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

Suicide prevention is an important imperative in psychiatric hospitals, where nurses have a crucial role in and make essential contributions to suicide prevention and promoting the recovery of patients experiencing suicidal ideation. The present qualitative grounded theory study aimed to uncover and understand the actions and aims of nurses in psychiatric hospitals during their interactions with patients experiencing suicidal ideation. Interviews were conducted with 26 nurses employed on 12 wards in four psychiatric hospitals. The data analysis was inspired by the Qualitative Analysis Guide of Leuven. The findings show that nurses' actions and aims in their interactions with patients experiencing suicidal ideation are captured in the core element 'promoting and preserving safety and a life-oriented perspective'. This core element represents the three interconnected elements 'managing the risk of suicide', 'guiding patients away from suicidal ideation', and 'searching for balance in the minefield'. The enhanced understanding of nurses' actions and aims can inform concrete strategies for nursing practice and education. These strategies should aim to challenge overly controlling and directing nursing approaches and support nurses' capacity and ability to connect and collaborate with patients experiencing suicidal ideation

The working alliance with people experiencing suicidal ideation : a qualitative study of nurses’ perspectives

Aims: This study aimed to enhance the conceptual understanding of the working alliance in the context of nursing care for people experiencing suicidal ideation. Design: A qualitative study based on grounded theory was conducted. Methods: Two authors conducted individual semi-structured interviews from September 2017-January 2019. Twenty-eight nurses in 13 wards of four psychiatric hospitals participated. The Qualitative Analysis Guide of Leuven was used to support constant data comparisons and the cyclic processes of data collection and data analysis. Findings: The nurses' perspectives revealed that the working alliance can be understood as an interpersonal and collaborative relational process. This relational process highlighted the core variable 'seeking connectedness and attunement with the person at risk of suicide'. The core variable underpinned three clusters: investing in the foundations of the working alliance, nourishing the clinical dimension of the working alliance and realizing an impact with the working alliance. Conclusion: This study highlights the importance for nurses to assess, evaluate and respond to persons' suicidal ideation in harmony with a commitment to connect with them and attune to their perspective. Impact: The relational process uncovered through this study offers valuable insights to support advanced nursing practice, where nurses meaningfully integrate relational elements of care with their contributions to suicide prevention and treatment

Restrictive practice in relation to self-harm:necassary or unnessary?

Background Despite the use of restrictive measures in mental healthcare to keep patients and staff safe is a highly controversial issue, this practice is still ongoing in inpatient mental healthcare. A possible explanation is that mental healthcare providers and psychiatric patients have different understandings on what is perceived as restrictive. Objective Within the framework of the nurse patient relationship in relation to measures that were taken to reduce or limit self-injurious behaviour, this study was designed to explore: 1) What measures were perceived as restrictive and (2) Why these measures were perceived as restrictive? Method: A qualitative research was conducted. Data were collected from 10 patients and 6 nurses. The participants were selected using purposive sampling. Data were analysed using the constant comparative method influenced by the grounded theory approach. Rigour was achieved through audit trail, peer debriefing, data-saturation and research triangulation. Results: Beside measures that ‘re experienced as restrictive due to the already restrictive nature of the measure, the participants described a variety of atypical restrictive measures, like being insisted to take care themselves for their self-inflicted wounds. With regard to their own recovery, all participants described conflicting perceptions and an ambivalent position towards the appropriateness of the mentioned measures. These ambivalence was not only related to the measures that ‘re taken to withhold them to self-injure, but also in relation to their urge to self-harm and the way how they dealt with it and how help was offered by nurses. Analysis of the data gathered from the patients showed how the use of restrictive measures increased their perceived ambivalence towards their own self harm-related behaviour. Analysis of the data from the nurses showed how exposure to self-injurious behaviour evoked strong and overwhelming feelings, resulting in protective responses which enhanced the use of restrictive measures. Conclusion: Instead of focussing on the use of restrictive practice, patients whom self-harm want nurses being sensitive with respect to their ambivalent feelings and thoughts. By exploring and normalising these experienced ambivalence, nurses can help patients to maintain themselves. Education goals: Participants will…. 1. Have an understanding about how restrictive measures are experienced by hospitalised self-harming patients and their primary nurses 2. Realise how interpersonal attitudes and skills of health care providers contribute to help self-harming patients to maintain themselves in disturbing conditionsstatus: publishe

Verpleegkundige begeleiding bij automutilatie: balanceren tussen begrip en onbegrip. Een exploratief onderzoek

