adults. London: University College London; 2018. Google Scholar
- Vandewalle J, Van Bos L, Goossens P, Beeckman D, Van Hecke A, Deproost E, Verhaeghe S. The perspectives of adults with suicidal ideation and behaviour regarding their interactions with nurses in mental health and emergency services: a systematic review. Int J Nurs Stud. 2020;110:103692. https://doi.org/10.1016/j.ijnurstu.2020.103692. Epub 2020 Jun 20. PMID: 32682109. ArticlePubMedGoogle Scholar
- Madsen T, Erlangsen A, Nordentoft M. Risk estimates and risk factors related to psychiatric inpatient suicide-an overview. Int J Environ Res Public Health. 2017;14(3):253. https://doi.org/10.3390/ijerph14030253. PMID: 28257103; PMCID: PMC5369089. ArticlePubMed CentralGoogle Scholar
- Brookes N. Phil Barker: the tidal model of mental health recovery. In: Alligood MR, editor. Nursing theorists and their work. 9th ed. St. Louis: Elsevier Health Science; 2018. p. 504–26. Google Scholar
- Sellin L, Kumlin T, Wallsten T, Wiklund GL. Caring for the suicidal person: a Delphi study of what characterizes a recovery-oriented caring approach. Int J Ment Health Nurs. 2018;27(6):1756–66. https://doi.org/10.1111/inm.12481. Epub 2018 May 30. PMID: 29847010. ArticlePubMedGoogle Scholar
- Berg SH, Rørtveit K, Aase K. Suicidal patients’ experiences regarding their safety during psychiatric in-patient care: a systematic review of qualitative studies. BMC Health Serv Res. 2017;17(1):73. https://doi.org/10.1186/s12913-017-2023-8. PMID: 28114936; PMCID: PMC5259991. ArticlePubMedPubMed CentralGoogle Scholar
- Michel K, Valach L, Gysin-Maillart A. A novel therapy for people who attempt suicide and why we need new models of suicide. Int J Environ Res Public Health. 2017;14(3):243. https://doi.org/10.3390/ijerph14030243. PMID: 28257071; PMCID: PMC5369079. ArticlePubMed CentralGoogle Scholar
- Arman M, Ranheim A, Rydenlund K, Rytterström P, Rehnsfeldt A. The Nordic tradition of caring science: the works of three theorists. Nurs Sci Q. 2015;28(4):288–96. https://doi.org/10.1177/0894318415599220. PMID: 26396212. ArticlePubMedGoogle Scholar
- Omerov P, Kneck Å, Karlsson L, Cronqvist A, Bullington J. To identify and support youths who struggle with living-nurses’ suicide prevention in psychiatric outpatient care. Issues Ment Health Nurs. 2020;41(7):574–83. https://doi.org/10.1080/01612840.2019.1705946. Epub 2020 Apr 14. PMID: 32286108. ArticleCASPubMedGoogle Scholar
- Clua-García R, Casanova-Garrigós G, Moreno-Poyato AR. Suicide care from the nursing perspective: a meta-synthesis of qualitative studies. J Adv Nurs. 2021; https://doi.org/10.1111/jan.14789. Epub ahead of print. PMID: 33591582.
