1
|
Causer H, Spiers J, Chew-Graham CA, Efstathiou N, Gopfert A, Grayling K, Maben J, van Hove M, Riley R. Filling in the gaps: A grounded theory of the experiences and needs of healthcare staff following a colleague death by suicide in the UK. DEATH STUDIES 2024:1-12. [PMID: 38602818 DOI: 10.1080/07481187.2024.2337202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Health-workers are more likely to die by suicide than their counterparts in other occupational groups. The suicide of a staff member can be widely felt by colleagues, leading to complex emotional and cognitive responses. Exposure to suicide heightens the risk of dying by suicide. We investigated the impact of a colleague suicide on National Health Service (NHS) staff. Twenty-nine staff were interviewed; all participants were white British, and so not representative of the ethnic make-up of the NHS. Data were analyzed using grounded theory methods. A theory, "filling in the gaps" was developed. Staff experiences gave rise to needs that were not always met. Staff endeavored to "fill in the gaps" in support; however, sometimes fell through those gaps. Organizational and professional contexts shaped their experiences and responses. Recommendations include skilled and targeted support and compassion for affected staff. Cultural change is needed to challenge suicide stigma and unhelpful narratives.
Collapse
Affiliation(s)
- Hilary Causer
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Johanna Spiers
- School of Health Sciences, University of Surrey, Guildford, UK
| | | | - Nikolaos Efstathiou
- School of Nursing and Midwifery, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anya Gopfert
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, UK
| | | | - Jill Maben
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Maria van Hove
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, UK
| | - Ruth Riley
- School of Health Sciences, University of Surrey, Guildford, UK
| |
Collapse
|
2
|
Daly KA, Segura A, Heyman RE, Aladia S, Slep AMS. Scoping Review of Postvention for Mental Health Providers Following Patient Suicide. Mil Med 2024; 189:e90-e100. [PMID: 36661225 DOI: 10.1093/milmed/usac433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION As suicides among military personnel continue to climb, we sought to determine best practices for supporting military mental health clinicians following patient suicide loss (i.e., postvention). MATERIALS AND METHODS We conducted a scoping review of the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Our initial search of academic databases generated 2,374 studies, of which 122 were included in our final review. We categorized postvention recommendations based on the socioecological model (i.e., recommendations at the individual provider, supervisory/managerial, organizational, and discipline levels) and analyzed them using a narrative synthesizing approach. RESULTS Extracted recommendations (N = 358) comprised those at the provider (n = 94), supervisory/managerial (n = 90), organization (n = 105), and discipline (n = 69) levels. CONCLUSIONS The literature converges on the need for formal postvention protocols that prioritize (1) training and education and (2) emotional and instrumental support for the clinician. Based on the scoped literature, we propose a simple postvention model for military mental health clinicians and recommend a controlled trial testing of its effectiveness.
