Caring for patients with suicidal behaviour: an exploratory study

Abstract

Presentation to the Emergency Department (ED) of patients with suicidal behaviours is relatively common. While many of these patients may be referred on to specialist mental health services, many are either discharged with no psychiatric follow-up or leave before being seen. There is therefore an increasing onus on the staff of Emergency Departments to become involved in the assessment and initial management of this patient group. The aim of this study was to describe the experiences and challenges that nurses encounter when caring for patients who present to the ED with suicidal behaviour. Forty-two ED nurses completed a 15-item semi-structured questionnaire. Participants in this study identified risk assessment as part of their role but did not focus on psychosocial assessment or psychological management of this patient group. Feelings of sympathy and compassion were reported towards these patients; however, there was often a prior judgement of the perceived 'genuineness' of the presentation. Finally, challenges experienced included a lack of appropriate communication skills and insufficient resources within the ED department to adequately care for this vulnerable patient group.

Emergency department staff attitudes towards mental health consumers: A literature review and thematic content analysis

“…In addition to the fear and anger engendered by aggressive or bizarre behaviour (Kerrison & Chapman 2006, Pich et al 2009), staff tension was further increased due to the revolving door nature of many presentations and lack of feedback or apparent follow-up resulted in a sense of hopelessness and a why bother attitude (Anderson et al 2003, Hadfield Emergency Department Attitudes Toward Mental Illness 9 et al , McElroy & Sheppard 1999. One qualitative study reported that staff perceived individuals with mental health presentations to be manipulative (Bergmans et al 2009) whilst another one stated that complaints were often not seen as genuine on initial presentation (Doyle et al 2007). MacKay and Barrowclough (2003) found that the greater the negative affect of staff towards the individual, the less the propensity to help.…”

“…A number of both qualitative and quantitative studies reported that ED staff generally felt ill-prepared to assess and care for individuals with mental health problems (Doyle et al 2007, Friedman et al 2006, Pich et al 2009, Summers & Happell 2003. The three papers, which measured perceived skill level and attitude, all found that those with greater perceived self-efficacy in assessment and treatment had more positive attitudes (Kishi et al 2011, McAllister et al 2001, Wright et al 2003.…”

“…The continuous need for hyper vigilance on the part of the staff in order to prevent violence or risk to self was perceived as draining (Doyle et al 2007, Kerrison & Chapman 2007, Pich et al 2011). …”

“…Doyle et al (2007), Friedman et al (2006) and Hadfield (2009) acknowledge that uncertainty about how to intervene, communicate with and support patients due to perceived lack of skills is a barrier to engagement. Hadfield et al (2009) suggest that another reason could be explained as a defensive position and a means of protecting themselves, and possibly also the consumer, from developing negative attitudes triggered by having no perceived meaningful role in caring for patients who require more specialist care than they believe they can offer; as well as the consequential frustration and loss of empathy evoked by repeat presentations.…”

“…However, McCallister et al (2002) found that there is no statistically significant link between length of experience and improved confidence when working with this patient group. Conversely, repeated exposure to presentations considered by clinicians as 'revolving door patients' and the perception that little they do changes a patient's situation could result in increasing pessimism, loss of empathy and consequently development of negative attitudes (Doyle et al 2007, Commons-Treloar & Lewis 2008, Hadfield et al 2009, Conlon et al 2010). This may therefore explain why attitudes become less positive after a certain amount of time.…”