Elsevier

Journal of Professional Nursing

Volume 30, Issue 5, September–October 2014, Pages 426-435
Journal of Professional Nursing

Original Article
An Interpretive Study of Nursing Students' Experiences of Caring for Suicidal Persons

https://doi.org/10.1016/j.profnurs.2014.03.003Get rights and content

Suicide is a worldwide public health problem. Although preparing nursing students to care for suicidal persons has been a standard part of nursing education for many years, nurses consistently report that they lack competencies in caring for this population of patients. The purpose of this phenomenological and hermeneutical study was to understand the experiences undergraduate nursing students had in regard to caring for suicidal persons. The aim of the study was to obtain insights into the basic preparation of students in the care of suicidal persons to inform pedagogical approaches pertaining to suicide and improve the nursing care for these individuals. Twelve senior nursing students were recruited for the study. Data were collected using in-depth, unstructured interviews. The study themes indicated that (a) when participants read about suicidal persons' mental status and behavior in patient, records they initially feared interacting with and caring for these individuals; (b) participants' abilities to gather information about suicide risk was influenced by how much patients talked with them about their suicidal tendencies; and (c) participants' capacity to provide safe and therapeutic suicide prevention interventions was impacted by judicious critical thinking skills. Teaching strategies that align with the themes are provided.

Section snippets

Literature Review

The research on teaching undergraduate nursing students about suicide is sparse. The few studies that do exist describe students' knowledge and attitudes about suicide and their skills in providing suicidal care. To determine knowledge and attitudes about suicide, Kawanishi et al. (2006) administered a questionnaire to groups of nursing students, psychiatric nurses, and social workers. They compared the findings between these groups with a group of medical students who had previously completed

Research Design

The investigators used phenomenology (Heidegger, 1927/1962) and hermeneutics as the research design (Gadamer, 1960/1989). Phenomenology permitted an “unfolding, explicating, and laying out” of students' experiences (Caputo, 1987, p. 53) of caring for suicidal persons. Consistent with Heideggerian phenomenology, the researchers assumed that students' experiences would include expressions about what concerned them most (Heidegger, 1927/1962, p.83). Hermeneutics provided an approach through which

Sample

Following institutional review board approval, the investigators recruited 12 senior, baccalaureate nursing students to participate in the study. The students recruited were in a class of 24 students who had completed a 7-week long psychiatric/mental health nursing course as part of their nursing curriculum at a private midwestern university. At the time of the study, the school of nursing within the university enrolled 88 nursing students each academic year. The students completed the clinical

Data Collection

Data were collected using unstructured, audio-taped interviews. All of the interviews were face-to-face and were conducted in a private location at a mutually agreed upon time. The investigators began each interview with the following open-ended question: “You have just completed your psychiatric/mental health nursing course. During the clinical rotation you learned how to assess a patient for suicidal ideation. Can you tell me about a particular time when you were assessing a patient for

Data Analysis

The investigators analyzed the data using Benner, 1985, Benner, 1994) and Diekelmann and Ironside's (1998) approaches to phenomenological and hermeneutical data analysis. They began the data analysis by reading each transcript numerous times. This repeated reading of the transcripts permitted a comprehensive understanding of the data (Benner, 1994). They then coded the data by excerpting exemplars, which were strong instances of participants' experiences of caring for suicidal persons (Benner,

Rigor

The investigators maintained rigor by adhering to Madison's (1988) principles for evaluating interpretive research. Madison developed these principles from Gadamer's philosophical works. He contended that the principles are similar to ethical norms whereby the investigator(s) uses them to maintain “good judgment” when interpreting texts (p. 30). The principles included appropriateness, coherence, comprehensiveness, agreement, suggestiveness, and potential. They ensured appropriateness by

Findings

Three themes emerged from the data analysis. Each theme presents a distinct but important understanding of participants' experiences of caring for suicidal persons.

