A modified grounded theory study of how psychiatric nurses work with suicidal people
Section snippets
What is already known about the topic?
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Psychiatric/mental health (P/MH) nurses have a major role to play in the care of the suicidal person.
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The current ‘care’ emphasis for this client group can be described as ‘defensive’, ‘observation led’ and short term.
What this paper adds
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The key psychosocial processes involved in moving the suicidal person from a ‘death orientated’ position to a ‘life orientated’ position can be encapsulated by the core variable, ‘re-connecting the person with humanity’.
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People in suicidality need a different form of care than is currently being practiced in most mental health units and within the community.
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The participants in this study were clear in indicating that they do not want to be treated mechanically, as epitomised by being ‘under’
The study of suicide: a brief historical overview
Even a cursory examination of the extant literature will show that a substantial associated body of work exists. The focused study of factors associated with suicide has been well documented during the last 60 years. Not surprisingly, this has resulted in a body of knowledge that is far from unified and unequivocal; containing, as it does, many unresolved controversies (Silverman, 1997). Encouragingly, two issues that appear to have a very high degree of consensus within the scientific academy
Research method and design: modified Grounded Theory
The research team decided that a modified Grounded Theory method would be the most appropriate method for this study. This method was chosen as the most appropriate for the study as a result of the following reasons.
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It is well documented that a qualitative method is usually used when little is known about a phenomenon (Morse and Field, 1995).
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Qualitative methods are particularly useful when describing a phenomenon from the ‘emic’ perspective (i.e. from the native's or participant's point of
Data analysis
It is important to note, that given the process of the constant comparison method within modified Grounded Theory, the stages of data collection and data analysis do not occur in a linear sequence, they are cyclic in nature. However, for the purposes of reporting the research, the process of analysis is described in stages. The first stage involved transcribing each interview. Following this, Glaser and Strauss’ (1967) process of open coding was applied. This entails examining the text line by
Findings
Since the core variable has been described in detail elsewhere (Cutcliffe and Stevenson, in press) this paper contains a brief summary of the core variable and then focuses on the sub-core variables: ‘reflecting an image of humanity’ (stage one), ‘guiding the individual back to humanity’ (stage two), and ‘learning to live’ (stage three).
Stage one: relecting an image of humanity
This sub core variable explains how the first stage of meaningful, transformative care for the suicidal person is actualized through a combination of two key processes, and these are captured in the conceptually robust categories—‘experiencing intense, warm, care-based human to human contact’ and ‘implicitly challenging suicidal constructs as a result of encountering contrary experiences’.
Stage two: guiding the individual back to humanity
This sub core variable explains how the second stage of meaningful, transformative care for the suicidal person is actualized through a combination of three key processes, and these are captured in the conceptually robust categories—‘Nurturing insight and understanding’, ‘Supporting and strengthening pre-suicidal beliefs’, and ‘Encountering a novel interpersonal, helping relationship.’ Furthermore, it is important to note that while the first stage had a distinct sense of stillness rather than
Stage three: ‘learning to live’
This sub-core variable explains how the third stage of meaningful, transformative care for the suicidal person is actualized through a combination of two key processes, and these are captured in the conceptually robust categories—‘accommodating an existential crisis, past, present and future’ and ‘going on in the context set by the existential relationship with suicide.’
Discussion
Given that nursing is a practice-based or practice-orientated discipline, a hallmark of high-quality nursing research then would be implications for practice that arise from the study findings (Cutcliffe and Ward, 2003). Accordingly, we have identified seven distinct practice implications and these are summarized in Cutcliffe et al. (2003). However, as a result of word/space limits, we have decided to focus on the first of these namely, any nurses who wish to work with suicidal people will need
Conclusions
The findings of the study indicate that the key psychosocial processes involved in moving the suicidal person from a ‘death orientated’ position to a ‘life orientated’ position can be encapsulated by the core variable, ‘re-connecting the person with humanity’. This re-connection is brought about through a three-stage process comprised of the sub-core variables: Reflecting an image of humanity; guiding the individual back to humanity; and learning to live. The findings further indicate that
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