Considering the care of the suicidal client and the case for ‘engagement and inspiring hope’ or ‘observations’

Abstract

Psychiatric/mental health (P/MH) nursing has rightly been described as a 'broad church', and one that contains many contested matters and areas of differing opinion. One such contested matter is that of the appropriate care for the person who is at risk of suicide. Recent, albeit limited, debate of this issue has taken place, and the literature, such as it is, indicates two principal (though linked) positions. These can be summarized as the 'engagement and hope inspiration' position and the 'observations' position. Given the P/MH nurse's unique position in providing 24-hour, day-to-day care to suicidal clients and the growing problem of suicide within people who suffer from mental health problems, it is both necessary and perhaps timely to consider this debate in more detail. Accordingly, this paper considers the debate regarding care for suicidal mental health care clients. First, the paper briefly describes the historical policy context of care for the suicidal client. Next, it focuses on 'observations' and concludes that there is a range of well-established, empirically based problems or drawbacks to this approach. Following this, it focuses on 'engagement, inspiring hope' and points out the key processes of engagement: forming a relationship, a human-human connection, conveying acceptance and tolerance, and hearing and understanding. The value and importance of these most fundamental of interpersonal processes is described and alluded to throughout the limited research into care of the suicidal client. The paper then describes the range of criticisms that have been levelled at the engagement-inspiring hope approach and considers these criticisms in more detail. As a result of this detailed examination, the paper then reiterates the need to replace 'observations' with 'engagement-hope inspiration' as the principal approach to caring for suicidal mental health clients.

Identifying Key Factors Associated with Aggression on Acute Inpatient Psychiatric Wards

“…If the association is an artefact of workforce allocation policies, no action is necessary. If aggressive incidents are triggered by interactions per se, this runs counter to a long research tradition sampling staff (Altschul 1972;Cormack 1976) and patients (Rogers, Pilgrim, & Lacey 1993) that descries low interaction rates, and calls for greater engagement and interaction with patients (Bowles et al 2002;Cutcliffe & Barker 2002). However, some patients reportedly value nurses that display a 'benign non-intervention', using flexibility and tolerance to establish a therapeutic ambience (Rogers & Pilgrim 1994).…”

Om begrepet håp

“…Dette gir en mer relasjonell forståelse av håpløshet som en opplevelse av å vaere sosialt utestengt. I en serie kvalitative studier av sykepleieres rolle i behandlingen av suicidale pasienter har John R. Cutcliffe og medarbeidere satt fokus på betydningen av relasjonen mellom sykepleier og pasient som kilde til håp hos pasienten (Cutcliffe & Barker, 2002;Collins & Cutcliffe, 2003;Cutcliffe et al, 2007). I den siste studien fant de at deltagerne gjennomgående beskrev en følelse av disconnection from humanity, og at den psykiatriske sykepleieren gjorde det mulig for dem å tilkoble seg igjen gjennom å vaere en varm, omsorgsfull representant for menneskeheten som pasientene fikk tillit til.…”

Les interventions infirmières estimées bénéfiques par les adolescents à risque de suicide

“…Toutefois ces tâches, appliquées systématiquement à tous les patients à risque pour suicide, ont été remises en question durant les dernières années. Selon Cutcliffe et Barker (2002), l'intervention de surveillance infirmière représente une approche aliénante et inefficace qui échoue dans 20 à 33 % des cas. Cependant, bien que ce protocole puisse avoir des consé-quences négatives, la recherche démontre que l'accompagnement infirmier peut aussi avoir des effets positifs sur la santé et le bien-être du patient.…”