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Suicide-Related Behaviour: Understanding, Caring and Therapeutic Responses
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Waddell C. So much research evidence, so little dissemination and uptake: mixing the useful with the pleasing. Download references. We are also grateful to Isabelle Butcher for technical assistance with formatting of the tables. The first author YA conceived the idea for the study, YA and ESN recruited participants and conducted the interviews to collect the data. All authors contributed to iterations of drafting and approval of the manuscript.
Correspondence to Yvonne F Awenat. All participants provided written consent to participate. All other authors confirm that they have no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and Permissions. Search all BMC articles Search. Abstract Background Suicide is a global problem and suicidal behavior is common in acute psychiatric wards. Methods Thematic analysis of semi-structured individual qualitative interviews with twenty suicidal psychiatric inpatients to investigate their views and expectations about ward-based suicide-focused psychological treatment.
Results Two main themes were identified. Conclusions We conclude that hospitalization of suicidal individuals offers a critical opportunity to intervene with effective treatment to preserve life and that suicide-focussed psychological therapy is likely to be well received by suicidal inpatients warranting further testing with a sufficiently powered definitive trial. Open Peer Review reports.
Methods Design This qualitative study was nested within a mixed-method feasibility study involving a pilot clinical trial which was conducted from October to December across five acute adult psychiatric wards of a NHS mental health service in Northern England. Analysis Analysis was led by the first author assisted by the second, fifth and sixth authors who contributed to initial and iterations of coding with further contributions to critical discussions of analytic interpretations from the third, fourth and seventh authors thereby enhancing trustworthiness of the final themes [ 55 ].
Results Participants Twenty participants, comprising fourteen males, were recruited from five acute psychiatric wards in a NHS psychiatric hospital in Northern England, UK. Table 1 Participant Socio-demographic Information Full size table.
ustanovka-kondicionera-deshevo.ru/libraries/2019-11-29/1201.php Table 2 Themes and Sub-themes Full size table. Table 3 User-informed conceptual model of in-patient suicide-focused psychological therapy [ 52 ] Full size table. Barriers to suicide-focussed therapy Past negative experiences Some participants held negative views of psychological therapy based on past unsatisfactory experiences, for example, discussion of sensitive matters during therapy was perceived to have worsened their condition. Fears of increased suicidality Participants viewed relief of distress as the prime goal of therapy, yet some feared that suicide-focussed therapy might increase distress or even trigger suicidal ideation representing a potential barrier to accepting such treatment.
Strengths The contextual challenges of conducting research in psychiatric wards are extensive [ 72 ]. Limitations It is possible that individuals who volunteered to participate may have been more comfortable and interested in talking about suicide and we may not have recruited people who would be less likely to engage in a suicide-focused talking therapy. Recommendation for research and clinical practice We have demonstrated that the suicidal in-patient participants in this study would welcome ward-based suicide-focussed psychological therapy as an additional treatment choice as recommended in UK statutory guidelines [ 16 ].
Table 4 Recommendations for research and practice of suicide-focused psychological therapy Full size table. Conclusion Hospitalisation of suicidal individuals offers a critical opportunity to engage inpatients in effective treatment and preserve life. References 1. Google Scholar 5. Article Google Scholar 6. The essential feature of major depressive disorder is a period of two weeks during which there is either depressed mood most of the day nearly every day or loss of interest or pleasure in nearly all activities.
Other potential symptoms include:. The symptoms of major depressive disorder cause significant distress or impairment in social, occupational, or other areas of functioning. The possibility of suicidal behavior exists at all times during a major depressive episode. Although women with depression are more likely to attempt suicide, men are more likely to die by suicide. Different people experience different symptoms of depression, and symptoms for men can differ from symptoms for women.
A combination of medication and psychotherapy is effective for most people with depression. Changes in lifestyle can also help. In mild cases of depression, daily exercise improved eating habits, and a specific sleep routine can assist in alleviating some symptoms. Thus, there is a tendency to distrust others and the individual becomes more and more isolated, delaying the beginning of the treatment, which aggravates the clinical picture even more.
Often the first contact with the health services occurs sometimes after the appearance of the first symptoms. As the person does not perceive the symptoms of schizophrenia and cannot distinguish what is real from what is not, there is often a lack of insight into the pathology, making the therapy relationship a constant challenge. The purpose of this mini review is to address the challenges of the therapeutic relationship between the nurse and the person with schizophrenia.
The nursing assessment of the person with schizophrenia is a complex process in most cases, requiring the collection of data from several sources, since in the acute phase of the disease the person is rarely able to give reliable information. It is necessary to appeal to the family and significant people, as well as to clinical records when they exist. Initially a mental examination should be performed, identifying the present symptomatology, such as delusions, hallucinations, disorganization and negative symptomatology. In order for an adequate evaluation to be performed, the nurse must know the characteristic behaviours of this disorder.
As a nursing diagnosis in the presence of delusions, the Nursing Interventions Classification NIC defines Delusion Control , which is defined as the provision of a safe and therapeutic environment to the patient in acute state of confusion. It is important not to discuss or deny belief so as not to risk compromising trust. Reasonable doubt must therefore be used as a therapeutic technique.
The nurse should also be attentive during feeding and taking medication, since the delirium of poisoning may be present and the patient may believe that the food or medication is to poison him. Thus, it may be necessary to confirm whether the patient has taken the medication. In the presence of these signs, the nurse should avoid touching the patient without warning, as the touch may be understood as a threat. Nurses must display an attitude of acceptance to help the patient share the content of the hallucination.
This sharing is important to avoid unwanted reactions towards the self or others, if command hallucinations are present. Listening to music or watching television may be a good technique to distract the patient from the attention given to auditory hallucinations.
These interventions are intended to establish a relationship of empathy and trust with the patient, causing the patient to begin to be critical towards the disease so that new intervention strategies can be implemented. Furthermore, often the first contact with the health services is against their will, because of lack of insight. Caring for these patients requires that nurses have a great capacity for understanding and empathy and non-stigmatization of mental illness, so that an effective and efficient therapeutic relationship can be established.
The nurse must be able to see that beyond the symptoms, there is a person in terrible mental suffering, despair, hopelessness and incomprehension, and may even entertain suicidal thoughts. Nurses must be able to understand that these people live in a frightening unreal world and has difficulty distinguishing reality from delusions and hallucinations, because everything seems real to them.
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For all of these reasons, it takes a great deal of hard work for nurses to understand the person with schizophrenia who is suffering from a mental pathology and that it is essential to learn to live with symptoms and adhere to therapy to prevent relapse. Rogers reinforces this idea, pointing out that in a therapeutic relationship, one who assumes the role of helping the other must have a high level of self-knowledge, be genuine, authentic and capable of empathy.
The orientation phase is extremely complex in these patients and crucial to the beginning of the relationship. What is essential at this stage is to have the patient understand the difficulties they are facing and the need for cooperation. In the exploitation phase, the patient is expected to explore all the possibilities and services offered. In the resolution phase, individual patient requirements must be met for completion of the relationship. Therefore, establishing a therapeutic relationship is not easy, requiring special attention on the part of the nurse.
Authenticity is necessary, allowing the person to distinguish between what is part of the disease and what is not part of it, i. It is crucial to help the patient find their personal resources and identify achievable goals in the medium and long term and the means to achieve them.