The lived experience of psychiatric-mental health nurses who work with suicidal adolescents in inpatient psychiatric settings
Greene, Pamela Eckstein
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At least five to six thousand adolescents commit suicide annually in the U.S.; another 500,000 are known to attempt suicide. Many suicidal adolescents are hospitalized in inpatient psychiatric treatment settings. Nurses are directly responsible for assessing the level of suicidality and intervening to prevent suicide 24/7. The purpose of this phenomenological study was to gain understanding of the experiences of psychiatric-mental health (PMH) nurses who work with suicidal adolescents in inpatient psychiatric treatment settings. Data collected during face-to-face interviews with twelve PMH nurses were analyzed and interpreted using synthesis of Colaizzi’s (1978) steps and van Manen’s (1990) research activities. Trustworthiness and authenticity criteria were documented and used to ensure methodological rigor. Seven themes, each with subthemes, emerged from the data; Self, Safety, Therapeutic Relationships, Why Stay, Professional Development for PMH Nurses, Interdisciplinary Team, and Patient Factors. While participants experienced profound discouragement working with suicidal adolescents, they continued to work with them because of the ability to make a difference in an adolescent’s life. Participants experienced the self as being an integration of components used deliberately in the development of the therapeutic relationship and in maintaining safety. Safety was viewed as a multi-faceted endeavor and participants were keenly aware of their responsibilities for maintaining safety. Participants struggled to develop a repertoire of effective interventions. Participants identified inadequate preparation for working with suicidal adolescents; but from those initial experiences, strategies to mentor new nurses emerged. Participants found suicidal adolescents to be more complex than numbers on screening tools implied and presented insights into the dynamics faced by the adolescents that influenced nursing interventions. Recommendations for nursing practice focused on assessment and interventions. Additional recommendations targeted reform of nursing education and orientation programs PMH nurses were called upon to use their collective voice to influence changes in public policies that impact resource allocations for better suicide prevention programs and improved mental health care.