Nursing people who are suicidal on psychiatric wards in Taiwan: action/interaction strategies

Suicide is a major mental health problem in Taiwan. Estimations revealed that approximately 41% of people who committed suicide had a previous history of psychiatric inpatient care. To date, a suicide nursing care theory has not been developed. Consequently, the aim of this study was to formulate a suicide nursing care theory with the aim of enhancing and advancing the nursing care provided to people who attempt suicide or have suicidal thoughts. A qualitative approach using grounded theory was adopted. A total of 15 peoples who had either suicidal ideas or had attempted suicide and 15 psychiatric nurses were interviewed and observed. Data were analysed using open, axial and selective coding and the NUD*IST software program. A substantive theory of suicide nursing care was developed from the emergent findings. Four categories surfaced in the nursing care theory relating to the nurses' 'action/interaction strategies'. They were: the holistic assessment of people who are suicidal; providing protection; providing basic care; and providing advanced care. The findings from this study could be used to influence and advance nurse education and training, clinical practice, management and further research.     

How people live with or get over being suicidal: a review of qualitative studies

Title. How people live with or get over being suicidal: a review of qualitative studies Aim. To systematically review qualitative research which addresses how people live with suicidality or recover a desire to live. Background. Suicide is a pressing social and public health problem. Much emphasis in suicide research has been on the epidemiology of suicide and the identification of risk and protective factors. Relatively little emphasis has been given to the subjective experiences of suicidal people, but this is necessary to inform the care and help provided to individuals. Data sources. Electronic searches of CINAHL Plus with full text, Medline and PsychArticles (included PsycINFO, Social Services Abstracts and Sociological abstracts) were undertaken for the period from 1997 to April 2007. In addition, the following journals were hand searched (1997–2007): ‘Mortality’, ‘Death Studies’, ‘Archives of Suicide Research’ and ‘Crisis: The Journal of Crisis Intervention and Suicide Prevention’. Method. A systematic review of the literature and thematic content analysis of findings. The findings were extracted from selected papers and synthesized by way of content analysis in narrative and tabular form. Findings. Twelve studies were identified. Analysis revealed a number of interconnected themes: the experience of suffering, struggle, connection, turning points and coping. Conclusions. Living with or overcoming suicidality involves various struggles, often existential in nature. Suicide may be seen as both a failure and a means of coping. People may turn away from suicide quite abruptly through experiencing, gaining or regaining the right kind of connection with others. Nurses working with suicidal individuals should aspire to be identified as people who can turn people’s lives around.     

Attitudes toward suicide and suicidal risk among younger and older persons

Despite a burgeoning literature on some aspects of elder suicide, little is known about the specific attitudes that older people hold about suicide. The present study examined attitudes toward suicide and suicidal risk among 96 younger and 79 older adults. Participants completed the Suicide Opinion Questionnaire and the Suicide Risk Scale. Regarding suicidal risk, younger adults scored significantly higher than older adults. Regarding attitudes, older adults scored significantly higher than younger adults on 7 of 15 subscales, indicating that for older adults, suicide was more acceptable, more strongly related to a lack of religious conviction, more lethal, more normal, more irreversible or permanent, more strongly related to demographics, and more strongly related to individual aspects. An implication is that older adults hold both adaptive and maladaptive attitudes about suicide that may be useful in providing a social and cultural context to the study, prevention, and treatment of elder suicide.     

ATTITUDES TOWARD SUICIDE AND SUICIDAL RISK AMONG YOUNGER AND OLDER PERSONS

Despite a burgeoning literature on some aspects of elder suicide, little is known about the specific attitudes that older people hold about suicide. The present study examined attitudes toward suicide and suicidal risk among 96 younger and 79 older adults. Participants completed the Suicide Opinion Questionnaire and the Suicide Risk Scale. Regarding suicidal risk, younger adults scored significantly higher than older adults. Regarding attitudes, older adults scored significantly higher than younger adults on 7 of 15 subscales, indicating that for older adults, suicide was more acceptable, more strongly related to a lack of religious conviction, more lethal, more normal, more irreversible or permanent, more strongly related to demographics, and more strongly related to individual aspects. An implication is that older adults hold both adaptive and maladaptive attitudes about suicide that may be useful in providing a social and cultural context to the study, prevention, and treatment of elder suicide.     

