Suicide Problem in the United States: Statement of the Phenomenon of Interest - Essay Example

? ANALYSIS OF QUALITATIVE RESEARCH ARTICLE ment of phenomenon of interest Suicide is the ninth leading cause of death in the United States with many people seeking professional help from healthcare providers prior to committing suicide. These people present with several complaints which may help in assessing the indices of suicidal risk. In order to prevent suicide health professionals should have the ability to accurately assess a patient. However, their attitudes towards suicide, intuitive understanding and insight of suicide, clinical knowledge and skills acquired over time, and the context will largely influence the assessment process. Inappropriate assessment of patients by nurses may result in high incidences of suicide. Both qualitative and quantitative assessment methods are available for use and the method used may be depend on the setting. Purpose The purpose of the research was to understand how nurses conceptualize suicide among patients in addition to the strategies they use in the process of assessment. Due to the emerging trends in suicide assessment inappropriate assessment might fail to pick potential suicide patients. Research design and research tradition The traditional phenomenography which analyses the different ways in which people experience, conceptualize, identify, and familiarize themselves with various aspects of phenomena in the world around them was used in this study. This method is frequently used in health care research and was utilized in an inductive, qualitative and descriptive approach to help understand the conceptualizations of suicide by psychiatric nurses and the strategies that psychiatric nurses utilize when conducting a suicide evaluation. Sampling A convenience/snowball sampling method was utilized in the study to recruit six psychiatric-mental health nurse participants for the ten months study period. The participants were obtained from two advanced practice nurses agencies in different psychiatric settings and different Northeastern states with the help of nurse managers. One of the settings chosen was a psychiatric hospital's emergency assessment unit while the other was an inpatient psychiatric unit of a general hospital. Five of the six participating nurses were females with four of them having more than 15 years experience while the fifth had nine months experience as a psychiatric mental health nurse and more than five years experience as a mental health worker. The sixth participant was a male nurse with more than 15 years experience. All the participants were white with one having a master’s degree in nursing, three with bachelor’s degree and two with associate degrees in nursing. Data collection The research methods used for data collection were approved by the University of Rhode Island’s Institutional Review Board. Before data collection began consent was sought from both the participating nurses and the patients. The inclusion criteria for the patients included more than 18 years of age, ability to understand and speak English in addition to giving informed consent. The patients were also informed that their participation or non participation in the research would not affect the care they received from the institution. The data in this study was mainly obtained through interviews with the psychiatric nurses after suicide assessment of adult patients. The assessment sessions varied from between 15 minutes to one and a half hours among different patients. The interviews with the psychiatric nurses were recorded in a private room and were guided by a few questions. The nurses were however allowed to express their perceptions, in a clear and systematic manner, of how they conceptualize suicide and the strategies they use in the suicide assessment process. In a bid to obtain as much information and as possible the participating nurses were encouraged to think out aloud, deliberate, and even to pause before answering the questions if they need to. All the participating nurses were subjected to the same interviews after every assessment session. Data analysis The researcher familiarized himself with the contents of each audio recorded interview conversations from each participant by listening to the audio conversation and reading the transcripts several times. This led to selection of the most significant statements given by the participant nurses representative of the entire interview report. These were then written down using the seven steps of phenomenographic research. The transcripts were then continually reviewed for clarity and fidelity in their entirety by two nurses with expertise in phenomenography to ensure their credibility. The preliminary data obtained was appropriately adjusted to avoid overlapping and grouped into ten categories after consultation with the phenomenographic experts. Sources of variations or agreements were identified by comparing several pieces of interviews. This was done by making a list of the ten categories and those who used or did not use each of the categories in the assessment of the patients. Additionally, these categories were further evaluated considering their similarities and qualitative differences and thus clustered in three dimensions. Findings The study indicated differences and similarities in the suicide assessment of the psychiatric nurses. Inpatient psychiatric patients spent less time with their nurses since the nurses knew their history which probably accounted for the differences in suicide assessment. Each participant used a combination of four to six of the ten strategies identified during their assessments. However, no participant used the suicide assessment guidelines or suicide assessment instruments. A number of findings were notes and included the following: 1. Conceptualizations of Suicide Assessment The results obtained indicated that all the participants related suicide to feelings of despair, frustration and suffering thus the thought that the patient will end his or her life to avoid the intolerable pain they are feeling. The widespread view of the participants linked suicide to depression, persistent suffering and psychological hopelessness and none of the participants thought of suicide as an impulse. However, suicide can also occur in the absence of depression such as in patients with schizophrenia, bipolar and borderline personalities disorders. 