Background
Review question
Methods
Inclusion and exclusion criteria
Search strategy and study selection
Synthesis of results
Example of extracted data | Meaning units | Descriptive theme | Analytical theme |
---|---|---|---|
Lack of acknowledgment from observers; these perceptions sometimes overlapped with perceptions of a lack of empathy. Such behaviors included observers’ reading books, appearing distracted or uninterested in the participant, and acting like the participant was a burden [40]. | 61. Lack of observer support manifests as lack of empathy and acknowledgement | Receiving support from the observers | Protection |
Feelings of objectifications in formal observation without interpersonal engagement…It’s a scary thing going somewhere where you feel like you’re isolated and locked away. (Claire)…Being watched like that; it’s freaky…a bit invasive…that separation, that ‘us and them’. It’s a bit tricky. (Kate) [26]. | 62. Feeling objectified and detached without observer support | ||
“They don’t care. You get that feeling quite often. It just kind of supports that hopeless kind of feeling that life isn’t worth living and nobody cares about anything.” Such encounters did little to alleviate hopelessness, and six participants noted that they increased their anxiety or aggravated their dysphoria [40]. | 63. Feeling objectified increases stress and hopelessness |
Results
Study selection
Author/year/origin | Aim | Sample | Setting | Data collection methods and analysis | Key points related to in-patient care |
---|---|---|---|---|---|
Vatne & Nåden, 2016 [38]. Norway | To develop a deeper understanding of suicidal patients in the aftermath of suicide attempts | Ten patients considered with serious suicidality after a suicide attempt. Non-psychotic. Interviewed after suicide attempt. | Two emergency psychiatric wards and one crisis resolution team. | Semi-structured interviews. Analysed using thematic analysis inspired by Braun and Clarke. Gadamerian hermeneutic approach. | • Connectedness, someone who cares • Hospital admission important for staying alive • Support from family and friends |
Lees, Procter and Fassett, 2014 [26]. Australia | To explore the experiences and needs of mental health-care consumers who had a suicidal crisis (shortened). | Nine patients recovered from a recent suicidal crisis where they received mental health in-patient care. | Setting not specified. Experiences of psychiatric in-patient care are described. | In-depth, semi-structured interviews collected as part of a larger multi-method study. Analysed with a constant comparative method and classical content analysis. | • Therapeutic engagement central to quality of care • Isolation, loss of control, objectification |
Montross Thomas et al., 2014 [28]. USA | To better understand suicide experiences from the perspective of patients diagnosed with serious mental illness. | 23 patients hospitalized after a suicide attempt. Diagnosed with serious mental illness. Interviewed after discharge. | Veterans Affairs Hospital, mental health program. | Qualitative interviews with audio/videotaping. Analysed using van Manen’s phenomenological framework. | • Need for clinicians’ empathy, compassion and listening skills • Addressing problems underlying suicide attempt |
Vatne & Nåden, 2014 [32]. Norway | To explore the experiences of being suicidal and encounters with health care personnel. | Ten patients considered seriously suicidal. Psychosis excluded. Interviewed after suicide attempt. | Psychiatric emergency ward, sub-emergency psychiatric wards and one crisis resolution team. | Semi-structured interviews. Analysed using thematic analysis inspired by Braun and Clarke. Gadamerian hermeneutic approach. | • Openness and trust • Someone who addresses the matter • Being met on equal terms, humiliated |
Cutcliffe et al., 2012a [41]. Unknown origin. | To better understand the observed increased risk for suicide following discharge from an in-patient psychiatric service. Key theme one. | 20 patients admitted to the hospital with suicidal ideation and/or a lifetime history of suicidal behaviour. Interviewed after discharge. | In-patient psychiatric service. | Hermeneutic interviews. Analysed using van Manen’s phenomenology. | • Anxiety to go back to life without having a sense of control • Need to be involved in discharge planning |
Cutcliffe et al., 2012b [42]. Unknown origin. | To better understand the observed increased risk for suicide following discharge from an in-patient psychiatric service. Key theme two. | 20 patients admitted to the hospital with suicidal ideation and/or a lifetime history of suicidal behaviour. Interviewed after discharge. | In-patient psychiatric service. | Hermeneutic interviews. Analysed using van Manen’s phenomenology. | • Patients still suicidal at discharge • Disorientation concerning what to do with their life • Need for post-discharge support |
