A theory for the nursing care of patients at risk of suicide

AIM: This paper presents a nursing care theory developed to guide the care given to people with suicidal ideas and those with a previous suicide attempt. BACKGROUND: Suicide is a major public health problem. According to the World Health Organization, international suicide rates range from highs of more than 20 per 100,000 people in Hungary (1997 figures), to fewer than 10 per 100,000 in the United Kingdom (2002 figures). In 2002, the number of completed suicides in Taiwan increased by nearly 10% over the previous year, and the Taiwanese Government has set targets to reduce this rate. Psychiatric nurses play a vital role in helping reduce the suicide rate through prevention, education and by providing care that promotes the healing of patients who attempt suicide. METHODS: A grounded theory approach was used. Fifteen patients who had either suicidal ideas or had attempted suicide and 15 psychiatric nurses working on acute wards were interviewed and observed using an observer-as-participant strategy. Data were collected through field notes and by tape-recorded interviews during 2003, and analysed using open, axial and selective coding and the qualitative software program QRS NUD*IST. FINDINGS: The core category that emerged from the data collected was the provision of 'safe and compassionate care via the channel of the therapeutic relationship'. Other key categories linked to and embraced within this core category were: providing holistic assessments; providing protection; providing basic care; and promoting healing through advanced care. CONCLUSION: The theory generated from the findings could be used by nurses as a guide as they initiate and maintain therapeutic relationships with patients who are at risk of suicide. The theory could advance the quality of care provided by nurses. In addition, it holds potential for instilling hope in patients who have lost their ability to cope with life events and perhaps life itself.     

A theory to guide families and carers of people who are at risk of suicide

Aims. The aim of this study was to explore family members’ and ex‐patients’ perceptions of caring for people who had previously attempted suicide. Background. Suicide is a major public health problem in Taiwan. Official figures demonstrate that suicide was one of the top 10 causes of death in the last eight years, with 18·8 per 100,000 people taking their own lives in 2005. The Taiwanese Government has set targets to reduce this rate. All members of the population play a role in the prevention of suicide, including families and carers of those at risk. Evidence is sparse on the role that families take in caring for members who have been discharged from hospital following a suicide attempt. Methods. Grounded theory using one‐to‐one tape‐recorded interviews were conducted with patients who had just been discharged from hospitals following a suicide attempt (n = 15) and family members (n = 15). Data were analysed using open, axial and selective coding. Results. The core category that emerged was ‘Impending burnout’, depicting family members’ experience of caring for people who had attempted suicide. Other key categories linked to and embraced within this core category were: on guard day and night, maintaining activities of daily living and creating a nurturing environment. Conclusion. Families and carers could use the emergent theory as a guide to caring for people at risk of suicide. Psychiatric nurses could use the theory as a framework to educate family members on enhancing the quality of care provided to this group of people. The theory could go some way towards reducing suicidal attempts and decreasing re‐hospitalisation rates. Relevance to clinical practice. The finding indicated that family members experienced difficulties when caring for those who had previously attempted suicide. Consequently, nurses have a pivotal role in educating families and carers on preventive strategies before suicidal patients are discharged from hospitals.     

The attitudes of casualty nurses in Taiwan to patients who have attempted suicide

Aims and objectives. The aims of this study were to investigate a sample group of casualty nurses’ attitudes towards patients who have attempted suicide in the middle of Taiwan and to identify factors contributing to their attitudes towards attempted suicide. Design. A quantitative study using a questionnaire containing 22 statements with a five‐point Likert‐type scale was developed from the Domino's Suicide Opinion Questionnaire, and from a comprehensive analysis of research literature on the area of attitudes towards suicide. Methods. The questionnaire was distributed to casualty nurses (n = 155) to investigate their attitudes toward patients who have attempted suicide. Seven large hospitals in the middle of Taiwan were targeted. Results. This sample group of casualty nurses from the middle of Taiwan held positive attitudes toward patients who have attempted suicide. In addition, three statistically significant differences were identified: (i) The higher the level of nursing education the more positive the nurses’ attitudes towards patients who had attempted suicide. (ii) The casualty nurses who did not have a religion held more positive attitudes towards suicidal behaviour than those who followed a religion. (3) Casualty nurses who had suicide care experience with 1–10 patients had more positive attitudes towards suicidal patients than nurses who had nursed above 10 patients who had attempted suicide. Conclusions. The results indicated that casualty nurses in Taiwan require further education on and training in all aspects of suicide to foster more positive attitudes towards patients who attempt suicide. Relevance to clinical practice. The role of casualty nurses is pivotal to the front‐line care of people who are suicidal and their attitudes play a major part in the provision of effective care.     

