Nursing “Best Practices” for Patients at Risk for Suicide: Adolescent Perceptions of Helpful Care. Catherine P. Gros, N, MSc (A ) - PowerPoint PPT Presentation
Nursing “Best Practices” for Patients at Risk for Suicide: Adolescent Perceptions of Helpful Care Catherine P. Gros, Catherine P. Gros, N, MSc (A N, MSc (A ) ) Assistant Professor, McGill University School of Nursing Assistant Professor, McGill University School of Nursing Nurse Clinical Specialist, Nurse Clinical Specialist, Douglas Mental Health Institute Douglas Mental Health Institute Tamsin Mulvogue, MSc(A); Sacha Jarvis, MSc(A); Tamsin Mulvogue, MSc(A); Sacha Jarvis, MSc(A); Johanne Renaud, MD Johanne Renaud, MD 3 rd Nursing Research & Evidence-Based Practice Symposium: The Power of TEAM Inquiry University of Vermont & FAHC University of Vermont & FAHC
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Nursing “Best Practices” for Patients at Risk for Suicide: Adolescent Perceptions of Helpful Care
Catherine P. Gros, Catherine P. Gros, N, MSc (AN, MSc (A) ) Assistant Professor, McGill University School of Nursing Assistant Professor, McGill University School of Nursing
Nurse Clinical Specialist, Douglas Mental Health InstituteNurse Clinical Specialist, Douglas Mental Health Institute
3rd Nursing Research & Evidence-Based Practice Symposium:
The Power of TEAM Inquiry
University of Vermont & FAHC University of Vermont & FAHC November 12, 2011November 12, 2011
The Power of TEAM Inquiry:
What’s wrong with this picture?
In Collaborative Nursing Practice, Patients & families are
•ESSENTIAL team members
•ACTIVE PARTICIPANTS in assessment, planning & evaluation of care
Patient & Family-Centered Care:
means the person & family are at the center of care!
Therefore,
Nursing “Best Practices” are ultimately determined
by patients & families…
What are the perceptions of adolescents regarding “helpful” Nursing care during suicide risk?
The Power of TEAM Inquiry: Who Decides?
Suicide is a complex phenomenon:
Influenced by an open system of biophysical-social-environmental interactions
Related 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 Québec & a significant health concern worldwide
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:
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
In the Literature:
The vast majority of healthcare research related to
suicide focuses on interventions delivered by
professionals other than nurses
•Evaluating risks•Searching for & removing dangerous objects•Implementing 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
Research on Nursing Intervention during Suicide Risk…
Working in partnership to manage illness & suicide risk
Creating a health-promoting
hospital environment
Results: Based on Interviews with Suicidal Teens: Helpful Nursing Interventions occur across 3 Domains of
Care
IDENTIFY & ACCOMMODATE INDIVIDUAL PREFERENCES: “Notice [what’s] unique to me... If there’s something special I want, like chocolate milk, make sure [it’s] there for me.”INITIATE CONVERSATION: “Talk to me.” “It really helps when someone tries to start a conversation”…“Ask about my life & take an interest in what we do. Asking everyday questions like: ‘How’s your day going?’ helps us feel safe.”
SMILE! “Be kind & friendly”. “If someone’s smiling, you’re smiling; it can spread.” GET UP-CLOSE & PERSONAL: “Be intimate.”
“[Don’t] talk in the doorway…Come in & sit down on my bed.”
LISTEN WTHOUT IMPOSING CONSEQUENCES: “If I speak of suicidal ideas, be present & listen. Don’t panic & take away my privileges. We just need to talk when we’re 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 is”
EARN TRUST: “[having a nurse you can trust] helps you get better, because …it’s really hard to find people you trust when you’re in that situation” [suicidal]
LEARN TO TRUST: “Believe in us. We’re the best judge. No one knows better than me if I’m going to kill myself.”
IDENTIFY & WORK WITH STRENGTHS: “Focus on the positive”… “like notice the parents care”…“that will help so much, cuz… if you’re going to therapy, you’re saying your problems. It’s negative, negative…” “[pointing out the things you’re good at] makes you want to live. It really does. It makes you think that you’re not completely worthless.”
OFFER PERSPECITVE: “Give a different point of view… ’cuz when you’re in that mindset, your vision is very tunneled, so to open [the patient’s] mind really could make a difference”
BRIDGE HOSPITAL & HOME LIFE: “Do normal activities” “… more like you’re having like your real life” “Make us feel like we’re 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 wasn’t 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’.”
Summary of Findings:
In the hospital setting: Strongly Agree
When I’m 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 I’m feeling better & I’m no longer considered suicidal.
100%
Reported health outcomes resulting from nursing care: Strongly Agree
The 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 I’m 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%
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 practiced• Their 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 & support
Future research includes: To develop, validate & test the HNQ
Conclusions & Implications
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3. McLaughlin, C. (1999). An exploration of psychiatric nurses and patients’ opinions regarding in-patient care for suicidal patients. Issues and innovations in nursing practice, 29(5), 1042-1051.
4. Yonge, O. (2002). Psychiatric patients’ perceptions of constant care. Journal of Psychosocial Nursing & Mental Health Services, 40(6), 22-29.
5. Stewart, D., Bilgin, H. & Bowers, L. (2010). Special observation in psychiatric hospitals: A literature review. Report from the Conflict and Containment Reduction Research Programme, London: Institute of Psychiatry at the
Maudsley. November, 2010.6. Jones, J., Ward, M., Welman, N., Hall, J., & Lowe, T. (2000). Psychiatric inpatients’ experience of nursing observation. U.K perspective. Journal of Psychosocial Nursing & Mental Health Services, 38(12), 10-20. 7. Cardell, R., & Pitula, C. R. (1999). Suicidal inpatients’ perceptions of therapeutic and nontherapeutic aspects of
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