Patients’ Experiences After Attempted Suicide: A Literature Review

The aim of this study has been to synthesize research on suicidal patients’ experiences of the suicide process. A literature search was performed in CINAHL, PubMed, and PsycINFO, and the analysis of the 15 articles covered was based on meta-synthesis. Patients experience a wide variety of feelings regarding their situation during the suicide process, and these exist on two levels: they relate to the different aspects of care that the patients receive and the patients’ need to communicate with others and regain hope. The patients in this study described the struggle to maintain hope when life became too difficult and their suffering despite a sense of security, and they sought to achieve emotional balance. A good understanding of how suicidal individuals live with and manage suicidal ideation, while maintaining hope is important for planning effective nursing care. Further research from the patient perspective is needed to further develop psychiatric care for people at risk of suicide.     

Suicide attempt by drug overdose

Suicide attempts by drug overdose are a growing health care problem, now reaching epidemic proportions. The patient who attempts suicide is typically a young, single adult female with interpersonal conflicts who takes an overdose of a prescribed drug, frequently a benzodiazepine. Patients who have recently been separated or divorced and those who are alcoholic, depressed or previously suicidal are also at risk. The family physician is in the best position to prevent suicide.     

EXPLORATION OF THE RELATIONSHIP BETWEEN PHYSICAL AND/OR SEXUAL ABUSE,ATTITUDES ABOUT LIFE AND DEATH,AND SUICIDAL IDEATION IN YOUNG WOMEN

Experiencing sexual and/or physical abuse at any point in one's life can be quite traumatic. In addition to the immediate effects of the abuse, numerous long-term consequences have been identified, including an increased risk of developing psychological disorders and attempting suicide. We sought to determine if a relationship exists between abuse experiences, attitudes about life and death, and suicidal ideation by surveying 644 college women between the ages of 18 and 24. Participants completed packets containing standardized abuse questionnaires, the Multi-Attitude Suicide Tendency Scale, and the Adult Suicidal Ideation Questionnaire. We concluded that abuse plays a role in how these young women think about life and death. Specifically, less repulsion by death and more repulsion by life were reported by women with more significant abuse histories. In addition, these same women endorsed higher levels of current suicidal ideation. It was also determined that women who had experienced more abuse tended to have been in therapy for longer periods of time. Implications of this study for mental health professionals working with suicidal young adults are discussed.     

Exploration of the relationship between physical and/or sexual abuse, attitudes about life and death, and suicidal ideation in young women

Experiencing sexual and/or physical abuse at any point in one's life can be quite traumatic. In addition to the immediate effects of the abuse, numerous long-term consequences have been identified, including an increased risk of developing psychological disorders and attempting suicide. We sought to determine if a relationship exists between abuse experiences, attitudes about life and death, and suicidal ideation by surveying 644 college women between the ages of 18 and 24. Participants completed packets containing standardized abuse questionnaires, the Multi-Attitude Suicide Tendency Scale, and the Adult Suicidal Ideation Questionnaire. We concluded that abuse plays a role in how these young women think about life and death. Specifically, less repulsion by death and more repulsion by life were reported by women with more significant abuse histories. In addition, these same women endorsed higher levels of current suicidal ideation. It was also determined that women who had experienced more abuse tended to have been in therapy for longer periods of time. Implications of this study for mental health professionals working with suicidal young adults are discussed.     

Ignoring the evidence dictating the practice: sexual orientation, suicidality and the dichotomy of the mental health nurse

International epidemiological studies demonstrate that gay and bisexual males are four times more likely to report a serious suicide attempt than their heterosexual counterparts. Data on completed suicides, usually derived from mortality statistics misrepresent the rate of suicides among homosexual populations. However, an increasing number of studies comparing representative samples of gay, lesbian and bisexual youths with heterosexual controls demonstrate increased rates of mental health problems and subsequent suicide among the homosexual population. Homosexual orientation must therefore be considered a risk factor for mental distress and as such should be a focus for any contemporary public health agenda. One of the difficulties of addressing the problem through a public health agenda is the juxtaposition proffered by our political and social environment. The Diagnostic and Statistical Manual of Mental Disorder ceased to define homosexuality as pathological in 1973 replacing it with a new 'illness' of 'gender identity disorder'. Until recently in England, Section 28 of the Local Government Act (1988), forbidding the promotion of homosexuality, further reinforced negativity towards this group of people. This compounded the negative mental health consequences for those developing a gay sexual orientation in a climate of heterosexism. Current health care policy in England concerns itself with the rising number of suicides among young people but fails to acknowledge the importance of the research findings relating to gay people by integrating them into the development of mental health policy. This paper reviews the literature relating to homosexual people and suicidality, and addresses the seriousness of a policy rhetoric which results from ignoring the evidence while dictating mental health nursing practice.     