Rural community mental health nursing: a grounded theory account of sole practice

ABSTRACT:  This paper examines community mental health in rural and remote settings, characterized as sole practice. Using a grounded theory approach, the research reported here explored how meanings of health and health care are advanced within the context of rural mental health care, dominated and in the main led by nurses. Five different practice sites in rural New South Wales were involved. The study articulated a model of therapeutics that foregrounds a relationship of intense professional intimacy and trust against a context of geographical disadvantage and professional isolation. The meanings of the relationship are elaborated in terms of unusually high levels of responsibility, professional ingenuity, powerlessness and the independent and risky character of life in the bush.     

Recovery-oriented daily care practice for community-based mental health service consumers in Japan: A grounded theory approach

Recovery, which is a non-linear, unique process allowing mental health service consumers to live autonomously, has become a prominent concept. However, adapting recovery-oriented practice to daily care is challenging. We explored recovery-oriented practice among mental health professionals in Japan via semi-structured interviews including nurses, occupational therapists, and psychiatric social workers (17 professionals in total). Data were analysed using grounded theory. Six categories emerged. The core category was ‘Continuing to adjust care to meet consumers’ needs for their unique lives'. The professionals stated that they practised in accordance with the service consumers' sincere hopes based on an equitable relationship because they believed that this approach would enhance consumers' personal agency, proactive behaviour, and self-choice. Despite negative consequences, the professionals did not view the consumers' choices as ‘failures' and instead helped them to find meaning in their experiences. Although the therapeutic relationship tended to be paternalistic, participants described how concrete practices helped build an equitable relationship. In recovery-oriented practice, the provision of support centred on consumer values is important, without imposing own's own values. Care practices should also be aligned with consumers' hopes, needs and goals.     

The structure of contraceptive education and instruction within nurse led family planning clinics: a grounded theory study

Aims. This study aimed to explore and analyse how nurses instruct women in contraceptive use during consultations in family planning clinics to produce a grounded theory of contraceptive education. Background. Nurses play a key role in instructing women how to use contraception in family planning clinic consultations. These one‐to‐one situations are encounters where women are taught how to use contraceptive methods effectively. However, very little is known about the nature of these consultations. Design. A qualitative study using a grounded theory approach was used. Results. Three linked ‘core categories’ emerged from the data analysis. Firstly, women are educated about their body and how it responds to contraception: ‘reproductive education’. This core category is closely linked to ‘surveillance’ where women are taught to monitor their reproductive health and to ‘contraceptive regimen’ where women are instructed in techniques to successfully use a contraceptive method. Together these three core categories present a grounded theory of ‘contraceptive education’. Conclusions. Nursing practice in this important area of women’s health care is complex and requires skilled practitioners. This study presents unique empirical data into how nurses conduct one‐to‐one consultations with women – providing a novel insight into how contraception is explained in clinical situations. Key issues for practice from the data were the lack of a balance when discussing side effects, the rigidity of some instructions and the lack of recognition of risk from sexually transmitted infection. Relevance to clinical practice. Nurses working in sexual health need to ensure that women understand the often complex instructions they provide and that rigid instruction be occasionally amended to enable some flexibility. The manner in which side‐effects are discussed should also be balanced. Nurses need to address the risk of sexually transmitted infections more substantially in contraceptive discussions.     

Designing a grounded theory study: some practicalities

Grounded theory is an interpretative research methodology frequently used by social science researchers seeking to discover the underlying social processes shaping interaction. The methodology is useful to create knowledge about the behavioural patterns of a group. The aim of this paper was to discuss some practical issues that the prospective grounded theory researcher planning a small-scale project may consider. Discussion focuses on the basic premises, choosing a version of grounded theory, the research problem, the purpose of study, the research question and the place of the literature in a study. The specific skills required of the grounded theory researcher are considered and some cautions are exercised. The paper may assist student researchers in a critical care setting and may be of interest to their supervisors and experienced. grounded theory researchers.     

