The study considers numerous factors potentially related to suicide ideation in adults, including life stress, stress perceptions, social support, personality, alcohol use, chronic conditions, distress symptoms and sociodemographic background. Using data from a health survey of 825 adult residents in the urban Reykjavik area of Iceland, the study finds that financial hardship, legal stress, family difficulties, stress perceptions and low material support are significantly related to thoughts of committing suicide. Multiple chronic conditions, frequent alcohol use and various forms of distress (e.g. depression, anxiety, hopelessness, pain) are also related to suicide ideation. Furthermore, low self-esteem and external locus of control (low sense of mastery) are both associated with suicidal thoughts. No significant relationships were found between sociodemographic background and suicide ideation. The meaning of the results, and their implications for continued theoretical and clinical work in this area, are discussed. Suicide research has primarily focused on completed suicides (e.g. Durkheim [1897] 1951; Fisher et al. 1993; Henry and Short 1954; Lester 1974; Pritchard 1996) or suicide attempts (e.g. Diekstra 1982; Maris 1981; Slap et al. 1989; Smith and Crawford 1986; Stack and Wasserman 1995). Relatively few studies have focused on thoughts of own death or suicide, or suicide planning. Nevertheless, there is a growing understanding that ideation and planning are important steps in a process of suicide, characterised by a stepwise hierarchy of actions with an underlying gradient of severity (Beck 1986; Bonner and Rich 1987; Diekstra 1993; Smith and Crawford 1986). Ideation precedes planning, which may result in an attempt leading to death. If nonfatal, the attempt may increase the likelihood of subsequent ideation, planning and attempt (see paths a-e in Fig. 1). It should therefore be of theoretical as well as clinical value to consider the risk factors associated with suicide ideation and planning.

This study measures the attitudes of the psychiatric nurses, after having received an education and training intervention program (ETI-PROGRAM) in family systems nursing, towards the importance of the families in their care. Nurses' knowledge of the impact that family nursing intervention can have on family members may increase positive attitudes towards families. However, little is known about the impact that education and training intervention can have on nurses' attitudes, towards families in clinical practice. Quasi-experimental design was used to assess the change in nurses' attitudes towards families in psychiatric care after the intervention, which included a one-day seminar on the Calgary family nursing conceptual frameworks and skills training with clinical vignettes of families from psychiatry. The Families Importance in Nursing Care - Nurses' Attitude questionnaire was used to evaluate nurses' attitudes. A total of 81 nurses (65%) working in psychiatric care responded to the questionnaire. Nurses with more than 15 years of work experience were significantly more supportive of families in their care compared with less experienced nurses. Out of the 81 nurses, 52 (64%) answered the questionnaire again 14 months later. Furthermore, psychiatric nurses saw families significantly less burdensome after having participated in the ETI-PROGRAM.

Providing clinically meaningful education and training in family nursing through programs such as the ETI program for practicing nurses at a university hospital is essential in supporting nurses applying new knowledge, when providing evidence-based health care services, to individuals and their family members. Such training can facilitate integration of new and needed information in clinical practice.

Valid and reliable instruments are needed to measure how family members perceive support from nurses when a family member is experiencing serious illness. The purpose of this article is to describe the development and psychometric testing of a new instrument, the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ). The concepts in the original version of the ICE-FPSQ (suggesting 24 items and 4 categories) were developed from the Calgary Family Intervention Model. In the first phase of the instrument construction, 179 family members answered the original ICE-FPSQ, and 236 answered the questionnaire in the second phase of testing. Principal Component Analysis (PCA) reduced the original questionnaire to 21 items. Cronbach's α = .959 explained 68% of the total variance, with three factors emerging: (a) emotional support (α = .925), (b) recognition of families' strengths (α = .926), and (c) cognitive support (α = .841). Confirmatory Factor Analyses (CFA) resulted in a final version of the questionnaire containing 14 items with total alpha of .961 and two factors: (a) cognitive support (α = .881) and (b) emotional support (α = .952). The instrument measures family's perceptions of support provided by nurses and will be helpful in examining the usefulness of family nursing interventions.