‘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.     

Host and guest: an applied hermeneutic study of mental health nurses' practices on inpatient units

The metaphor of host and guest has value for exploring the practice and role identity of nurses on inpatient mental health units. Two complementary texts, one from the ancient Zen record of Lin‐chi, and the other from the contemporary hermeneutic philosopher Richard Kearney, are used to elaborate meanings of host and guest that can be applied to the situation of mental health nurses. In a doctoral study with a hermeneutic design, I addressed the topic of nurse–patient relationship using an interpretive framework that included sources from Buddhist thought. The positions of host and guest emerged from interviews with nurses as one interpretive theme to open up new understanding of the topic. The two texts, originally distant in era and culture, both employ the host and guest metaphor. They are applied to extracts from interviews to open up discussions of hierarchy, status, patients' perspectives, otherness and resistances as features of nurses' complex experience. These provide insights into understanding practice and suggest implications for how institutional environments shape practice. An intercultural reading of texts can provide a source of new understanding of nurse–patient relationships.     

Nurses’ articulations of the patients’ role when the vision is partnership: A qualitative study

Although principles such as ‘patient participation’ and ‘patient involvement’ have become ideals in health‐care, they have proven to be difficult to apply in practice. In 2014, one Danish region issued an official document that included the vision of ‘the patient as partner’. However, little is known about how such a vision affects clinical practice. The purpose of this study was to investigate nurses’ views on how partnerships between them and patients are established considering this vision. We conducted semi‐structured interviews with eight nurses working in Danish hospitals. Then, we analysed the interviews in a Norman Fairclough‐inspired critical discourse analysis. During this three‐dimensional analysis, we identified three discourses. We found that a liberalistic discourse wins hegemony based on the nurses’ expectations of the patient's role. Nurses construct a picture of the patient's role, expecting the patient to be responsible and to participate. For the partnership to arise as envisioned, the patient is perceived as being dependent on the nurse's professional knowledge. Surprisingly, the nurses’ articulations of the patient's role were identical to the vision's elements. Therefore, we suggest that the vision reflects prevailing societal norms for individuals, thereby reflecting society's attitude towards people's responsibility for their own lives.     

A sanctuary of safety: A study of how patients with dual diagnosis experience caring conversations

The prevalence of dual diagnosis, that is, the combination of psychiatric illnesses and substance use disorders, is high. As a vast majority of previous research in this context focusses on the effects of different treatment methods, rather than interpersonal issues, the purpose of the present study was to explore and illuminate in what way patients with a dual diagnosis experience conversations with nurses in an outpatient clinic to be caring. Five patients were interviewed regarding their experiences of caring conversations. The analysis and interpretation were inspired by a previously‐used hermeneutical process. These yielded three themes: (i) reciprocity creates safety and communion; (ii) suffering is made visible and understandable; and (iii) self‐esteem is restored. When synthesized, these themes gave rise to a main theme – a sanctuary of safety – where suffering is alleviated and dignity and self‐esteem are restored. It is concluded that the caring conversation contributes to experiences of safeness. In this specific context, safety appears to be more fundamental than trust for patients’ recoveries. The caring conversation also contributes to recovery, as it supports the individual's learning and understanding as a way to cope with problems, which also enables patients to make informed decisions about their own care. The caring conversation contributes to the alleviation of suffering and restoration of dignity and self‐esteem for patients with a dual diagnosis. However, there is a need for further research focussing on how the caring conversation can contribute to psychiatric nurses’ caring expertise.     

Perspectives and experiences of Iranian nurses regarding nurse–physician communication: A content analysis study

Background: Nurse–physician communication in the healthcare setting is an important subject that requires international attention because of its relationship with nurses' job satisfaction, turnover, patient safety, and above all, the quality of care. The importance of conducting studies on communication in different cultures and contexts in order to increase nurses' knowledge regarding nurse–physician communication cannot be overemphasized. Aim: The purpose of this study was to explore the perspectives and experiences of Iranian nurses regarding nurse–physician communication. Methods: A qualitative study, using the content analysis approach, was conducted. Semistructured interviews were held with 22 female nurses with a Bachelor's degree who were working in two teaching hospitals in an urban area of Iran. Results: During the data analysis, three main themes emerged: “no independence in decision‐making”, “lack of acknowledgment of nurses' capabilities”, and “unequal support by the healthcare system”. Conclusion: Healthcare team members and administrators should listen to nurses' perspectives and try to address the problematic areas of nurse–physician communication if they are improving the quality of nursing care that is expected.     

Italian midwives' experiences of late termination of pregnancy. A phenomenological–hermeneutic study

In this phenomenological–hermeneutic study, we explored how midwives perceive the burden of care, while assisting termination of pregnancy after 16 weeks' gestation. Between February and April 2013, 17 Italian midwives from three different units were interviewed. Data were collected using semistructured interviews. Four themes emerged from the interviews: influences, supports, empathy, and emotions. At the end of the study, researchers observed that midwives assert conscientious objection to the termination of pregnancy, which does not influence their experiences and memories. The midwives felt that it was important to share experiences with colleagues, discussing cases together and with the rest of the team. The midwives also suggested some strategies to improve this type of care: organize shifts in a way that could lead to improved and personalized care for women, continuous development, involvement of relatives, and special measures for these women's rooms. Moreover, they considered help from other professionals as fundamental in order to manage the clinical and emotional complexities related to these terminations.