Professional Documents
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Received 19 March 2005; received in revised form 30 July 2005; accepted 10 September 2005
Abstract
Background: People with mental health problems continue to present a disproportionately high risk of suicide.
Despite the relevance of suicide to psychiatric/mental health (P/MH) nurses, there is a documented paucity of research
in this substantive area undertaken by or referring specically to P/MH nurses; there is currently no extant theory to
guide P/MH nursing care of the suicidal person.
Objectives: Accordingly, this paper reports on a study undertaken to determine if P/MH nurses provide meaningful
caring response to suicidal people, and if so how.
Design: The study used a modied grounded theory method and was conducted in keeping with the Glaserian tenets
of Grounded Theory.
Settings: The study was conducted in two geographical locations within the United Kingdom, one in the North and
the other in the Midlands; both locations contained large urban centres.
Participants: A total of 20 participants were selected across the locations by means of theoretical sampling. All the
participants were over 18 years old, had made a serious attempt on their lives or felt they were on the cusp of so doing
and had received crisis care from the emergency psychiatric services.
Methods: The study adhered to the principle features of Glaserian grounded theory namely(a) theory generation,
not theory verication; (b) theoretical sampling, (c) the constant comparative method of data analysis; and (d)
theoretical sensitivity (searching for/discovering the core variable, one which identied the key pychosocial process and
contains temporal dimensions stages). Further, the authors ensured that the study was concerned with generating
conceptual theory, not conceptual description.
Findings/Conclusion: The ndings indicate that this key psychosocial problem is addressed through the core variable,
re-connecting the person with humanity. This parsimonious theory describes and explains a three-stage healing
process consisting of the sub-core variables: reecting an image of humanity, guiding the individual back to humanity
and learning to live.
r 2005 Published by Elsevier Ltd.
Keywords: Psychiatric/mental health nurses; Suicide; Re-connecting with humanity; Grounded theory
Corresponding author. Visiting Professor of Nursing, University of Tennessee (Knoxville), College of Nursing, 1200 Volunteer
Blvd. Knoxville, TN 379964180, USA.
E-mail addresses: dr.johnr@shaw.ca, jcutcliffe@gwmail.utk.edu (J.R. Cutcliffe).
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Psychiatric/mental
1. Introduction
Suicide remains as one of the most imposing
contemporary public-health issues facing many nations
of the world (Health Canada/Canadian Institutes of
Health Research (CIHR), 2003; World Health Organization, 2002). According to the WHO (2002), since 1950,
the global rate of suicide has continued to rise
exponentially. Neither Canada nor the UK is spared
from the devastating impact of (relatively) high rates of
suicide and the effects are both multi-dimensional and
widespread. Suicide is expensive, not only in terms of the
human cost in the form of suffering (Shneidman, 2004),
but also economically (Institute of Medicine, 2002,
2003), socially (CASP, 2004; Maris, 1997) and spiritually
(Jobes et al., 2000). Some recent success has been
documented in reducing suicide rates in the UK (DofH,
2005). This report indicates a downward trend in the
completed suicide rate per 100,000 of the population;
from 9.2 in 1995 to 8.6 in 2002/2003. However, the
number of completed suicides indicates that there is no
case for complacency. Additionally, the international
epidemiological data depict a very different representation. For example, the alarmingly signicant rates in the
former Eastern block countries notwithstanding, according to the rst national Canadian Blueprint for
Suicide Prevention Strategy (CASP, 2004) not only does
Canada have a higher suicide rate than many indus-
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It
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4. Data analysis
It is important to note, that given the process of the
constant comparison method within modied Grounded
Theory, the stages of data collection and data analysis
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5. Findings
Since the core variable has been described in detail
elsewhere (Cutcliffe and Stevenson, in press) this paper
contains a brief summary of the core variable and then
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individual
live
back to humanity
Categories
Categories
Nurturing insight
care-based human to
and understanding.
human contact.
Categories
Accommodating an
existential crisis, past,
present and future.
Implicitly challenging
suicidal constructs as a
result of encountering
Supporting and
strengthening
pre-suicidal beliefs.
contrary experiences.
Encountering a novel
interpersonal,
helping relationship.
Fig. 1. Re-connecting the person with humanity.
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9. Discussion
Given that nursing is a practice-based or practiceorientated discipline, a hallmark of high-quality nursing
research then would be implications for practice that
arise from the study ndings (Cutcliffe and Ward, 2003).
Accordingly, we have identied seven distinct practice
implications and these are summarized in Cutcliffe et al.
(2003). However, as a result of word/space limits, we
have decided to focus on the rst of these namely, any
nurses who wish to work with suicidal people will need
to be comfortable with co-presencing, be able to hold
back from being too instrumental and need to be
comfortable with death; talking about suicide. Normative approaches to discussions of research results require
the researchers to compare the ndings with existing
empirical work; most often to indicate supporting
evidence. However, we have adopted a Popperian
(1963) approach in the sense that we attempt to refute
our ndings through comparison with the extant
empirical literature. Popper (1963) asserts that if
researchers cannot disprove their theory then this adds
substantially to its credibility and authenticity. However, it should be noted that the authors are hindered in
this endeavor since the width and depth of the extant
literature is hardly extensive.
Sun et al. (2005) describe a simplistic process of care
for suicidal Taiwanese psychiatric in-patients. They
outline a four-stage model: holistic assessment, provides
protection, provides basic and advanced care. While
they do not appear to explain how, for example,
restraining or secluding suicidal people helps address
suicidal ideation or suicidality per se; their emerging
theory emphasizes a more custodial driven approach to
caring for suicidal people than that described in the
present study. Interestingly, Sun et al. (2005, p. 281)
conclude,
The emergent ndings yindicated that psychiatric
nurses should have the skills and qualities required to
provide advanced care for suicidal patients, the
compassionate art of nursing was generated as the
overarching principley
Talseth et al.s insightful (1997, 1999) work does not
refute the ndings in the current study. Talseth et al.
(1997, 1999) report the following processes and experi-
801
10. Conclusions
The ndings of the study indicate that the key
psychosocial processes involved in moving the suicidal
person from a death orientated position to a life
orientated position can be encapsulated by the core
variable, re-connecting the person with humanity. This
re-connection is brought about through a three-stage
process comprised of the sub-core variables: Reecting
an image of humanity; guiding the individual back to
humanity; and learning to live. The ndings further
indicate that people in suicidality need a different form
of care than is currently being practiced in most mental
health units and within the community. The participants
in this study were clear in indicating that they do not
want to be treated mechanically, as epitomized by being
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