Suicide assessment by psychiatric mental health nurses: A phenomenographic study

Suicide is the eleventh leading cause of mortality in the United States. This study explored suicide assessment by psychiatric nurses. The primary aims of this study were to gain an understanding of nurses\u27 conceptions regarding suicide and suicide assessment, describe the strategies of suicide assessment adopted by psychiatric nurses, and contrast these to contemporary standards and practice guidelines of suicide assessment. The research design was an inductive descriptive phenomenographic study. The nurse participants consisted of a snowball sample of six psychiatric nurses practicing in two psychiatric settings. The data were collected through participant observations of nurses\u27 assessing patients and semi-structured in-depth interviews with nurses regarding their assessments of actual cases and vignettes. The participants in the study while performing suicide assessments relied on several different strategies among the common 10 categories that emerged as the core set of strategies. In most cases the nurses used between four to six different strategies in combination rather than relying solely on one specific strategy. However, the strategies used in suicide assessments by these nurses did not cover the areas identified in the standard guidelines in a comprehensive or all-inclusive manner, suggesting that the nurses were not systematic in their assessments. Out of the 10 categories, four have been linked to qualitative differences in suicide risk assessment. Namely, (1) reliance on exemplars, (2) reliance on intuition, (3) reliance on the assessments of other professionals, and (4) reliance on related stories. The characteristics of the 10 categories of description regarding suicide assessment could be classified into three dimensions: (a) the Knowledge Dimension, (b) the Method Dimension, and (c) the Reference Dimension. These Dimensions provide a “structure of suicide assessment” used in nursing practice by the participants of this study. The findings of this investigation are descriptive and were discovered in the nurses\u27 practice. The results do not address correct or incorrect ways of practicing. However, the findings provide knowledge about actual nursing practice. This descriptive work can serve as a foundation for the development of a theory of nursing assessment. The findings have implications for nursing knowledge development, practice, education, administration, and research