La filière de soin des suicidants aux urgences

In France, a suicide attempt is recorded every 40 seconds, and a death by suicide occurs every 40 minutes. Suicide is the primary cause of mortality in people aged between 15 and 45 years. Suicidal tendencies have been identified as a major public health issue since the 1990s. Mental illnesses (including depression, schizophrenia, and addictions) as well as any personal and family history of suicidal behaviour are major risk factors. Identification and treatment of people in a suicide crisis and/or making a suicide attempt can help prevent repeated suicide attempts. Recommendations for good practice make a hospital, and in particular the emergency departments, a requisite location where a multidisciplinary approach is available. This leads to the need to organize a care process from reception to guidance based on an evaluation in three steps: physical, psychological, and social. The implementation of hospital care and/or intensive outpatient follow-up needs to be adjusted to match each situation. Training general practitioners in detection and treatment of suicidal patients and/or those suffering from depression is critical. Training is also necessary for teams in the emergency departments and in the crisis services with specialisation in handling suicidal adolescents or elderly people in some of them. The emergency wards are also, in a large number of cases, the first place of contact with a psychiatric. The quality of welcoming initial cares, relationships between the nursing staff and carers within the hospital and between the downstream organisations will determine to what extent the patients being treated will continue their treatment, will ensure the continuity of care, and will help to prevent repeated attempts.     

The suicide attitude vignette experience (save): A search for sexual stereotypes in the perception of suicidal behavior

Using a modification of the Suicide Attitude Vignette Experience (SAVE), a study identified no sexual stereotypes in the perceived rationality and appropriateness of completed suicide in response to crises. Respondents who were depressed or who had a history of suicidal preoccupation did view the choice of suicide as more rational and more appropriate.     

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.     

Suicide: a literature review and its implications for nursing practice in Taiwan

In recent years the suicide rates have been increasing gradually in many countries. In order to reduce the number of suicides, further research on suicide and the nursing care of suicidal people is required to enhance and advance the quality of suicide nursing care provided. Statistical evidence shows that the most common method of completing suicide in many countries is hanging. Other evidence demonstrates that some suicides could be prevented if all patients were assessed for suicide risk and if psychiatric nurses provided effective nursing care, which centres on therapeutic communication skills. This paper explores the literature on suicide and on the nursing care of people who are suicidal, and also on the importance of integrating theory with practice.     

Gender issues in youth suicidal behaviour

There are gender differences in youth suicidal behaviour that are evident in childhood and persist throughout adolescence and young adulthood. In Western countries, young females are twice as likely as males to report suicidal ideation and suicide attempt behaviour. However, despite the fact that females make more suicide attempts, males are three‐ to fourfold more likely to die by suicide than females. This paper reviews the epidemiological evidence for gender differences in suicidal ideation, attempted suicide and completed suicide among young people and explores possible reasons for the observed differences. These reasons include differences in methods, intent, ascertainment, the cultural acceptability of suicide, psychopathology (including substance abuse, mood disorder, externalizing behaviours and propensity to violence), and psychosocial differences between males and females. While it is often suggested that gender differences in youth suicidal behaviour may be explained solely or predominantly by method choice, careful examination suggests that the issues are much more complex. In fact, females may enjoy more protection from suicide than males in a number of areas. See Commentary, page 8.     