- Bullington J, Söderlund M, Bos Sparén E, Kneck Å, Omérov P, Cronqvist A. Communication skills in nursing: a phenomenologically-based communication training approach. Nurse Educ Pract. 2019;39:136–41. https://doi.org/10.1016/j.nepr.2019.08.011. Epub 2019 Aug 28. PMID: 31487674. ArticlePubMedGoogle Scholar
- Cutcliffe JR, Hummelvoll JK, Granerud A, Eriksson BG. Mental health nurses responding to suffering in the 21st century occidental world: accompanying people in their search for meaning. Arch Psychiatr Nurs. 2015;29(1):19–25. https://doi.org/10.1016/j.apnu.2014.09.008. Epub 2014 Oct 22. PMID: 25634870. ArticlePubMedGoogle Scholar
- Sharma T, Bamford M, Dodman D. Person-centred care: an overview of reviews. Contemp Nurse. 2015;51(2–3):107–20. https://doi.org/10.1080/10376178.2016.1150192. Epub 2016 Mar 9. PMID: 26866531. ArticlePubMedGoogle Scholar
- Bernert RA, Hom MA, Roberts LW. A review of multidisciplinary clinical practice guidelines in suicide prevention: toward an emerging standard in suicide risk assessment and management, training and practice. Acad Psychiatry. 2014;38(5):585–92. https://doi.org/10.1007/s40596-014-0180-1. Epub 2014 Aug 21. PMID: 25142247; PMCID: PMC4283785. ArticlePubMedPubMed CentralGoogle Scholar
- Lindstrom UA, Lindholm Nyström L, Zetterlund J. Theory of caritative caring. In: Alligood MR, editor. Nursing theorists and their work. 9th ed. St. Louis: Elsevier Health Science; 2018. p. 140–64. Google Scholar
- Barker P. The tidal model: the lived-experience in person-centred mental health nursing care. Nurs Philos. 2001;2(3):213–23. https://doi.org/10.1046/j.1466-769X.2000.00062.x. ArticleGoogle Scholar
- Omerov P, Craftman ÅG, Mattsson E, Klarare A. Homeless persons’ experiences of health- and social care: a systematic integrative review. Health Soc Care Community. 2020;28(1):1–11. https://doi.org/10.1111/hsc.12857. Epub 2019 Sep 16. PMID: 31524327. ArticlePubMedGoogle Scholar
- The ICN Code of ethics for nurses International Council of Nurses Revised 2012 https://www.icn.ch/sites/default/files/inlinefiles/2012_ICN_Codeofethicsfornurses_%20eng.pdf.
- Karman P, Kool N, Poslawsky IE, van Meijel B. Nurses’ attitudes towards self-harm: a literature review. J Psychiatr Ment Health Nurs. 2015;22(1):65–75. https://doi.org/10.1111/jpm.12171. Epub 2014 Dec 9. PMID: 25490929. ArticleCASPubMedGoogle Scholar
- Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ Theory Pract. 2009;14(4):595–621. https://doi.org/10.1007/s10459-007-9090-2. Epub 2007 Nov 23. PMID: 18034364. ArticlePubMedGoogle Scholar
- Van Schalkwyk SC, Hafler J, Brewer TF, Maley MA, Margolis C, McNamee L, Meyer I, Peluso MJ, Schmutz AM, Spak JM, Davies D, Bellagio Global Health Education Initiative. Transformative learning as pedagogy for the health professions: a scoping review. Med Educ. 2019;53(6):547–58. https://doi.org/10.1111/medu.13804. Epub 2019 Feb 14.PMID: 30761602. ArticlePubMedGoogle Scholar
- O’Connor RC, Kirtley OJ. The integrated motivational-volitional model of suicidal behaviour. Philos Trans R Soc Lond Ser B Biol Sci. 2018;373(1754):20170268. https://doi.org/10.1098/rstb.2017.0268. PMID: 30012735; PMCID: PMC6053985. ArticleGoogle Scholar
- Cutcliffe JR, McKenna H, Keeney S, Stevenson C, Jordan J. Straight from the horse’s mouth’: rethinking and reconfiguring services in Northern Ireland in response to suicidal young men. J Psychiatr Ment Health Nurs. 2013;20(5):466–72. https://doi.org/10.1111/jpm.12012. Epub 2012 Nov 12. PMID: 23145993. ArticleCASPubMedGoogle Scholar