Discussion

Findings of this study indicate that, when participants read documentation about suicidal persons' mental status and behavior, they experienced initial fears about interacting with them. These fears disrupted their perceived ability to provide nursing care for suicidal persons. These findings closely align with a plethora of literature indicating that nursing students commonly fear those with mental health problems and that these fears can impede their ability to care for these individuals (

Educational Implications

The study themes provide understandings about nursing students' care of suicidal persons. Educational implications that align with these themes are summarized in Table 1. In regard to patient documentation, nurse educators need to remind students that documentation facilitates communication about a suicidal person's status, needs, and progress. Nonetheless, they need to acknowledge and discuss with students the fear they can experience when reading records of suicidal persons and how this fear

Limitations and Future Research

A limitation of this study was that it was a single site, qualitative study with a homogenous sample. The study design limited the investigator's abilities to quantify how students' completion of the mental health course influenced their care of suicidal persons. In addition, the open-ended interview limited asking specific questions about how other sources of students' experiences (e.g., students' personal experiences of suicide within their own family, their perceptions of suicide, etc.) may

Conclusion

Nurses interact with suicidal persons on a regular basis in various health care settings. Their reports about lacking competencies in caring for suicidal persons raise serious concerns that highlight the imperative need to address the preparation of nursing students in caring for this population of patients. This study provides a step toward understanding pedagogies that can improve how nursing students learn to care for suicidal persons across health care settings in ways that contribute to

Acknowledgments

The authors wish to thank Viterbo University for funding this study. They also wish to thank Elizabeth Harrison and Jennifer Hedrick-Erickson for their thoughtful review of this article.

References (65)

  • P. Benner

    The roles of embodiment, emotion and lifeworld for rationality and agency in nursing practice

    Nursing Philosophy

    (2000)
  • J.M. Bertolote et al.

    A global perspective on the magnitude of suicide mortality

  • C.V. Billings

    Psychiatric inpatient suicide: Focus on intervention

    Journal of the American Psychiatric Nurses Association

    (2004)
  • L. Binding et al.

    Human understanding in dialogue: Gadamer’s recovery of the genuine

    Nursing Philosophy

    (2008)
  • B.K. Buxton

    Interaction, unscripted

    Journal of Psychosocial Nursing and Mental Health Services

    (2011)
  • J.D. Caputo

    Radical hermeneutics: Repetition, deconstruction, and the hermeneutic project

    (1987)
  • P. Carlén et al.

    Suicidal patients as experienced by psychiatric nurses in inpatient care

    International Journal of Mental Health Nursing

    (2007)
  • Centers for Disease Control and Prevention

    Suicide facts at a glance

  • J.A. Crook

    How do expert mental health nurses make on-the-spot clinical decisions? A review of the literature

    Journal of Psychiatric and Mental Health Nursing

    (2001)
  • J.R. Cutcliff et al.

    Considering the care of the suicidal client and the case for ‘engagement and inspiring hope’ or ‘observations’

    Journal of Psychiatric and Mental Health Nursing

    (2002)
  • V. Dickerson-Swift et al.

    Doing sensitive research: What challenges to qualitative researchers face?

    Qualitative Research

    (2007)
  • J. Diekelmann

    The retrieval of method: The method of retrieval

  • N. Diekelmann et al.

    Hermeneutics

  • C. Ewashen et al.

    Pedagogy, power and practice ethics: Clinical teaching in psychiatric mental health settings

    Nursing Inquiry

    (2007)
  • M. Feldman et al.

    Let’s not talk about it: Suicide inquiry in primary care

    Annals of Family Medicine

    (2009)
  • J.E. Fisher

    Fear and learning in mental health settings

    International Journal of Mental Health Nursing

    (2002)
  • A. Fontanna et al.

    The interview: From neutral stance to political involvement

  • Gadamer HG. (1989). Truth and method (J. Weinsheimer & D.G. Marshall, Trans.). New York, NY: Continuum. (Original work...
  • B. Hamilton et al.

    ‘She’s manipulative and he’s right off’: A critical analysis of psychiatric nurses’ oral and written language in the acute inpatient setting

    International Journal of Mental Health Nursing

    (2006)
  • B. Happell et al.

    Developing more positive attitudes towards mental health nursing in undergraduate nursing students: Part 1—does more theory help?

    Journal of Psychiatric and Mental Health Nursing

    (2008)
  • P. Hazell et al.

    A survey of suicide prevention curricula taught in Australian universities

    Australian and New Zealand Journal of Psychiatry

    (1999)
  • Heidegger, M. (1962). Being and time (J.M.E. Robinson, Trans.). New York, NY: HarperCollins. (Original work published...
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