Relational Principles in the Care of Suicidal Inpatients: Experiences of Therapists and Mental Health Nurses

Abstract

This study explored and compared therapists' and mental health nurses' experiences of caring for suicidal inpatients in light of ethics of care and ethics of justice. Analysis of interview data from eight therapists and eight mental health nurses indicates two approaches: "connection and care" and "duty and control," reflecting aspects of both ethical perspectives. There are some differences between the two professional groups, and sometimes there might be conflicts between the two approaches and ethical perspectives. Clinical practice is increasingly shaped by standardization and guidelines, and it is important to promote professionals' efforts to provide relational-emotional care for suicidal patients.

‘Promoting and preserving safety and a life‐oriented perspective’: A qualitative study of nurses’ interactions with patients experiencing suicidal ideation

“…These findings can be associated with the study of Gerace and Muir‐Cochrane (), indicating that nurses view restraint and seclusion as ‘measures of last resort’ to maintain safety. The present study confirms that a large number of nurses conform to these protocol‐based measures in order to meet organizational expectations and to protect themselves in the event of an adverse outcome (Cutcliffe & Stevenson , Hagen et al , Manuel & Crow 2014). As with other studies, nurses urge to conform to protocol‐based practice was also associated with experiencing strong emotions when interacting with patients experiencing SI, including uncertainty, fear, and a strong sense of responsibility and accountability (Hagen et al ; Morrissey & Higgins ).…”

“…The findings imply that revising policy documents (e.g. protocols) and strategies is warranted so that these do not (unintentionally) contribute to an overemphasis in nursing practice on directing and controlling approaches, and to an understatement of connecting and collaborating approaches (Hagen et al ; Higgins et al ). In this respect, the present study can inform policies that aim to reduce the use of restraint and seclusion in psychiatric hospitals and to replace formal observations with approaches that foster meaningful engagement (Cox et al ).…”

To die or not to die: a qualitative study of men’s suicidality in Norway

“…This is in line with comprehensive research, which shows that clinicians should stop categorizing patients in relation to the level of suicide risk, and that health authorities should withdraw guidelines that require this [41]. The diversity of stories and needs of the patients rather calls for time to build up strong meeting-points with health personnel [42, 43]. Professionals must be given space, time and trust to apply their health professional skills when meeting the individual patient [44].…”

Contact and communication with patients experiencing suicidal ideation: A qualitative study of nurses’ perspectives

“…In addition, it is argued that nurses are increasingly involved in protocol‐based practices for suicide prevention. These practices are often defensive and do not value or obstruct nurses’ efforts to provide relational–emotional care for patients experiencing SI (Hagen, Hjelmeland, & Knizek, ; Horsfall & Cleary, ; Manuel, Crowe, Inder, & Henaghan, ).…”

“…The aforementioned insights reflect and reinforce concerns that nurse‐patient contacts might become increasingly truncated, thus doing little or nothing to support the development of therapeutic nurse–patient relationships (Cutcliffe & McKenna, ). As a result, such contacts may limit nurses’ potential to contribute to suicide prevention and to support patients’ recovery (Hagen, Hjelmeland, et al, ; Lees et al, ). These concerns have led to a call for ongoing and renewed attention to the fundamentals of nursing care and to its conceptual understanding in psychiatric wards as a complex and demanding environment (Cleary, Hunt, Horsfall, & Deacon, ; Gunasekara, Pentland, Rodgers, & Patterson, ).…”