Abstract
Suicidal individuals often communicate their intention to commit suicide, but not necessarily verbally. Psychiatric nurses play a central role in the care of patients exhibiting suicidal behaviour or thoughts. Thus, the aim of this study was to explore nurses’ experiences of the indirect messages about forthcoming suicide from patients’ everyday life before they committed suicide. A qualitative design was used with a phenomenological hermeneutical approach. Seven nurses working in specialist psychiatric care were interviewed about their experience of the phenomenon communication about suicide. Results show how the nurses noticed changes in patients just before they committed suicide. These changes included rapid improvement, disguise of real feelings, and unreceptiveness to further treatment or encouragements. The nurses also described patients becoming aware of painful life conditions of losing hope and confidence in the future and experiencing feelings of powerlessness or an inability to influence the situation. Their last moments were characterised by a greater preoccupation with thoughts about death and finding ways to express farewells. This manifested itself in practical preparations and expressing gratitude to people, which was understood by the nurses as a way of saying goodbye. This study shows that it is possible for skilled staff to develop an understanding of a suicidal patient’s internal state and to recognise the non-verbal messages of someone who later committed suicide. The knowledge of how patients prepare and act before suicide could be used to complement a structural suicide risk assessment.
Highlights
Suicide is significantly associated with psychiatric illness, with unipolar or bipolar depression, schizophrenia, anxiety disorder, personality disorders, and alcohol or drug misuse (Pennel, Quesada, Begue, & Dematteis, 2015; Runeson, Haglund, Lichtenstein, & Tidemalm, 2016; Tidemalm, Langstrom, Lichtenstein, & Runeson, 2008)
This study shows that it is possible for skilled staff to develop an understanding of a suicidal patient’s internal state and to recognise the non-verbal messages of someone who later committed suicide
About 20% - 40% of all suicides occur during treatment or ongoing contact with inpatient or outpatient psychiatric care (Hawton, Houston, & Shepperd, 1999; Hoyer, Licht, & Mortensen, 2009; Hunt et al, 2010; Kapur et al, 2013; Lönnqvist, 2009), so ongoing treatment seems not enough to prevent someone from committing suicide
Summary
Suicide is significantly associated with psychiatric illness, with unipolar or bipolar depression, schizophrenia, anxiety disorder, personality disorders, and alcohol or drug misuse (Pennel, Quesada, Begue, & Dematteis, 2015; Runeson, Haglund, Lichtenstein, & Tidemalm, 2016; Tidemalm, Langstrom, Lichtenstein, & Runeson, 2008). The process is influenced by risk factors such as psychiatric illness, repeated suicide attempts, crises and personality characteristics, and by protective factors such as interpersonal relationships, and good problem solving characteristics/coping strategies (Wasserman, 2001; Wasserman, 2016a). It is important that nurses and other care staff are able to recognise signs of intent to commit suicide, whether verbal or otherwise, and to determine how far along the suicidal process a patient has come (Wasserman, 2016b) Another challenge is to ensure that a patient’s thoughts or explanation of their reasons for not wanting to live are documented; such documentations are often missing from clinical records (Sundvall et al, 2018). This underlines the importance of good communication between care staff and the patients’ of kin, such that suicidal communication can be better identified (Sellin, Asp, Wallsten, & Wiklund Gustin, 2016)
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