Pavulans et al. 2012 [27]. Sweden | To explore the experience of being suicidal, including a suicide attempt, and identify possible implications for health care professionals. | Ten patients interviewed after a suicide attempt while hospitalized in a psychiatric ward. | Psychiatric in-patient care at one university hospital. | Semi-structured interviews. Analysed using van Manen’s phenomenology and qualitative content analysis. | • Being in need of control • Re-establish control before the point of no return • Control related to problem-solving and insight |
Vatne & Nåden, 2012 [29]. Norway | To explore experiences of persons after a suicide crisis or a recent suicide attempt. | Ten patients considered seriously suicidal. Psychosis excluded. Interviewed after suicide attempt. | Psychiatric emergency ward, sub-emergency psychiatric wards and one crisis resolution team. | Qualitative interviews. Analysed using thematic analysis. Gadamerian hermeneutic approach. | • Losing touch with the world • Someone to see, listen and understand • Desperation increases with involuntary hospitalization |
Holm & Severinsson, 2011 [31]. Norway | To explore how recovery processes facilitate changes in suicidal behaviour in women with borderline personality disorder. | 13 patients with suicidal behaviour. Borderline personality disorder. | Recruited from different settings within mental health. Experiences of psychiatric in-patient care were described. | In-depth interviews. Data analysed with thematic analysis. | • Changing suicidal behavior by feeling confirmed, safe, and trusted.
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Cutcliffe et al, 2006 [36]. England | To determine if psychiatric/mental health nurses provide meaningful caring responses to suicidal people, and if so, how was it achieved. | 20 patients with experiences from a serious suicide attempt. | Crisis care in emergency psychiatric services. | Semi-structured interview. Data analysed with constant comparative method. Glaserian grounded theory approach. | • Reconnecting the person with humanity • Guiding the individual back to humanity, learning to live |
Sun, et al 2006b [25]. Taiwan | Presentation of a nursing care theory developed to guide the care given to people with suicidal ideas and those with a previous suicide attempt. | 15 patients with either suicidal ideas or attempted suicide. Interviewed while hospitalized. | Psychiatric hospital ward. | Semi-structured interviews and participant observation. A grounded theory approach. | • Safe and compassionate care giving via the therapeutic relationship |
Sun et al, 2006a [24]. Taiwan | To investigate nurses’ and patients’ perceptions of psychiatric wards (the context of care) and the professionals’ response (the intervening conditions) that may impact the delivery of suicidal nursing care. | 15 patients with either suicidal ideas or attempted suicide. Interviewed while hospitalized. | Psychiatric hospital ward. | Semi-structured interviews and participant observation. A grounded theory approach. | • Protective environment • Access to lethal items • Group support, spiritual support |
Talseth, Gilje & Nordberg, 2003 [30]. Norway | To describe a process of consolation revealed by two suicidal patients’ experiences. | Two patients. Interviewed after a suicide attempt (from the Talseth et al., 1999 [34] study). | Psychiatric hospital ward. | Qualitative interviews. Phenomenological hermeneutic study inspired by Ricoeur’s philosophy. | • Vulnerability and deep despair • Closeness • Connection • The dialogue with HCPs |
Wiklander, Samuelsson, & Åsberg, 2003 [33]. Sweden | To extract and analyse the interview data concerning experiences of shame. | 13 patients with experiences from attempted suicide. Interviewed after discharge. | Specialized psychiatric in-patient care. | Qualitative semi-structured interviews. Transcripts analysed using qualitative methods (not specified). | • Sensitive to attitudes and behaviours of HCPs • Shame reactions related to aspects of care |
Talseth, Jacobsson & Nordberg, 2001 [39]. Norway | To illuminate the experience of being treated by physicians. | 21 patients expressing the wish to die or attempted to commit suicide. Interviewed while hospitalized. | Psychiatric emergency wards, psychiatric sub-emergency wards and one psycho-geriatric ward. | Qualitative interviews interpreted using a phenomenological hermeneutic approach inspired by Ricoeur’s philosophy. | • Need for confirmation in interactions with physicians |
