Suicide prevention training: self-perceived competence among primary healthcare professionals

Examination of medical student and physician attitudes towards suicide reveals need for required training

The attitudes of healthcare providers towards suicidal patients are known to influence their motivation to treat patients during a suicidal crisis. Patients who attempted suicide are more likely to have recently visited a primary care provider who is not necessarily sufficiently trained in managing a suicidal patient rather than a mental health provider who is trained to do so. For those reasons, documenting medical students and physicians' attitudes towards suicide can help in the development of effective intervention training to prepare them to manage these types of patients. In this mini review, attitudes towards suicidal patients, the effectiveness of training on changing their attitudes are discussed. In summary, primary care providers are recognized as a top area where improvements can prevent suicides; providing proper suicide prevention training can effectively improve attitudes and quality of care for suicidal patients.

Nurses' Attitudes and Perceptions Regarding Suicidal Patients: A Quasi-Experimental Study of Depression Management Training

Suicide prevention is a priority globally. Community nurses are on the frontline of healthcare, and thus well placed to identify those at risk of suicide and act to prevent it. However, they are often ill-equipped to do so. This study examines whether depression management training for nurses may also help them manage suicide-risk patients.

METHOD

This quasi-experimental study used a questionnaire that included a randomly assigned textual case vignette, measures related to patient descriptions portrayed in the vignette, and demographic and clinical/training information. The participants were 139 Israeli nurses who were mostly Jewish, Israeli-born, and married women working as community nurses. Almost half had completed depression management training (DMT) in their routine work.

RESULTS

Nurses who completed depression management training were more likely than non-trainees to query the patient regarding mental status and suicide plans and were more likely to refer them to appropriate further treatment. The graduate nurses also reported higher self-competence and more positive attitudes regarding their ability to assess depression and suicide risk than nurses who had not received depression management training.

DISCUSSION

The results highlight the importance of depression management training, as suicide assessment and referral are among the major steps to suicide prevention.

Non-Qualified Staff's Experience of Suicidal Behaviour in Adult Mental Health Inpatient Services

Suicide and attempted suicide of people receiving care in Adult Mental Health Inpatient Services (AMHIS) leads to significant emotions amongst mental health professionals, characterised by guilt and shame. A sense of responsibility occurs due to hospital being seen as a safe place. However, little is known about what it is like for 'non-qualified' staff. This study explored experiences of suicide and attempted suicide on 'non-qualified' staff in AMHIS. Semi-structured interviews explored ten staff's experiences. Participants were recruited online and transcripts were analysed using Reflexive Thematic Analysis. Four themes were identified; 'Direct personal impact', 'Unrealistic expectations', 'Attempting to contain the impact' and 'Acclimatisation'. Ten sub-themes outlined; responsibility for assessing risk, shame and protective strategies to aid acceptance. The results provide insight into the unique experience of non-qualified staff in AMHIS experiencing suicidal behaviour.

Radiographers' experiences and educational needs in relation to caring for suicidal patients during radiology examinations

INTRODUCTION

Researchers have explored the experiences, attitudes, and educational needs of several healthcare professional groups in relation to caring for suicidal patients. However, radiographers have not been included in these studies. Radiographers are likely to encounter these patients when they present for diagnostic imaging following suicide attempts.

METHODS

An online questionnaire exploring radiographers' experiences and educational needs in caring for suicidal patients was circulated to radiographers working in 23 acute hospitals across Ireland and posted to a Facebook page targeting Irish-based radiographers. Closed-ended questions were used to capture respondents' demographics and five-point Likert scale questions to establish their confidence levels in imaging suicidal patients. Open-ended questions were used to explore their experiences and educational needs. Quantitative data was analysed using descriptives statistics, and qualitative data thematically analysed.

RESULTS

One hundred and four radiographers responded to the questionnaire, 96% of whom had imaged suicidal patients. Radiographers were confident in justifying and optimising these radiographic examinations, however, less confident in communicating with and caring for these patients. Radiographers reported insufficient patient history on imaging referrals and challenges in communicating with suicidal patients, which many attributed to lack of training. Radiographers expressed interest in further education related to caring for patients who've attempted suicide, which they felt should include an introduction to psychiatry, strategies for communicating with suicidal patients and building resilience.

CONCLUSION

Radiographers' experiences of imaging suicidal patients have been reported along with several challenges which could be addressed through further education.

IMPLICATIONS FOR PRACTICE

Further education in caring for suicidal patients should be offered to radiographers which aligns with their educational needs. Referring clinicians should be reminded of the importance of informing radiographers of patients' suicide attempt when referring them for diagnostic imaging.

