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Nursing Best Practices for Patients at Risk for Suicide:
Adolescent Perceptions of Helpful Care
Catherine P. Gros, N, MSc (A) Assistant Professor, McGill
University School of Nursing Nurse Clinical Specialist, Douglas
Mental Health InstituteTamsin Mulvogue, MSc(A); Sacha Jarvis,
MSc(A); Johanne Renaud, MD3rd Nursing Research & Evidence-Based
Practice Symposium: The Power of TEAM InquiryUniversity of Vermont
& FAHC November 12, 2011
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The Power of TEAM Inquiry:Whats wrong with this picture?
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In Collaborative Nursing Practice, Patients & families are
ESSENTIAL team membersACTIVE PARTICIPANTS in assessment, planning
& evaluation of carePatient & Family-Centered Care:means
the person & family are at the center of care!
Therefore,Nursing Best Practices are ultimately determined by
patients & familiesWhat are the perceptions of adolescents
regarding helpful Nursing care during suicide risk? The Power of
TEAM Inquiry: Who Decides?
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Suicide is a complex phenomenon: Influenced by an open system of
biophysical-social-environmental interactionsRelated to personal
life experiences, gene expression & human bio-pscho-social
development
Suicide in Context:
Suicide is a principal cause of death in the adolescent
population in Qubec & a significant health concern
worldwide
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Human studies: traumatic relational life experiences (child
abuse) alters gene expression, leading to changes in the brain
& increased susceptibility to anxiety, depression and suicide
(McGowan et al, 2009)
Animal Studies:Rat pups experiencing caring maternal
interactions showed healthy brain development & were
significantly calmer than high stress rats from low care
mothers.
Conclusion: caring interactions affect gene expression &
determine hypothalamic-pituitary-adrenal (HPA) functioning,
affecting healthy brain development and behaviour (McGowan, et al,
2009).
Epigenetic Research Findings:
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Helping Suicidal Patients: The Nurses Role
During suicide risk: Nurse-patient contact is intense
Intervention is: close to continuous 24/7
High dose nursing care = High impact on patient outcomes
Frontline nurses spend more time intervening with hospitalized
patients than any other professional group; admission to
discharge
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In the Literature:
The vast majority of healthcare research related to suicide
focuses on interventions delivered by professionals other than
nurses
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Evaluating risksSearching for & removing dangerous
objectsImplementing close or constant surveillance
Regarding Nursing Interventions & Suicide Risk Existing
research is:Qualitative Rare (few in number)Narrow in scope Current
studies focus on: Prescribed treatments & control
measures1-5
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Research on Nursing Intervention during Suicide Risk Target
outcomes focus mainly on: Patient safety Physical protection
Preventing self-harm1-5
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In Conclusion
Little attention has been paid to the interventions nurses
implement in their daily interactions with suicidal in-patients
Relational nursing interventions offered throughout the course
of hospitalization are poorly described
Little is known about the impact of nursing care on patient
health outcomes
The patients perspective of helpful Nursing interventions during
suicide risk requires further study...
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What are the perceptions of adolescents at risk for suicide
regarding helpful nursing care during hospitalization?
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% (n=6)Age16171866.616.616.6SexMenWomen16.683.3Ethnicity
CaucasienOther100.00LanguageFrenchEnglishBilingual16.650.033.3DiagnosisDepressionAnorexia/Bulimia
& DpressionBorderline Personnality33.316.650.0Length of
Hospital Stay1 7 days1 4 weeks> 1 month50.033.316.6Suicide
RiskCurrentPrevious33.366.6
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Developing a unique & caring human relationship
Working in partnership to manage illness & suicide
riskCreating a health-promoting hospital environmentResults: Based
on Interviews with Suicidal Teens: Helpful Nursing Interventions
occur across 3 Domains of Care
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IDENTIFY & ACCOMMODATE INDIVIDUAL PREFERENCES: Notice
[whats] unique to me... If theres something special I want, like
chocolate milk, make sure [its] there for me.INITIATE CONVERSATION:
Talk to me. It really helps when someone tries to start a
conversationAsk about my life & take an interest in what we do.
Asking everyday questions like: Hows your day going? helps us feel
safe. SMILE! Be kind & friendly. If someones smiling, youre
smiling; it can spread. GET UP-CLOSE & PERSONAL: Be intimate.
[Dont] talk in the doorwayCome in & sit down on my bed.
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LISTEN WTHOUT IMPOSING CONSEQUENCES: If I speak of suicidal
ideas, be present & listen. Dont panic & take away my
privileges. We just need to talk when were feeling bad.UNDERSTAND
THE PAIN: probably the most important thing, [is ]actually
understanding, not just on a scientific level, but on an emotional
level, how deep the despair isEARN TRUST: [having a nurse you can
trust] helps you get better, because its really hard to find people
you trust when youre in that situation [suicidal]LEARN TO TRUST:
Believe in us. Were the best judge. No one knows better than me if
Im going to kill myself.
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IDENTIFY & WORK WITH STRENGTHS: Focus on the positive like
notice the parents carethat will help so much, cuz if youre going
to therapy, youre saying your problems. Its negative, negative
[pointing out the things youre good at] makes you want to live. It
really does. It makes you think that youre not completely
worthless.