2. The Knowledge Dimension The amount of knowledge held by a psychiatric nurse on the factors contributing to suicide risk determines the efficiency and scope of the assessment. i. Risk factors Depression was a key risk factor identified by all the participants. Other risk factors identified included substance abuse, age, gender, ethnicity, family history, and psychosis. However, not all the participants reviewed each of the additional risks they mentioned probably due to insufficient knowledge or processing of information. For instance, even though schizophrenia, bipolar and borderline personality disorders are known causes of suicide none of the participants assessed for these causes. Other variable risk factors such as fear and nervousness were not specifically identified. Additionally, the intensity and precision of the inquiry differed among the participants with some using confusing psychiatric terms leading to unreliable assessment. None of the participants inquired about the availability of firearms which could be used for completing suicide. This important component of suicide assessment was neglected despite its importance since half suicides are completed by use of guns. ii. Associated States All the participants were aware of the psychological states which predispose people to suicide such as people with poor insight, judgment and being hasty in decision making. These judgments were made based on the patients responses. However, not all the suicide associated risks were assessed exhaustively by the participants. iii. Resources The existence and accessibility of support resources such as responsible family, other social support groups and outpatient providers were identified by all six participants as important components of suicide assessment. Those without good resources were viewed as more likely to commit suicide since they relieve stress from the patient. iv. Plan/Feasibility All participants in the study evaluated their patients’ suicide plan and possibility of committing suicide. Despite its relevance the manner in which the patients would kill themselves was however not inquired directly by the psychiatric nurses but inferred from the conversation and whether they had access to the plan. v. Prior Experience/Exemplars Two out of the six participants had past experiences from suicide victims. This was helpful to these participants since they incorporated and compared the experiences of their patients to these cases. The experiences from cases in text books also formed part of the assessment to compare similarity of the cases. 3. The Method Dimension The participants tried to obtain additional information on the history and current psychological status of the patient in their assessment. This information was obtained from the patients themselves on their verbal or non verbal behavior or the thoughts of other people who are familiar with the patient. This was achieved through listening and information from people close to the patient. i. Listening All the participants demonstrated the importance of listening attentively as the patients narrated their past and/or present problems. More experienced nurses were more at ease and skillful in their ability to listen. ii. Significant Others Two out of the six participants who were most experienced in the field sought opinion about their client’s mental status from significant others such as friends or family members. This information can help give additional insight into the level of the patient's risk for suicide. 4. The Reference Dimension This refers to the process of making judgments. Related stories, intuition, and collaboration with other professionals were also utilized by the nurses during assessment to formulate ideas about clients' situations. By comparing the current situation of their patients and similar cases and their intuition or decisions of other professionals they can make their judgments. i. Related Stories and Other Suicide Cases Stories from other suicide cases obtained from personal experiences or otherwise formed an important basis of suicide patient assessment by all the participants. Allowing the client to tell their stories could provide important clues to the overall risk level of suicide. ii. Intuition Only two out of the six participants interviewed used their intuition during their assessment. These nurses were more experienced in the field in addition to holding a Bachelor’s and master’s degree in nursing. Additionally, both nurses had worked as acute psychiatric evaluators in a psychiatric hospital. iii. Collaboration with Other Professionals Of the four participants who consulted other professionals in the field to validate their assessment, three of them had worked in an acute psychiatric evaluation service for many years. However, one participant with the least experience exclusively in a general hospital’s inpatient service consulted due to her inability to solely trust her judgment to perform and depend on her comprehensive mental status assessments. The exclusive reliance of the participant on the change of the client’s mental status compared to the assessment done earlier in the day could however be lethal. Conclusions Phenomenography is mainly used for identifying the similarities and differences of complex phenomena such as nurses’ conceptualization of suicide. The data obtained is reliable due to the enhanced analysis by two nurse researchers. Despite the small number of participants in the study, these results can provide useful information concerning suicide assessment settings in different settings. Additionally the findings of this study underscore the importance of the use of several strategies so as to achieve a comprehensive assessment of the patients. This study demonstrated the significant variations in suicide assessment occurring in the actual practice. Due to the limited sample size, these results cannot be generalized but it shows that some variations may be detrimental. Thus it is important that nurses have a thorough understanding of the potential risk factors in addition to standard assessment theories. Recommendations i. Comprehensive suicide assessment related education needs to be incorporated in undergraduate nursing education ii. There is need to evaluate the knowledge of nursing staff engaged in suicide assessment to identify the gaps in order to provide them with refresher courses that reflect the current best practices iii. There is need to perform the same study involving a larger sample size in different settings which is more representative so as to shed more light on the complex suicide assessment. Writer's summary and assessment From the writer’s point of view the findings of this research will contribute significantly to the understanding of knowledge on suicide assessment. This will definitely advance suicide assessment skills among nurses in all settings. References Aflague, J. M. & Ferszt, G. G. (2010). Suicide Assessment by Psychiatric Nurses: A Phenomenographic Study. Issues in Mental Health Nursing, 31: 248-256. Read More