Interacting with patients at risk of self-harm or suicide - A qualitative study of community pharmacists and pharmacy staff

Background

Suicide and self-harm are significant public health concerns. Community pharmacies are accessible and frequented regularly by the public, making them well positioned to identify and intervene with those at risk. The aims of this research project are to evaluate pharmacy staff experiences of dealing with people at risk of suicide/self-harm, and explore how best to support staff during these interactions.

Methods

Semi-structured online and telephone interviews were conducted with a sample of community pharmacists and community pharmacy staff (CPS) in the south west of Ireland. Interviews were audio recorded and transcribed verbatim. The Braun and Clarke approach to inductive thematic analysis was used to analyse the data.

Results

Thirteen semi-structured qualitative interviews were conducted in November-December 2021. Most participants had encountered a person at risk of suicide/self-harm in their practice, however participants described a lack of training and guidelines around how to navigate these scenarios. Three major themes emerged: (i) Interacting with patients at risk of suicide/self-harm- facilitators and barriers; (ii) Referrals and signposting; (iii) Addressing uncertainty. Positive relationships between the person and pharmacy staff facilitated interactions, while privacy, time constraints and uncertainty among staff were seen as barriers. Participants felt it was necessary to refer at-risk people to other supports, and made suggestions for increasing staff confidence through the implementation of support tools within the pharmacy setting.

Conclusions

This study highlights that at present, community pharmacy staff feel uncertain regarding how to handle interactions with people at risk of suicide/self-harm, due to lack of training and supports. Future research should focus on building upon existing resources and obtaining specialist and stakeholder input to produce the most effective support tool(s), tailored to the pharmacy setting.

Development and evaluation of a blended learning training programme for pharmacy technicians' continuing education

OBJECTIVES

The role of the pharmacy technician (PT) has expanded in recent years, requiring new competencies, better communications skills and high-level knowledge about drugs. The objective of this study is to develop and evaluate a blended learning programme for PTs' continuing professional development.

METHODS

A blended learning programme designed to enhance knowledge, skills and attitudes was created using a six-step approach to curriculum development for medical education. The first part included three short microlearning videos to improve knowledge; the second consisted of a 1.5 hour 'edutainment' session for groups of 5-6 PTs to deepen their knowledge and practice skills. Impacts on knowledge, degree of certainty and self-perceived competence were evaluated before training (pre-test), after the microlearning (post-test 1) and after the edutainment session (post-test 2).

RESULTS

The three microlearnings were entitled 'Communication', 'Cut-crush a tablet/open a capsule' and 'Pharmacy website'. The edutainment session used team-based learning, game-based learning, peer instruction and simulation. Twenty-six PTs of mean±SD age 36±8 years participated. Pre-test and post-test 1 evaluation scores showed significant overall improvements in mean knowledge (9.1/18 vs 12.1/18, p<0.001), mean degree of certainty (3.4/5 vs 4.2/5, p<0.001) and mean self-perceived competence (58.6/100 vs 72.3/100, p<0.001). After post-test 2, mean knowledge (12.1/18 vs 13.1/18, p=0.010) and mean self-perceived competence (72.3/100 vs 81.1/100, p=0.001) scores had improved, but not mean degree of certainty (4.2/5 vs 4.4/5, p=0.105). All participants found the blended learning programme suitable for their continuing professional development.

CONCLUSIONS

The present study showed the positive effects of using our blended learning programme to improve PTs' knowledge, degree of certainty and self-perceived competence, to their great satisfaction. This pedagogical format will be integrated into PTs' continuing professional development and include other educational topics.

Two Halves of the Same Whole: A Framework to Integrate Autism and Mental Health Services

Given the higher rates of co-occurring mental health issues experienced by autistic people, there is a pressing need to implement an effective framework that integrates autism services with appropriate mental health services. This paper discusses the impact of mental illness on the person with autism and their families, and the current challenges they face when accessing mental health support. A framework for service providers is proposed to support the mental health needs and preferences of autistic people. The paper concludes by highlighting the importance of health professionals utilising mental health interventions appropriate for autistic people, including autism-specific suicide prevention and awareness programs.

Effective suicide prevention strategies in primary healthcare settings: a systematic review

Background

There is a fundamental need for health systems, health managers, and policymakers to identify effective components of suicide prevention strategies (SPS) and programs in primary healthcare (PHC) settings. Accordingly, this systematic review aimed to identify and summarize effective and significant evidence on suicide prevention in PHC setting. We systematically searched the published literature in English from PubMed, Web of Science, Scopus, CINAHL, PsychoINFO, and Embase up to 31 July 2022. The study searched all records reporting effective and significant strategies and programs on suicide prevention in PHC settings. A content analysis approach was carried out to extract major components of suicide prevention strategies in PHC settings.

