Barriers to Suicide Risk Management in Clinical Practice: A National Survey of Oncology Nurses

Abstract

Standards of practice identify the nurse's pivotal role in risk detection, assessment, intervention, and management of suicidal patients, but scant research explores the barriers that hinder this role. This study describes the analysis of barriers to suicide risk management from a survey of a random sample of members of a national organization, the Oncology Nursing Society (n = 1200), who participated in a descriptive study exploring nurses' knowledge and attitudes about suicide. The 454 (37%) respondents included respondents from the United States, Canada, and Puerto Rico. Instruments included a demographic inventory, the Suicide Opinion Questionnaire (SOQ), a suicide attitude measure (SUIATT), and a vignette of a suicidal patient. Nurses knew an average of 4.8 out of 9 suicide risk factors and 49.4% miscalculated the risk of suicide. In contrast with their moderate to high ratings of suicide risk, they indicated minimal interventions. Barriers to management of suicidal patients included deficits in skill, knowledge, referrals, patient teaching, advocacy, or consultation as well as participants' and religious/other values, uncomfortable feelings, personal experiences, and the weight of professional responsibility. Strategies for intervention include: suicide prevention education, consultation, values clarification, ethical analysis, and conflict resolution and psychosocial support to reduce barriers. Nurses are not alone in their request for more education about suicide prevention; this study confirms earlier research of psychologists and psychiatrists who report they need more education in suicide risk management.

The qualitative evaluation of a suicide prevention and management programme by general nurses

“…Comments on the support from senior staff, inadequate nursing staff, organisation of care and the physical environment reflected the difficulties encountered by nurses when taking care of patients with suicidal intent. Some of these barriers to suicide prevention and management in clinical practice were similar to those identified in literature, such as support from management and the need for guidelines (Valente & Saunders 2004). The physical structure of general wards is different from a purposive built mental health unit which is specially designed taking into consideration of safety and observation for patients with high risk of suicide.…”

“…Providing care for patients with suicidal ideation or after suicidal acts often poses particular challenges for nurses. Failure in helping these patients often causes nurses to feel frustrated, inadequate and unsure about their role (Valente & Saunders 2004). In a regional general hospital in Hong Kong, there are 20-30 patients on average per month attending the Accident and Emergency Department (A&E Department) who are classified as 'suicide cases'.…”

Health professionals' attitudes towards suicide prevention initiatives

“…2001). Apart from knowledge and skill set, health professionals' attitudes can be an important factor in determining successful response to a suicidal patient (Valente 2002, Valente & Saunders 2004).…”

Le suicide en cancérologie : une question taboue ?

“…Les infirmières en charge de ce type de patient rapportent souvent être en détresse en raison d'une connaissance insuffisante sur la conduite à tenir, en raison de convictions personnelles sur le suicide (morales ou religieuses), d'expériences personnelles et du poids de la responsabilité à prévenir ce type de problème [24]. Des stratégies impliquant l'éducation des équipes soignantes sur la prévention du suicide, la clarification des valeurs et l'analyse éthique des conflits soulevés par ce type de situation et la mise en place de stratégies de résolution de problèmes et l'apport d'un soutien type groupe de parole peut atténuer les résistances et barrières à la prise en charge de ces patients suicidaires [25,26].…”