- Pörn I. Health and adaptedness. Theor Med Bioeth. 1993;14:295–303. https://doi.org/10.1007/BF00996337. ArticleGoogle Scholar
- Larsson P, Nilsson S, Runeson B, Gustafsson B. Psychiatric nursing care of suicidal patients described by the sympathy-acceptance-understanding-competence model for confirming nursing. Arch Psychiatr Nurs. 2007;21(4):222–32. https://doi.org/10.1016/j.apnu.2007.02.010. PMID: 17673114. ArticlePubMedGoogle Scholar
- Lerner H. A critical analysis of definitions of health as balance in a one health perspective. Med Health Care Philos. 2019;22(3):453–61. https://doi.org/10.1007/s11019-018-09884-1. PMID: 30604351. ArticlePubMedGoogle Scholar
- Klonsky ED, May AM. The three-step theory (3ST): a new theory of suicide rooted in the “ideation-to-action” framework. Int J Cogn Ther. 2015;8(2):114129. ArticleGoogle Scholar
- Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner TE Jr. The interpersonal theory of suicide. Psychol Rev. 2010;117(2):575–600. https://doi.org/10.1037/a0018697. PMID: 20438238; PMCID: PMC3130348. ArticlePubMedPubMed CentralGoogle Scholar
- Jordan J, Anker L. Suicide in late life. In: Hantke N, Etkin A, O’Hara R, editors. Handbook of mental health and aging. 3rd ed. London: Academic; 2020. p. 107–20. ISBN 9780128001363. https://doi.org/10.1016/B978-0-12-800136-3.00030-2. ChapterGoogle Scholar
- Lakeman R, FitzGerald M. How people live with or get over being suicidal: a review of qualitative studies. J Adv Nurs. 2008;64(2):114–26. https://doi.org/10.1111/j.1365-2648.2008.04773.x. PMID: 18990092. ArticlePubMedGoogle Scholar
- Ueland V, Nåden D, Lindström UÅ. Longing – a dynamic power in the becoming of health when suffering from cancer. Scand J Caring Sci. 2018;32(2):924–32. https://doi.org/10.1111/scs.12527. Epub 2017 Sep 21. PMID: 28940617. ArticlePubMedGoogle Scholar
- Dahlberg H, Ranheim A, Dahlberg K. Ecological caring-Revisiting the original ideas of caring science. Int J Qual Stud Health Well-being. 2016;11:33344. https://doi.org/10.3402/qhw.v11.33344. PMID: 27914196; PMCID: PMC5134829. ArticlePubMedGoogle Scholar
- Quinlivan L, Littlewood DL, Webb RT, Kapur N. Patient safety and suicide prevention in mental health services: time for a new paradigm? J Ment Health. 2020;29(1):1–5. https://doi.org/10.1080/09638237.2020.1714013. Epub 2020 Jan 27. PMID: 31985302. ArticlePubMedGoogle Scholar
- Fazel S, Runeson B. Suicide. N Engl J Med. 2020;382(3):266–74. https://doi.org/10.1056/NEJMra1902944. Erratum in: N Engl J Med. 2020 Mar 12;382(11):1078. PMID: 31940700; PMCID: PMC7116087. ArticlePubMedPubMed CentralGoogle Scholar
- Stanley IH, Simpson S, Wortzel HS, Joiner TE. Documenting suicide risk assessments and proportionate clinical actions to improve patient safety and mitigate legal risk. Behav Sci Law. 2019;37:304–12. https://doi.org/10.1002/bsl.2409. ArticlePubMedGoogle Scholar
- Björkdahl A, Nyberg U, Runeson B, Omérov P. The development of the suicidal patient observation chart (SPOC): Delphi study. J Psychiatr Ment Health Nurs. 2011;18(6):558–61. https://doi.org/10.1111/j.1365-2850.2011.01758.x. Epub 2011 May 30. PMID: 21749563. ArticlePubMedGoogle Scholar
- Hagen J, Knizek BL, Hjelmeland H. Former suicidal inpatients’ experiences of treatment and care in psychiatric wards in Norway. Int J Qual Stud Health Well-being. 2018;13(1):1461514. https://doi.org/10.1080/17482631.2018.1461514. PMID: 29652227; PMCID: PMC5906934. ArticlePubMedPubMed CentralGoogle Scholar
- Bowers L. Safewards: a new model of conflict and containment on psychiatric wards. J Psychiatr Ment Health Nurs. 2014;21(6):499–508. https://doi.org/10.1111/jpm.12129. Epub 2014 Feb 19. PMID: 24548312; PMCID: PMC4237187. ArticleCASPubMedGoogle Scholar