DOEL. Dit exploratief kwalitatief onderzoek is bedoeld om inzicht te verwerven in hoe verpleegkundigen en patiënten automutilatie en de verpleegkundige benadering ervan beleven. METHODE. Een kwalitatieve studie, gebaseerd op de principes van ‘grounded theory’, werd uitgevoerd in een middelgroot psychiatrisch ziekenhuis in Vlaanderen. Er werden semigestructureerde interviews afgenomen bij vijf psychiatrisch verpleegkundigen met ervaring op het vlak van automutilatie en bij acht patiënten die automutileren. Bij de analyse van de interviews werd gebruikgemaakt van de constante comparatieve methode. RESULTATEN. Er werd een werkkader ontwikkeld dat inzicht biedt in hoe verpleegkundigen en patiënten automutilatie ervaren. De cruciale elementen hierin zijn het door de patiënt ervaren begrip of onbegrip. Het ervaren van begrip blijkt de drempel tot automutileren te verhogen. De kernopdracht van de verpleegkundige is bijgevolg de patiënt laten ervaren dat hij begrepen wordt. Dit kan onder andere door meer controle bij de patiënt te laten, verbondenheid te creëren en een klimaat uit te bouwen dat verdere beschadiging voorkomt. DISCUSSIE EN CONCLUSIE. Het ontwikkelde werkkader kan een basis vormen voor het opzetten van de verpleegkundige zorg bij automutilatie. Verder onderzoek kan het werkkader verfijnen, verdiepen en onderbouwen.status: publishe

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

AIM: To uncover and understand the core elements of how nurses in psychiatric hospitals make contact with patients experiencing suicidal ideation. DESIGN: A qualitative study based on the principles of grounded theory was performed. METHODS: Nineteen nurses on wards of four psychiatric hospitals were interviewed between May 2017 - February 2018. The Qualitative Analysis Guide of Leuven was used to facilitate the constant comparison of data. FINDINGS: Nurses make contact with patients experiencing suicidal ideation by "creating conditions for open and genuine communication" while maintaining a focus on "developing an accurate and meaningful picture of patients". These interconnected core elements represent nurses' attention to relational processes like building trust as well as their predominant focus on assessing suicide risk. Nurses put other emphases in their contacts with patients depending on whether their approach is guided more by checking and controlling suicide risk or by acknowledging and connecting (with) the person. CONCLUSION: The study enhances the conceptual understanding of how nurses on psychiatric wards can involve in compassionate and considerate contact and communication with patients experiencing suicidal ideation. These findings can be used to underpin the nurses' role in and contribution to suicide prevention. IMPACT: The core elements "creating conditions for open and genuine communication" while maintaining a focus on "developing an accurate and meaningful picture of patients" can inform policies for nursing practice and education that aim to preserve and improve the capacity of nurses to involve in compassionate and considerate contact and communication with patients experiencing suicidal ideation

Uitbouw van een traject herstel- en ervarignsdeskundigheid in GGZ en onderwijs

status: publishe

Verpleegkundige begeleiding bij automutilatie: balanceren tussen begrip en onbegrip: een exploratief onderzoek

DOEL. Dit exploratief kwalitatief onderzoek is bedoeld om inzicht te verwerven in hoe verpleegkundigen en patiënten automutilatie en de verpleegkundige benadering ervan beleven. METHODE. Een kwalitatieve studie, gebaseerd op de principes van ‘grounded theory’, werd uitgevoerd in een middelgroot psychiatrisch ziekenhuis in Vlaanderen. Er werden semigestructureerde interviews afgenomen bij vijf psychiatrisch verpleegkundigen met ervaring op het vlak van automutilatie en bij acht patiënten die automutileren. Bij de analyse van de interviews werd gebruikgemaakt van de constante comparatieve methode. RESULTATEN. Er werd een werkkader ontwikkeld dat inzicht biedt in hoe verpleegkundigen en patiënten automutilatie ervaren. De cruciale elementen hierin zijn het door de patiënt ervaren begrip of onbegrip. Het ervaren van begrip blijkt de drempel tot automutileren te verhogen. De kernopdracht van de verpleegkundige is bijgevolg de patiënt laten ervaren dat hij begrepen wordt. Dit kan onder andere door meer controle bij de patiënt te laten, verbondenheid te creëren en een klimaat uit te bouwen dat verdere beschadiging voorkomt. DISCUSSIE EN CONCLUSIE. Het ontwikkelde werkkader kan een basis vormen voor het opzetten van de verpleegkundige zorg bij automutilatie. Verder onderzoek kan het werkkader verfijnen, verdiepen en onderbouwen

Family expectations of inpatient mental health services for adults with suicidal ideation : a qualitative study

Involvement of family members of adults with suicidal ideation is a key area of improvement in inpatient mental health services. To support family involvement in this context, it is crucial to understand what care and treatment family members expect for their relative. This qualitative study based on grounded theory involved interviews with 14 family members, including partners, parents, adult children and siblings. The family members' expectations of care and treatment in inpatient mental health services were captured by the core element 'Struggling to remain hopeful while looking through the lens of uncertainty'. This core element interacted with four sub-elements: assuming safety as a priority, looking for a healing approach and environment, counting on continuity of care and wanting to be involved and supported. The family members fluctuated between hope and uncertainty depending on whether their expectations were met or unmet. Unmet expectations were common and underpinned by a sense of being marginalized during the admission of their relative with suicidal ideation. Mental health professionals, including nurses, can be more empathetic towards the family members and attuned to their expectations. This can underpin partnerships that help families to deal with their feelings of uncertainty and disempowerment. Such partnerships can flourish in recovery-oriented mental health services that allow meaningful family involvement