Collapse
Affiliation(s)
- Kelly A Daly
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Anna Segura
- Family Translational Research Group, New York University, New York, NY 10010, USA
- Faculty of Education, Translation, Sport and Psychology, Universitat de Vic-Universitat Central de Catalunya, Catalunya 08500, Spain
| | - Richard E Heyman
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Salomi Aladia
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Amy M Smith Slep
- Family Translational Research Group, New York University, New York, NY 10010, USA
| |
Collapse
|
3
|
Groves S, Lascelles K, Hawton K. Experiences of clinical staff who work with patients who self-harm by ligature: An exploratory survey of inpatient mental health service staff. J Psychiatr Ment Health Nurs 2023. [PMID: 37904647 DOI: 10.1111/jpm.12995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/30/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT Self-harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self-harm. Most fatal and non-fatal suicidal behaviours in inpatient settings are a result of ligature use. There is a lack of research which has explored the experiences of staff members who work within inpatient settings where patients may self-harm by ligature. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE Key issues related to self-harm by ligature reported by staff included (1) understaffing increasing risk of ligature incidents, (2) spreading of self-harm by ligature within inpatient settings and (3) negative attitudes of staff related to patients who self-harm by ligature. Working with self-harm by ligature can have negative impacts on staff's personal (e.g. fear of blame) and professional lives (e.g. increased cautiousness). Many staff members currently feel underprepared by training related to working with self-harm by ligature, and unsupported after responding to a ligature incident. WHAT ARE THE IMPLICATIONS FOR PRACTICE Training about self-harm by ligature needs to be improved and be accessible for all inpatient mental healthcare staff. Training should be coproduced, and could include practical components, education on potential reasons for self-harm, and acknowledgement of the emotional impact on staff. Support for staff members who respond to ligature incidents should be available for all staff members who respond to self-harm by ligature incidents. Stigma associated with accessing support should be challenged, alongside blame cultures within the workplace. ABSTRACT INTRODUCTION: Self-harm by ligature is a common form of self-harm within inpatient mental health services in England, where most suicides within inpatient settings involve hanging or suffocation. However, little research has examined the experiences of staff members working with this method of self-harm. AIM We explored the experiences of clinical staff who work with patients who self-harm by ligature. METHOD A staff survey was developed and disseminated to clinical staff working in inpatient settings in England. Quantitative data were analysed using descriptive statistics, and qualitative data using the framework approach. The study was STROBE checklist compliant. RESULTS 275 staff members participated. Challenges most frequently reported about working with self-harm by ligature included understaffing (210, 76.6%), spreading of ligature incidents (198, 72.8%) and negative attitudes held by clinical staff towards such patients (185, 68.5%). Participants' responses indicated that this work could have significant impacts on their professional and personal lives. Staff often reported inadequate training and lack of preparedness, alongside insufficient support opportunities following ligature incidents. DISCUSSION Staff had a diverse range of professional and personal experiences and identified multiple challenges associated with working with patients who have self-harmed by ligature. IMPLICATIONS FOR PRACTICE There is a need to improve accessibility, format and content of training and support for staff working within inpatient settings where patients may self-harm by ligature.
Collapse
Affiliation(s)
- Samantha Groves
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Karen Lascelles
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Keith Hawton
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
- Centre for Suicide Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| |
Collapse
|
4
|
Pedrollo LFS, Silva AC, Zanetti ACG, Vedana KGG. Creation and validation of a high-fidelity simulation scenario for suicide postvention. Rev Lat Am Enfermagem 2022; 30:e3699. [PMID: 36287402 PMCID: PMC9580988 DOI: 10.1590/1518-8345.6034.3699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE to create and validate a high-fidelity simulation scenario about the initial support to suicide bereaved people. METHOD a methodological research study to create and validate a simulation scenario about postvention. Its creation was based on scientific recommendations, the validation process was carried out by experts, based on an instrument developed by the authors; the data were statistically analyzed using the Content Validity Index and Gwet concordance coefficient. RESULTS the scenario was created to provide initial support to suicide bereaved people in the Primary Health Care context. As learning objectives, welcoming, health care and organization monitoring were proposed according to technical-scientific recommendations. The scenario was validated by 10 specialists in the themes of postvention (5 judges) and high-fidelity simulation (5 judges). The scenario items met the acceptance and reliability criteria (Content Validity Index = 0.80) and satisfactory concordance (Gwet coefficient = 0.640). CONCLUSION the study presented in full a scenario on postvention with innovative potential that can be used free of charge in clinical simulation development during training of different categories of health professionals, to act in support of suicide bereaved people.
