A recently published article in the Archives of Psychiatric Nursing illustrates the importance of authentic, empathic, and compassionate interpersonal engagement between mental health nurses and service users in psychiatric in-patient settings for adults amid suicidal crises. Their results highlight that, in some cases, the relationship between the suicidal person and the nurse may even be life-saving for the suicidal person.
“Many patients encountered compassion and involvement for the first time during their suicidal crises. They found it remarkable that nurses did not immediately judge or condemn them but instead initiated contact, showed respect, and supported them in bearing their suffering. When considering this engagement as genuine, this enabled patients to take cautious steps toward building trust and developing hope for a life that is not consumed by their suicidal crises,” the authors write.
“They appeared to be worth investing in and accepted for who they are, instead of being a burden or ‘a nobody who attempted suicide.’ Building trust and connecting with nurses who acknowledged their suffering was meaningful and for some patients a reason not to attempt suicide.”
Mental health nurses have the opportunity to affect a lot of change within the mental health care system. This is partly because nurses often engage with patients at a higher frequency than other healthcare providers.
The Belgian authors of the article, Joeri Vandewalle, Caressa Van Hoe, Bart Debyser, Eddy Deproost, and Sofie Verhaeghe, identified a need for qualitative research within the field of mental health nursing, especially as it relates to suicidality. In particular, they found a need for research that seeks to understand how suicidal patients perceive their nurses in mental health wards. The patient-nurse relationship is especially important to Vandewalle and colleagues. They write:
“Nurses often provide most of the direct care and use interpersonal and communicative approaches to bring about positive changes in patients. Moreover, they have daily opportunities to talk about suicide, determine suicide risk, and sense and respond to patients’ emotions.”
Participants for the qualitative study were recruited from six wards in three mental hospitals found across Northern Belgium. Eleven participants were found through purposive sampling. Each participant was aged between 23-65, spoke Dutch, was admitted into a mental hospital, and had experienced a suicidal crisis in the past year. After selection, a mental health nurse conducted semi-structured interviews over six months.
After the interviews, following the framework of Grounded Theory, a qualitative methodology, the interviewer examined and wrote narrative reports of each interview, created memos, and then shared the interviews with two other authors who added their memos and discussed emerging themes within the transcriptions and recordings. Then, the authors utilized qualitative data software to aid in the coding process. After coding, the authors identified a core process in the dataset.
The core process, ‘Feeling nurtured through an interpersonal engagement,’ is supported by two additional categories: ‘feeling safe and cared for while struggling to trust’ and ‘working toward alleviation and change of suicidal ideation.”
The core process, “feeling nurtured through an interpersonal engagement’ with mental health nurses, is exemplified by the authors’ findings that suicidal patients are best supported by their nurses when they feel they can trust those who offer them care via helping and supporting them to regain stability and security.
This occurred primarily through the nurse demonstrating authentic interest and genuine compassion in the suicidal person, via holding space for the suicidal person to develop trust and comfort, or by opening a conversation about suicide that allowed the service user to reimagine and differently understand their relationship with their suicidality.
Nurses play an essential role in mental healthcare in in-patient care with suicidal individuals. However, the authors note that although nurses can be incredibly helpful and important, they also can, inversely, be very neglectful and harmful. The authors hope that the conceptual insights of their article can support nurses in engaging with patients as a part of their day-to-day practice.
Vandewalle, J., Van Hoe, C., Debyser, B., Deproost, E., & Verhaeghe, S. (2021). Engagement between adults in suicidal crises and nurses in mental health wards: a qualitative study of patients’ perspectives. Archives of psychiatric nursing, 35(5), 541-548. (Link)