A Review of Adults with Suicidal Ideation and their Perspective of Interactions with Nurses in Mental Health and Emergency Settings

This week we will be discussing a systematic review article published in June 2020 in the International Journal of Nursing Studies. In this article, titled “The perspectives of adults with suicidal ideation and behaviour regarding their interactions with nurses in mental health and emergency services: a systematic review”, authors Vandewalle and colleagues examine and discuss the perceptions and experiences of individuals with some degree of suicidality with regard to their interactions with nurses. 

Why did they do it?

Suicide is one of the leading causes of death for adults worldwide, and the healthcare system is set up in such a way that community and inpatient mental health facilities are frontline avenues for individuals experiencing suicidality to receive care. Within these healthcare facilities there are professionals across a multitude of disciplines, including (but certainly not limited to) social workers, therapists, psychiatrists, and nurses. Oftentimes nurses hold the responsibility of detecting suicidality and applying preventative and/or therapeutic interventions when necessary. 

Amidst this responsibility, the authors of this study highlight that the guidelines provided to nurses on how to most effectively evaluate suicidality often lack substantive content and critical information regarding how to best interact with individuals who may be in crisis. Additionally, the suicide prevention guidelines provided to nurses focus heavily on the actions expected from nurses, rather than educating nurses on how to better understand the perspective of the patient. Thus, the authors explain that the purpose of this review was to illuminate the perspectives of persons with suicidal ideation and behavior, and understand what elements they perceive most critical in their interactions with nurses. It could be hypothesized that a better understanding of the patient’s perspective in these situations can lead to more effective interactions between patients and nurses, and potentially more effective care.

How did they do it?

The authors followed the Preferred Reporting Items for Systematic Reviews (PRISMA) framework to carry out their systematic review, with their literature search including peer-reviewed articles published up until January 2020. Overall, 26 studies met full inclusion criteria for the review and all studies had a primary focus on individuals admitted to, or discharged from, inpatient or community mental health and emergency services. Twenty-two qualitative and four quantitative studies were identified, with all 26 included studies being published between 1992 and 2019. 

What did they find?

The authors synthesized their findings into three themes and seven sub-themes, which included a variety of positive and negative patient perceptions and experiences. The following themes were discussed in depth by the authors:

1. Being cared for and acknowledged as a unique individual: The authors described this theme as reflecting the value that individuals with suicidal ideation attach to the nurses who are caring for their needs and trying to understand what they are going through.
2. Giving voice to myself in at atmosphere of connectedness: This theme focused heavily on the patient’s ability to freely speak about suicide to the nurses taking care of them. Individuals experiencing suicidal ideation explained their need and appreciation for nurses who conveyed openness via relaxed body language and initiating conversations concerning suicide, and also expressed some barriers to discussing suicide that eliminated opportunities to speak about their experience (e.g. anticipated stigma and perceived judgement). 
3. Encountering a nurturing space to address my suicidality: The third theme identified by the authors focused on individuals’ experiences of nurses who helped them cope with and make sense of themselves and their suicidal ideation and behavior. In this context, patients expressed an appreciation for nurses who made efforts to reduce their suffering and distract them from their negative thoughts. Patients also expressed that they wanted more constructive assistance from nurses, such as more stimulating discussions and emotional support.

Our review of the author’s results is intentionally brief. If you would like to read about their results in more detail, we encourage you to read their study.

What does it all mean (our take)?

We always appreciate a strong review study, particularly when it comes to relatively under-studied domains. The authors of this review are hitting on an important issue, which is how to empower caretakers (who may not necessarily be mental health specialists) to better understand and thus care for their patients who are experiencing some form of suicidality. As the authors acknowledge, a critical component to ensuring patient comfort within these conversations is having a better understanding of the patient’s perspective when they are interacting with healthcare professionals.

This is an approach that would be ideal for all caretakers to employ when discussing sensitive topics with their patients. However, of course, it is not always that easy, and it requires ongoing research (such as the study here) to better elucidate the internal experiences of patients while they are engaged in these conversations/situations. We thank the authors for this great work, and we believe that this study provides a critical contribution to the clinical world. We suspect that the more we learn about the internal experiences of patients during their interactions with clinical professionals, it is likely that the more effective our evaluations and subsequent interventions will be.