Collapse
Affiliation(s)
- Laysa Fernanda Silva Pedrollo
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Aline Conceição Silva
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Kelly Graziani Giacchero Vedana
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| |
Collapse
|
5
|
McDonnell S, Flynn S, Shaw J, Smith S, McGale B, Hunt I. Suicide bereavement in the UK: Descriptive findings from a national survey. Suicide Life Threat Behav 2022; 52:887-897. [PMID: 35611626 PMCID: PMC9790485 DOI: 10.1111/sltb.12874] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/12/2022] [Accepted: 05/05/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Those bereaved by suicide are a high-risk group of adverse health outcomes and suicidal behavior, yet little is known about the experiences and support needs of these individuals in the UK. METHODS We conducted a national cross-sectional study using an online survey and analyzed the experiences of 7158 participants who had been bereaved or affected by suicide. RESULTS Suicide had a major impact on 77% of participants, including those who had lost a friend and those exposed to suicide at a professional level. Mental and physical health problems linked to the suicide were reported in half. Adverse social outcomes and engaging in high-risk behaviors following the suicide were common. Over a third reported suicidal ideation and 8% had attempted suicide as a direct result of the suicide loss. Most had not accessed support services, with the majority viewing provision of local suicide bereavement support as inadequate. CONCLUSIONS Our results highlight the need for a multi-disciplinary approach in postvention and the provision of proactive outreach to support those bereaved by suicide. Postvention efforts need to acknowledge the death of a friend by suicide as a significant loss.
Collapse
Affiliation(s)
- Sharon McDonnell
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK,Suicide BereavementRamsbottomUK
| | - Sandra Flynn
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK
| | - Jenny Shaw
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK,Greater Manchester Mental Health NHS Foundation TrustManchesterUK,Independent Advisory Panel on Deaths in CustodyLondonUK
| | - Shirley Smith
- If U Care Share FoundationChesterUK,Support After Suicide PartnershipLondonUK
| | - Barry McGale
- Suicide BereavementRamsbottomUK,Support After Suicide PartnershipLondonUK
| | - Isabelle M. Hunt
- Faculty of Biology, Medicine and HealthCentre for Mental Health and SafetyUniversity of ManchesterManchesterUK
| |
Collapse
|
6
|
Causer H, Spiers J, Efstathiou N, Aston S, Chew-Graham CA, Gopfert A, Grayling K, Maben J, van Hove M, Riley R. The Impact of Colleague Suicide and the Current State of Postvention Guidance for Affected Co-Workers: A Critical Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811565. [PMID: 36141837 PMCID: PMC9517643 DOI: 10.3390/ijerph191811565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 05/11/2023]
Abstract
People bereaved by suicide are affected psychologically and physically and may be at greater risk of taking their own lives. Whilst researchers have explored the impact of suicide on family members and friends, the area of colleague suicide has been neglected and postvention guidance for supporting surviving colleagues is often poorly developed. This critical integrative review explored the impact of colleague suicide on surviving co-workers and reviewed postvention guidance for workplaces. Systematic searches found 17 articles that met the inclusion criteria. Articles were appraised for quality and extracted data were analysed using a thematic network method. Article quality was moderate. Two global themes were developed: impact of a colleague suicide comprised themes of 'suicide loss in the workplace'; 'professional identities and workplace roles'; 'perceptions of professional uniqueness'; and 'professional abandonment and silencing'. Postvention following a colleague suicide comprised 'individualised responses'; 'the dual function of stigma'; and 'complex pressure on managers'. A unifying global network 'after a colleague suicide' describes the relationships between all themes. A series of disconnects between existing postvention guidance and the needs of impacted workers are discussed. This review demonstrates the need for robust, systemic postvention for colleagues impacted by the complex issue of colleague suicide.