Samuelsson et al., 2000 [35]. Sweden | To describe the attempted suicide patients’ perceptions of receiving specialized in-patient psychiatric care. | 18 patients. Interviewed after a suicide attempt near the time of discharge. | Specialized psychiatric in-patient care. | Qualitative interviews. Analysed for qualitative content using methods inspired by Burnard. | • Perception of care and caregivers, a sense of security • Confirmation and lack of confirmation • Commitment and respect |
Cardell & Pitula, 1999 [40]. USA | To explore patients’ experience of constant observation to determine whether they derived any therapeutic benefits beyond the intended protective benefit. | 20 patients placed under constant observation for suicidality. | Psychiatric hospital ward and a general medical centre with a psychiatric in-patient unit. | Extensive in-depth interviews. Analysis of themes consistent with Hutchinson’s recommended management of grounded theory data. | • Constant observation not merely a protective intervention, but with therapeutic potential. • Need for engaged and supportive observers |
Fletcher, 1999 [43]. UK | To explore the perceptions of staff regarding the constant observation of a suicidal patient in mental health settings. | 24 patients at risk for suicide, constantly observed for at least 48 h. | Acute psychiatric hospital. | Ethnographic study with participant observation and semi-structured interviews. Data transcribed onto cards and subjected to content analysis. | • Patients’ negative feelings of being under constant observation related to staff actions |
McLaughlin, 1999 [37]. UK | To explore psychiatric nurses’ and patients’ opinions regarding the care offered to suicidal patients and how the care for suicidal patients could be improved. | 17 patients admitted for depression, suicidal ideation or overt suicidal behaviour. | Three psychiatric hospital wards. | Observation and semi-structured interview. Data analysed using content analysis by Field and Morse. | • The need to address difficulties • Help with problem-solving |
Talseth et al., 1999 [34]. Norway | To illuminate the meaning of suicidal psychiatric in-patients’ experiences of being cared for by mental health nurses. | 21 patients admitted with suicidal ideations or after a suicide attempt. | Psychiatric emergency wards, psychiatric sub-emergency wards and one psycho-geriatric ward. | Qualitative narrative interviews. A phenomenological–hermeneutic method inspired by Ricoeur used in the data analysis. | • Being confirmed • Lack of confirmation |
Study characteristics
Themes representing patients’ experiences regarding safety
Analytical theme | Descriptive theme |
---|---|
Connection | Meeting someone who cares Receiving a confirmation of feelings Being acknowledged as a human being |
Protection | Being protected from death Receiving support from the observers |
Control | Gaining insight Coping with difficulties and symptoms Attaining discharge readiness |
Connection
Meeting someone who cares
Receiving a confirmation of feelings
Being acknowledged as a human being
Protection
Being protected from death
Receiving support from observers
Control
Gaining insight
Coping with difficulties and symptoms
Attaining discharge readiness
Discussion
Limitations
Implications for research and practice
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Patient experiences should be considered an integral part of suicidal patients’ safety to guide clinical practice and the design of patient safety measures.
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Suicidal patients’ need for connection with health care personnel indicate that the relational component of patient safety is considered the most vital aspect of care and should thus be integrated into measures such as constant observation, suicide risk assessments, clinical supervision, ward therapeutic environments and encounters with health care personnel groups.
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Suicidal patients’ need for protection highlights the importance of constant observation in suicidal crises and the need for skilled professionals in close proximity to patients.
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Suicidal patients’ need for control emphasizes the need for therapeutic interventions that increases the patient’s insight and problem-solving skills as well as shared decision making regarding treatment plans, crisis plans, support systems and post-discharge follow-up activities.