Abstract
BackgroundIn-patient suicide prevention is a high priority in many countries, but its practice remains poorly understood. Patients in a suicidal crisis who receive psychiatric care can provide valuable insight into understanding and improving patient safety. The aim of this paper was therefore to summarize the qualitative literature regarding suicidal patients’ in-patient care experiences. The following question guided the review: How can we describe suicidal patients’ experiences regarding safety during psychiatric in-patient care?MethodsSystematic searches were conducted in the MEDLINE, Academic Search Premier, CINAHL, SOCINDEX and PsycINFO databases, identifying 20 qualitative studies on suicidal patients and their psychiatric in-patient care experiences. These studies were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, synthesized via thematic analysis and subjected to quality appraisals.ResultsPatients described safety as “feeling safe”, and three components, i.e., connection, protection and control, were vital to their experiences of safety. Fulfilling these needs was essential to patients recovering from suicidal crises, feeling safe during encounters with health care professionals and feeling safe from suicidal impulses. Unmet needs for connection, protection and control left patients feeling unsafe and increased their suicidal behaviour.ConclusionOur review addresses the importance of adopting a wider perspective of patient safety than considering safety solely in technical and physical terms. Safety for the suicidal patient is highly dependent on patients’ perceptions of their psychological safety and the fulfilment of their needs. The three patient-identified factors mentioned above – connection, protection and control – should be considered an integral part of patient safety practices and should form the basis of future efforts to understand the safety of suicidal patients during psychiatric in-patient care.
Highlights
In-patient suicide prevention is a high priority in many countries, but its practice remains poorly understood
Suicides rarely occur during in-patient care, these events are clinically important and are among the most concerning patient safety incidents in the mental health sector [2,3,4]
This paper posed the following review question: “How can we describe suicidal patients’ experiences regarding safety during psychiatric in-patient care?” Suicidal patients’ experiences with safety during psychiatric inpatient care were described in 20 studies that addressed whether their needs were met during their hospitalization
Summary
In-patient suicide prevention is a high priority in many countries, but its practice remains poorly understood. Patients in a suicidal crisis who receive psychiatric care can provide valuable insight into understanding and improving patient safety. The following question guided the review: How can we describe suicidal patients’ experiences regarding safety during psychiatric in-patient care?. Suicides rarely occur during in-patient care, these events are clinically important and are among the most concerning patient safety incidents in the mental health sector [2,3,4]. Suicide prevention is one of the primary tasks of health care professionals practicing in psychiatric wards [4]. To understand safety in health care services, information must be obtained from multiple sources, including the patient’s perspective. Patients can provide insight regarding care and can contribute important information when other sources of evidence are limited [9]. Patient experiences are considered one of the three pillars of health care quality, along with clinical safety and effectiveness of outcomes [13]
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