'Veiling sexualities': a grounded theory of mental health nurses responses to issues of sexuality

Title. ‘Veiling sexualities’: a grounded theory of mental health nurses responses to issues of sexuality. Aim. This paper is a report of a study to develop a grounded theory explaining how mental health nurses respond to issues of sexuality in clinical practice. Background. The history of sexuality and people with mental health problems has largely been a history shrouded in misunderstanding, stigma, myth and negativity. However, individuals with mental health problems may experience sexuality and relationship difficulties related to their life experiences, mental illness, or its treatment. Methods. Grounded theory was the methodology used for the study. Interviews were conducted in 2005–2006 with 27 mental health nurses working an urban area in the Republic of Ireland. Data were analysed using the concurrent processes of constant comparative analysis, data collection, theoretical sampling and memo writing. Findings. The core category to emerge from the data was ‘veiling sexualities’. This refers to participants’ accounts of how they responded to the sexuality dimension of clients’ lives. Participants’ main concerns about sexuality were related to feelings of personal and professional vulnerability, due to a lack of competence, comfort and confidence in this area. The theory highlights the manner in which nurses perpetuate practices that marginalize, discriminate and socially exclude clients as ‘sexual citizens’. Conclusion. The theory of Veiled Sexualities may facilitate acknowledgement of the presence of sexuality in all nurse–client encounters, and promote a discourse on the sexual rights of people experiencing mental distress among mental health nurses and all involved in the delivery of mental health services.     

Family coping with mental illness: a comparative study

Two studies were conducted by the same researcher, one in Canada, the other in Japan, looking at families' reactions to their relatives' mental illness. The focus was placed on family caregivers' transformation processes, which are a unitary process of pattern appraisal and deliberate mutual patterning based on a unitary transformative paradigm within Newman's theory of health as expanding consciousness.     

Meaning of hygiene care for patients as perceived by clinical nurses through an interactive care process: A grounded theory approach

Aim

This study aimed to explore the meaning of hygiene care for patients from the perspective of nurses, who provide them with care through an interactive process.

Methods

Sixteen registered nurses working in general wards for over 5 years were selected through purposive and snowball sampling. Individual semi-structured interviews were conducted between May and August 2021. Data were analyzed using a grounded theory approach, and the Consolidated Criteria for Reporting Qualitative Research was used to ensure quality and transparency.

Results

The participants recognized the core category “realizing oneself alive here,” where hygiene care energized patients and promoted their realization of “feeling alive.” Hygiene care created “time of relief, temporarily forgetting the illness,” and “restoring a sense of oneself.” A situation of care also created an “opportunity to treat each other as unique individuals,” “opportunity to face self,” and “encouraging the recovery and disease-fighting process.”

Conclusions

This study highlights the value of hygiene care provided by nurses to patients. The meaning of hygiene care conceptualized in this study should help build a conceptual framework for understanding the patient's experience and reaffirming the value of hygiene care.     

The acquisition and exercise of nephrology nursing expertise: a grounded theory study

Aims and objectives. This purpose of this study was to describe the process of expertise acquisition in nephrology nursing practice. Background. It has been recognized for a number of decades that experts, compared with other practitioners in a number of professions and occupations, are the most knowledgeable and effective, in terms of both the quantity and quality of output. Studies relating to expertise have been undertaken in a range of nursing contexts and specialties; to date, however, none have been undertaken which focus on nephrology nursing. Design. This study, using grounded theory methodology, took place in one renal unit in New South Wales, Australia and involved six non‐expert and 11 expert nurses. Methods. Simultaneous data collection and analysis took place using participant observation, semi‐structured interviews and review of nursing documentation. Findings. The study revealed a three‐stage skills‐acquisitive process that was identified as non‐expert, experienced non‐expert and expert stages. Each stage was typified by four characteristics, which altered during the acquisitive process; these were knowledge, experience, skill and focus. Conclusion. This was the first study to explore nephrology nursing expertise and uncovered new aspects of expertise not documented in the literature and it also made explicit other areas, which had only been previously implied. Relevance to clinical practice. Of significance to nursing, the exercise of expertise is a function of the recognition of expertise by others and it includes the blurring of the normal boundaries of professional practice.