- Miller WR, Rollnick S. Motivational interviewing: helping people change. New York: Guilford Press; 2013. p. 3. Google Scholar
- Santel M, Beblo T, Neuner F, Berg M, Hennig-Fast K, Jobes DA, Driessen M. Collaborative Assessment and Management of Suicidality (CAMS) compared to enhanced treatment as usual (E-TAU) for suicidal patients in an inpatient setting: study protocol for a randomized controlled trial. BMC Psychiatry. 2020;20(1):183. https://doi.org/10.1186/s12888-020-02589-x. PMID: 32321477; PMCID: PMC7178967. ArticlePubMedPubMed CentralGoogle Scholar
- Eckerström J, Allenius E, Helleman M, Flyckt L, Perseius KI, Omerov P. Brief admission (BA) for patients with emotional instability and self-harm: nurses’ perspectives – person-centred care in clinical practice. Int J Qual Stud Health Well-being. 2019;14(1):1667133. https://doi.org/10.1080/17482631.2019.1667133. PMID: 31526310; PMCID: PMC6758609. ArticlePubMedPubMed CentralGoogle Scholar
- Westling S, Daukantaite D, Liljedahl SI, Oh Y, Westrin Å, Flyckt L, Helleman M. Effect of brief admission to hospital by self-referral for individuals who self-harm and are at risk of suicide: a randomized clinical trial. JAMA Netw Open. 2019;2(6):e195463. https://doi.org/10.1001/jamanetworkopen.2019.5463. Erratum in: JAMA Netw Open. 2019 Oct 2;2(10):e1913724. PMID: 31173128; PMCID: PMC6563573. ArticlePubMedPubMed CentralGoogle Scholar
- Perseius KI, Kåver A, Ekdahl S, Asberg M, Samuelsson M. Stress and burnout in psychiatric professionals when starting to use dialectical behavioural therapy in the work with young self-harming women showing borderline personality symptoms. J Psychiatr Ment Health Nurs. 2007;14(7):635–43. https://doi.org/10.1111/j.1365-2850.2007.01146.x. PMID: 17880657. ArticlePubMedGoogle Scholar
- Frank A. The wounded storyteller. Chicago: Chicago University Press; 1995. BookGoogle Scholar
- Englander M. Empathy training from a phenomenological perspective. J Phenomenol Psychol. 2014;45(1):5–26. https://doi.org/10.1163/15691624-12341266. ArticleGoogle Scholar
- Carr A, Duff H, Craddock F. A systematic review of reviews of the outcome of noninstitutional child maltreatment. Trauma Violence Abuse. 2020;21(4):828–43. https://doi.org/10.1177/1524838018801334. Epub 2018 Sep 24. PMID: 30249161. ArticlePubMedGoogle Scholar
- Johnstone L, Boyle M with Cromby J, Dillon J, Harper D, Kinderman P, Longden E, Pilgrim D, Read J. The power threat meaning framework: towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society. 2018. Google Scholar
- Rajan G, Syding S, Ljunggren G, Wändell P, Wahlström L, Philips B, Svedin CG, Carlsson AC. Health care consumption and psychiatric diagnoses among adolescent girls 1 and 2 years after a first-time registered child sexual abuse experience: a cohort study in the Stockholm region. Eur Child Adolesc Psychiatry. 2020; https://doi.org/10.1007/s00787-020-01670-w. Epub ahead of print. PMID: 33130910.
- Pitman A, Osborn D, King M, Erlangsen A. Effects of suicide bereavement on mental health and suicide risk. Lancet Psychiatry. 2014;1(1):86–94. https://doi.org/10.1016/S2215-0366(14)70224-X. Epub 2014 Jun 4. PMID: 26360405. ArticlePubMedGoogle Scholar
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Authors and Affiliations
- The Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden Pernilla Omerov & Jennifer Bullington
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden Pernilla Omerov
- Pernilla Omerov