Suicide care from the nursing perspective: A meta‐synthesis of qualitative studies

Abstract

Aims: To explore nurses' experiences of suicide care and to identify and synthesize the most suitable interventions for the care of people with suicidal behaviour from a nursing perspective.Design: Qualitative meta-synthesis. Data sources:Comprehensive search of five electronic databases for qualitative studies published between January 2015 and June 2019. Review methods:The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme (CASP) qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso's method.Results: Seventeen articles met the inclusion criteria. The data analysis revealed 13 subcategories from which four main categories emerged: 'Understanding suicidal behaviour as a consequence of suffering', 'Nurses' personal distress in suicide care', 'The presence of the nurse as the axis of suicide care' and, 'Improving nurses' relational competences for a better therapeutic environment'. Conclusion:Further training of nurses on the therapeutic relationship, particularly in non-mental health care work settings, and monitoring of the emotional impact on nurses in relation to suicide is required to promote more effective prevention and care. Impact:This review provides new insights on how suicide is interpreted, the associated emotions, the way suicide is approached and proposals for improving clinical practice from the point of view of nurses. The results demonstrate that the nurse-patient relationship, ongoing assessment, and the promotion of a sense of security and hope are critical in nursing care for patients who exhibit suicidal behaviour. Consequently, to promote an effective nursing care of suicide, nurses should be provided with further training on the therapeutic relationship. Thus, health institutions do not only provide the time and space to conduct an adequate therapeutic relationship, but also, through their managers, they should supervise and address the emotional impact that is generated in nurses caring for patients who exhibit suicidal behaviour.

Newtonian science, complexity science and suicide—critically analysing the philosophical basis for suicide research: A discussion paper

“…This is evident in the culture of blame that exists in mental health settings surrounding suicide (Wand, 2017). In a meta‐analysis by Clua‐García et al (2021) authors report that some nurses feared that their organization would take legal action and blame them if they were unable to prevent a suicide attempt. Additionally, participants in a qualitative study by Morrisey & Higgins (2019) reported that discussions regarding suicide during their nursing education were based on a preventative risk framework where professional responsibility and accountability was emphasized.…”

“…The therapeutic relationship is established through listening, warmth, a non‐judgmental attitude, and the establishment of a safe environment where suicide can be openly discussed, hope can be promoted, and patient involvement in their own care can be facilitated (Cutcliffe & Barker, 2002; Sun et al, 2006; Clua‐Garcie et al, 2021; Derblom et al, 2021). The therapeutic nurse–patient relationship is valued by nurses as the essential tool for assessing and addressing the needs of people experiencing suicidality (Clua‐Garcie et al, 2021). The quality of this relationship however is significantly influenced by the environment in which it takes place.…”

“…The quality of this relationship however is significantly influenced by the environment in which it takes place. Clua‐Garcie et al (2021) found that providing care for people experiencing suicidality led to a range of difficult emotions for nurses, including fear, sadness, guilt, anxiety, loss of control, exhaustion and responsibility. The emotional distress experienced by nurses in these situations can have a negative impact on the quality of the nurse–patient relationships that they are able to establish.…”

The Meaning of Suicidal Behaviour for Portuguese Nursing Students

“…Appropriate pedagogy and student support services must be considered for nursing undergraduate students as the emotional intensity of dealing with suicide prevention is a focal point in preparing and supporting prospective nursing professionals [ 16 , 23 , 28 ]. A review of qualitative studies indicates that it is necessary to improve nurses’ relational skills and monitor the emotional impact related to suicide in order to promote more qualified care [ 15 ].…”

“…Nursing professionals can play a crucial role in suicide prevention and provide significant insight into the prognosis of people at risk of suicide [ 10 , 11 , 12 , 13 ]. Suicidal behavior is considered an enigmatic phenomenon, and assistance to people with suicidal behavior is considered by nursing professionals as a critical and challenging moment, which evokes feelings varied and requires knowledge, skills, and emotional control [ 14 , 15 , 16 ].…”