OFFER PERSPECITVE: Give a different point of view cuz when youre
in that mindset, your vision is very tunneled, so to open [the
patients] mind really could make a difference
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BRIDGE HOSPITAL & HOME LIFE: Do normal activities more like
youre having like your real life Make us feel like were not so
detached from our normal world ACCOMPANY PATIENTS OUTDOORS! Just
being able to feel the sun, being outside really helped me because
you got that feeling of liberation It felt like I wasnt in
prison.
BE WELCOMING TO PATIENTS & FAMILIES:The nurses would try to
build this cooperative family atmosphere. Like: Oh, right this way.
Come on in.
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Summary of Findings:
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In the hospital setting:Strongly Agree When Im on constant
observation, it helps when the nurse lets me spend some time alone,
if I say I need it. 100%It helps when my nurse keeps in touch and
continues to take an interest in me; especially when Im feeling
better & Im no longer considered suicidal.100%
Reported health outcomes resulting from nursing care:Strongly
AgreeThe nursing care I receive in the hospital can decrease my
risk of suicide by helping me feel more hopeful & positive
regarding myself, my family &/or my situation. 100%The nursing
care I receive when Im in the hospital has an impact on my ability
to cope at home, at school & with my family following
discharge. 100%Feedback on the Questionnaire:
Completing a questionnaire like this during my hospital stay can
help the nurse better understand me and my needs. 100%
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Nursing interventions make a significant difference to the
health & recovery of hospitalized teens at risk for
suicideRelational nursing interventions are low cost &
relatively easy to apply. However:They are neither routinely nor
deliberately practicedTheir therapeutic value may be
underestimated
Study Findings:Illustrate the importance of collaborative,
strengths-based nursing practice with suicidal in-patients-Call for
a critical review of current policies/procedures
Provide evidence for staff education & development-Knowledge
translation requires staff coaching & supportFuture research
includes: To develop, validate & test the HNQ Conclusions &
Implications
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****Ferand, Renaud, Changnon (2004)Murray & Wright
(2006)Bowley & Bratley (2005)Paulson & Everall (2003)Walsh
& Minor-Shork (1997)Langlois & Morrison (2002)De Munck,
Portzky & Van Heerington (2009)Sorter (2010)Allen & Warner
(2002)Gottlieb, Feeley, Dalton (2005)Gros & Young (2007)Thorne,
Kirkham & MacDonald-Emes (1997)
*Ferand, Renaud, Changnon (2004)Murray & Wright (2006)Bowley
& Bratley (2005)Paulson & Everall (2003)Walsh &
Minor-Shork (1997)Langlois & Morrison (2002)De Munck, Portzky
& Van Heerington (2009)Sorter (2010)Allen & Warner
(2002)Gottlieb, Feeley, Dalton (2005)Gros & Young (2007)Thorne,
Kirkham & MacDonald-Emes (1997)
*Ferand, Renaud, Changnon (2004)Murray & Wright (2006)Bowley
& Bratley (2005)Paulson & Everall (2003)Walsh &
Minor-Shork (1997)Langlois & Morrison (2002)De Munck, Portzky
& Van Heerington (2009)Sorter (2010)Allen & Warner
(2002)Gottlieb, Feeley, Dalton (2005)Gros & Young (2007)Thorne,
Kirkham & MacDonald-Emes (1997)
**Ferand, Renaud, Changnon (2004)Murray & Wright
(2006)Bowley & Bratley (2005)Paulson & Everall (2003)Walsh
& Minor-Shork (1997)Langlois & Morrison (2002)De Munck,
Portzky & Van Heerington (2009)Sorter (2010)Allen & Warner
(2002)Gottlieb, Feeley, Dalton (2005)Gros & Young (2007)Thorne,
Kirkham & MacDonald-Emes (1997)
*Ferand, Renaud, Changnon (2004)Murray & Wright (2006)Bowley
& Bratley (2005)Paulson & Everall (2003)Walsh &
Minor-Shork (1997)Langlois & Morrison (2002)De Munck, Portzky
& Van Heerington (2009)Sorter (2010)Allen & Warner
(2002)Gottlieb, Feeley, Dalton (2005)Gros & Young (2007)Thorne,
Kirkham & MacDonald-Emes (1997)
*Ferand, Renaud, Changnon (2004)Murray & Wright (2006)Bowley
& Bratley (2005)Paulson & Everall (2003)Walsh &
Minor-Shork (1997)Langlois & Morrison (2002)De Munck, Portzky
& Van Heerington (2009)Sorter (2010)Allen & Warner
(2002)Gottlieb, Feeley, Dalton (2005)Gros & Young (2007)Thorne,
Kirkham & MacDonald-Emes (1997)
*Cette recherche, dirige par une approche collaborative centre
sur le patient, mne des entrevues ainsi quun questionnaire
exploratoire auprs des adolescents a risque suicidaire pour mieux
comprendre quelles sont, selon eux, les meilleures actions,
attitudes et approches offertes par les infirmires dans le milieu
hospitalier*****
**