Collapse
Affiliation(s)
- Hilary Causer
- School of Health Sciences, University of Surrey, Kate Granger Building, 30 Priestly Road, Surrey Research Park, Guildford GU2 7YH, UK
- Correspondence:
| | - Johanna Spiers
- School of Health Sciences, University of Surrey, Kate Granger Building, 30 Priestly Road, Surrey Research Park, Guildford GU2 7YH, UK
| | - Nikolaos Efstathiou
- School of Nursing and Midwifery, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Stephanie Aston
- Samaritans, The Upper Mill, Kingston Road, Ewell, Surrey KT17 2AF, UK
| | | | - Anya Gopfert
- Department of Health and Community Sciences, University of Exeter Medical School, Exeter EX4 4PY, UK
| | | | - Jill Maben
- School of Health Sciences, University of Surrey, Kate Granger Building, 30 Priestly Road, Surrey Research Park, Guildford GU2 7YH, UK
| | | | - Ruth Riley
- School of Health Sciences, University of Surrey, Kate Granger Building, 30 Priestly Road, Surrey Research Park, Guildford GU2 7YH, UK
| |
Collapse
|
7
|
Malik S, Gunn S, Robertson N. The Impact Of Patient Suicide on Doctors and Nurses: A Critical Interpretive Meta-Synthesis. Arch Suicide Res 2022; 26:1266-1285. [PMID: 33631083 DOI: 10.1080/13811118.2021.1885533] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To provide a conceptual overview of how medical doctors and nurses experience patient suicide. METHOD A systematic search identified ten qualitative papers for this interpretive meta-synthesis. Constructs were elicited and synthesized via reciprocal translational analysis. RESULTS Findings comprised four inter-related themes: (1) Intrinsic but taboo: patient suicide perceived as inevitable yet difficult to discuss. (2) Significant emotional impact: clinicians deeply affected, with resilience important for mitigating impact. (3) Failure and accountability: intense self-scrutiny, guilt and shame, with blame attributed differently across professions. (4) Legacy of patient suicide: opportunities for growth but lack of postvention guidance. CONCLUSIONS Patient suicide affects clinicians profoundly. Further research should evaluate postvention procedures to inform effective guidance and support, acknowledging professional differences.HighlightsPatient suicide profoundly affects doctors and nurses as "suicide survivors."Despite common themes, professions differed in blame attributions.Organizations must develop postvention responses to meet clinicians' pastoral needs.
Collapse
|
8
|
Causer H, Bradley E, Muse K, Smith J. Bearing witness: A grounded theory of the experiences of staff at two United Kingdom Higher Education Institutions following a student death by suicide. PLoS One 2021; 16:e0251369. [PMID: 33979333 PMCID: PMC8115842 DOI: 10.1371/journal.pone.0251369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/24/2021] [Indexed: 11/21/2022] Open
Abstract
Wider networks of people are affected by a suicide death than originally thought, including those whose job-role brings them into contact with a death by suicide of another person. The impact of student suicide within United Kingdom (UK) Higher Education Institutions (HEIs) is unexplored and the experiences of staff members remain unknown. It is not known whether staff members have specific postvention needs following a student death by suicide. Any postvention support currently offered to staff members within UK HEIs lacks a context-specific evidence base. This study asked 'How is a student suicide experienced by staff members within a UK HEI and what are the features of that experience?' Staff members from diverse job-roles in two UK HEIs responded to a qualitative survey (n = 19) and participated in semi-structured interviews (n = 10). Data were transcribed and subjected to a constructivist grounded theory analysis. Participants' experiences informed the development of a core category: 'Bearing witness', which encompassed six further categories: 'Responding to a student suicide'; 'Experiencing a student suicide'; 'Needs and fears'; 'Experiences of support'; 'Human stories'; and 'Cultural stories'. The resulting grounded theory demonstrates how participants' perceptions of impact are informed by their experiences of undertaking tasks following a student suicide within the community of their HEI. Processes of constructing perceptions of closeness to the student who died are evident amongst participants who did not know the student prior to their death. Tailored postvention support is required to respond to the range and complexity of HEI staff needs following a student death by suicide.
Collapse
Affiliation(s)
- Hilary Causer
- School of Allied Health and Community, University of Worcester, Worcestershire, United Kingdom
| | - Eleanor Bradley
- College of Life, Health and Environmental Sciences, University of Worcester, Worcestershire, United Kingdom
| | - Kate Muse
- School of Psychology, University of Worcester, Worcestershire, United Kingdom
| | - Jo Smith
- School of Allied Health and Community, University of Worcester, Worcestershire, United Kingdom
| |
Collapse
|