Results

A total of 10 records (8 original articles and 2 reports) with 1,199,986 samples were included. In all the included articles, SPS decreased suicide rates. The majority of studies were conducted among the general population. The content analysis approach emerged five major components to SPS in PHC setting: (1) training and educating healthcare providers, (2) screening and suicide risk assessment, (3) managing depression symptoms and mental disorders, (4) managing suicide attempters and at-risk cases, and (5) prevention strategies at the general population.

Conclusions

This review provided reliable evidence for health systems to develop SPS in PHC and practitioners who are eager to provide brief and effective contact interventions for suicide risk to well-serve their patients.

Sodium Nitrite Intoxication and Death: Summarizing Evidence to Facilitate Diagnosis

BACKGROUND

Over the years, forensic pathology has registered the spread of new methods of suicide, such as the ingestion of sodium nitrite. Sodium nitrite causes increased methemoglobin, resulting in systemic hypoxia, metabolic acidosis, and cyanosis. Since sodium nitrite is a preservative, the ingestion of foods containing an excessive amount of this substance can also cause acute intoxication up to death. The present review is aimed at guiding health professionals in the identification and management of sodium-nitrite-related intoxications and deaths.

METHODS

A systematic literature search was carried out on PubMed by following the PRISMA statement's criteria. A total of 35 studies with 132 cases were enrolled, and the data were cataloged in Microsoft Excel. To establish the causal correlation between sodium nitrite ingestion and death, the Naranjo Adverse Drug Reaction Probability Scale was used.

RESULTS

In addition to the small number of cases that have currently been published, the study demonstrated that there was a general methodological discrepancy in the diagnostic process. However, some interesting results have emerged, especially in post-mortem diagnostics.

CONCLUSION

Sodium-nitrite-related deaths represent a challenge for forensic pathologists; therefore, it is important to promptly recognize the essential features and perform the necessary and unrepeatable examinations for the correct diagnosis of the cause of death.

Saving lives by asking questions: nurses' experiences of suicide risk assessment in telephone counselling in primary health care

AIM

To explore nurses' experiences of suicide risk assessment in telephone counselling (TC) in primary health care (PHC).

BACKGROUND

Globally, priority is given to developing suicide prevention work in PHC. However, suicide risk assessments in TC are not included in these interventions even though these are a common duty of nurses in PHC. More expertise in the field can contribute to knowledge important for developing nurses' tasks within PHC.

METHODS

A qualitative interview study was conducted with 15 nurses. Data were analysed using conventional content analysis.

FINDINGS

As suicide risk assessment in TC is a common duty for nurses in PHC, they need to be listened to and given the right conditions to perform this work. The nurses lack training in how to carry out suicide risk assessments and are forced to learn through experience. Intuition guides them in their work. A prerequisite for making correct assessments over the telephone is that the nurses are given time as well as the right competence. The PHC organisation needs to create these conditions. Furthermore, interventions to support suicide prevention need to include strategies to help nurses perform suicide assessment in TC.

Nurses' Experiences of Suicide Prevention in Primary Health Care (PHC) - A Qualitative Interview Study

AIM

The purpose was to describe nurses' experiences of suicide prevention work in primary health care (PHC).

BACKGROUND

Suicide is the tenth most common cause of death among adults. PHC has an important role in suicide prevention work, as patients often had contact with PHC before their suicide rather than with specialist psychiatric care. Nurses often have the first contact with the patient and are responsible for triage and assessment, making them important in suicide prevention work. Previous studies shed light on suicide prevention in a primary care context, but the nurses' voices are missing.

METHODS

Fifteen qualitative interviews were conducted with nurses in primary health care. Data was analyzed according to conventional content analysis techniques.

FINDINGS

Nurses may avoid asking questions about suicidality for fear of what to do with the answer. To support the nurses' ability in suicide prevention work, both educational and practical experience are fundamental. There was a lack of clarity about who is carrying responsibility for the patient, and it turned out to be difficult to help the patient move further to the next care institution. There was a need for guidelines as well as routines for collaboration with other care actors in suicide prevention work.

CONCLUSION

The PHC organization does not support nurses in suicide prevention, therefore they need the right conditions for their work. Suicide prevention needs to be given greater focus and space within education as well as training in the ongoing clinical work, which can be performed with less extensive efforts.