Finally, it became too much - experiences and reflections in the aftermath of attempted suicide

Scand J Caring Sci; 2012; 26; 304–312 Finally, it became too much – experiences and reflections in the aftermath of attempted suicide The purpose of the study was to explore the experiences of persons after suicidal crises or recently completed suicide attempts. The research question was ‘What thoughts do suicidal patients have about the crises they have experienced?’ Hermeneutic approach, inspired by Gadamer, has characterized the process of collection, analysis and interpretation of data. Data were collected using qualitative research interviews. Ten participants, six men, 25–52 years old, and four women, 21–45 years old, were informed and requested by specialists in psychology at emergency or subemergency psychiatric wards or by crisis resolution teams. Nine of the participants had experienced one or more suicide attempts. One person had been prevented in the attempt, by hospitalization in an emergency ward. This type of research requires sensitivity in the interview situation, where ethical responsibilities take precedence over research interests. Results obtained through a thematic analysis of six phases revealed five themes to be central: (i) Losing touch with the world, (ii) Relationship between the suicidal accident and life history, (iii) Struggling for death and life (iv) An open door as consolation and (v) Feeling shame and guilt. Being suicidal seems like a struggle in solitude, between longing to escape from suffering through death and longing for love, safety and dignity in life. Suicidal accidents happen when suffering becomes intolerable. Suicide rarely occurs without a struggle and consideration of moral conflicts. The thought of suicide can provide consolation and comfort to go on living. Shame seems to appear when a person cannot cope with her/his own life, and because of failed attempts, while guilt seems related to hurting other people.     

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.     

Never the twain? Reconciling national suicide prevention strategies with the practice,educational, and policy needs of mental health nurses (Part two)

Suicide remains as a distinct global public health problem and the reduction of rates continues to be a major concern of the governments of many countries. This two-part paper focuses on national suicide prevention strategies; it highlights common policy directions that appear to speak directly to the practice and/or educational needs of mental health (MH) nurses and juxtaposes these against the realities of their practice and educational needs. Part one focused on two of these policy directions, whereas part two concentrates on the following policy directions: (iii) initiatives to reduce access to lethal means; (iv) improve surveillance systems; and (v) training for caregivers to improve delivery of effective treatments. The paper argues that while being mindful of the physical environment and its associated access to means, the national suicide prevention policy literature should consider reflecting that this should be an adjunct to the more central aspects of MH nursing care of people who are suicidal. Further, it is argued that the suicide policy literature should consider replacing 'improving surveillance systems' with 'improving the ability and capacity of MH nurses to engage with people who are suicidal'. Lastly, the paper asserts that the suicide policy literature might consider refining the policy direction on additional training to indicate the need for additional post-graduate (post-basic) education and training in care of the person with suicidal tendencies, which includes dialectical behavioural therapy; the work emanating from the University of Toronto; and the skills, attitudes, and knowledge perhaps captured with the terms, engagement, co-presencing, and inspiring hope.     

Research endeavours into suicide: a need to shift the emphasis

According to the World Health Organization (WHO, 2002), approximately one million people died as a result of suicide in the year 2000. Perhaps more worrisome, evidence provided by the WHO (2002) indicates that the global rate of suicide has continued to rise since 1950. Consequently, suicide should be regarded as a global problem and one that is increasing in magnitude. Drawing predominantly on policy and empirical literature emanating from Canada and the UK, this article will show that, despite a substantial research effort and the production of an associated literature, suicide rates continue to rise in the example countries. Even given the existence of numerous positivistically oriented studies, and the introduction of a range of strategies to help prevent suicide, significant reductions in suicide rates have not been achieved. Similarly, while there exists a substantial literature on the issue of suicide, there are many gaps in our knowledge and our understanding of the experiences, and the meanings attributed to these experiences that motivate people to attempt suicide is far from complete. Accordingly, the author argues that there is an urgent need to better understand the particular life experiences and the meanings that individuals attach to suicidal experiences. In order to design interventions to help reduce the suicide rate, whether these are interventions at the pre-primary, primary or secondary level of care, it is argued that it is necessary to gain a more detailed and comprehensive understanding of this highly complex behaviour. Consequently, this article makes the case for the use of hermeneutic, phenomenological investigations, in order to further elucidate the lived experiences of people who have attempted suicide.     

Suicide ideation among Southern U.S. Sexual minority college students

Abstract

Sexual minority individuals are at higher risk for suicide ideation compared with heterosexual individuals. We tested whether the interpersonal-psychological theory of suicide explains increased suicide ideation among sexual minority college students living in the southeastern region of the United States. The cross-sectional study assessed correlates of suicide ideation in a convenience sample (n?=?82) of sexual minority college students. Perceived burdensomeness and thwarted belongingness correlated with suicide ideation. However, only perceived burdensomeness correlated with suicide ideation while controlling for depressive symptoms. Pending replication, perceived burdensomeness may be a target for suicide prevention and intervention among sexual minority college students.