Physicians' Stories about Suicidal Psychiatric Inpatients
Anne-Grethe Talseth RNT, MSc,
Lars Jacobsson MD, PhD, Astrid Norberg RN, PhD,
Corresponding Author
Anne-Grethe Talseth RNT, MSc
Tromsø College, Faculty of Health Sciences, Tromsø, Norway
Nursing, Umeå University, Umeå, Sweden
Tromsø College, Faculty of Health Sciences, M. H.-Bygget, Breivika, 9293 Tromsø, Norway. Fax: +47 77 66 06 12. E-mail: [email protected]Search for more papers by this authorAnne-Grethe Talseth RNT, MSc,
Lars Jacobsson MD, PhD, Astrid Norberg RN, PhD,
Corresponding Author
Anne-Grethe Talseth RNT, MSc
Tromsø College, Faculty of Health Sciences, Tromsø, Norway
Nursing, Umeå University, Umeå, Sweden
Tromsø College, Faculty of Health Sciences, M. H.-Bygget, Breivika, 9293 Tromsø, Norway. Fax: +47 77 66 06 12. E-mail: [email protected]Search for more papers by this authorAbstract
Fourteen Norwegian, three Danish, and two Swedish physicians employed at a Norwegian psychiatric hospital narrated their lived experiences in caring for suicidal psychiatric inpatients. The interview text was transcribed and interpreted using a phenomenological-hermeneutics method, inspired by Ricoeur's philosophy. Two main themes were found: Power Over, i.e. Communicating with the patients; Not accepting one's own mortality; Not accepting one's own vulnerability; Not accepting one's own fallibility; Being rejected by the patients; and Power To, Deep communicating with the patients; Accepting one's own mortality; Accepting one's own vulnerability; Accepting one's own fallibility; Being trusted by the patients. These findings were pondered in the light of Cissna's and Sieburg's writings about confirming. The study emphasizes the importance to physicians of confronting their own strong and frightening feelings about mortality, vulnerability and fallibility in order to confirm suicidal psychiatric patients during interactions with them, when in hospital after suicide thoughts and attempts.
REFERENCES
- 1 Beskow J. The prevention of suicide while in psychiatric care. Acta Psychiatr Scand 1987; 336 Suppl: 66–75.
- 2 Gralnick A. Suicide in the psychiatric hospital. Child Psychiatry Hum Dev 1993; 24: 3–12.
- 3 Brent DA, Perper JA, Moritz G, Allman C, Friend A, Roth C, et al. Psychiatric risk factors for adolescent suicide: a case-control study. J Am Acad Child Adolesc Psychiatry 1993; 32: 521–9.
- 4 Maltsberger JT, Buie DH. Countertransference hate in the treatment of suicidal patients. Arch Gen Psychiatry 1974; 30: 625–33.
- 5 Wolk-Wasserman D. Some problems connected with the treatment of suicide attempt patients: transference and countertransference aspects. Crisis 1987; 8: 69–82.
- 6 Fremouw WJ, de Perczel M, Ellis TE. Suicide risk: assessment and response guidelines. New York: Pergamon Press, 1990.
- 7 Cotton PG, Drake RE, Whitaker A, et al. Dealing with suicide on a psychiatric inpatient unit. Hosp Community Psychiatry 1983; 34: 55–9.
- 8 Valente SM. Psychotherapist reactions to the suicide of a patient. Am J Orthopsychiatry 1994; 64: 614–21.
- 9 Midence K, Gregory S, Stanley R. The effects of patient suicide on nursing staff. J Clin Nurs 1996; 5: 115–20.
- 10 Talseth AG, Lindseth A, Jacobsson L, Potter J. Nurses' narrations about suicidal psychiatric inpatients. Nord J Psychiatry 1997; 51: 359–64.
- 11 Talseth AG, Lindseth A, Jacobsson L, Norberg A. The meaning of suicidal psychiatric inpatients' experiences of being cared for by mental health nurses. J Adv Nurs 1999; 29: 1034–41.
- 12 Mishler E. Research interviewings— context and narrative. Cambridge, MA: Harvard University Press, 1986.
- 13 Ricoeur P. Interpretation theory. Discourse and the surplus of meaning. Fort Worth, TX: Christian University Press, 1976.
- 14 Ricoeur P. Hermeneutics and the human sciences. In: JB Thompson, editor. Essays on language, action and interpretation. Cambridge: Cambridge University Press, 1981, 131–65.
- 15 Ricoeur P. From text to action. Essays in hermeneutics II. (French original 1986, translated by K. Blamey and JB Thompson). Evanston, IL: Northwestern University Press, 1991.
- 16 Lindseth A, Marhaug V, Norberg A, Udén G. Registered nurses' and physicians' reflections on their narratives about ethically difficult care episodes. J Adv Nurs 1994; 20: 245–50.
- 17 Søderberg A, Gilje F, Norberg A. Dignity in situations of ethical difficulty in intensive care. Intensive Crit Care Nurs 1997; 13: 135–44.
- 18 Rasmussen B, Sandman PO, Norberg A. Stories of being a hospice nurse: a journey towards finding one's footing. Cancer Nurs 1997; 20: 330–41.
- 19 Fromm E. The anatomy of human destructiveness. London: Jonathan Cape Ltd., Thirty Bedford Square Press, 1973.
- 20 Fromm E. The art of loving. New York: Harper & Row, 1956.
- 21 Marcel G. The existential background of human dignity. Cambridge, MA: Harvard University Press, 1963.
- 22 Marcel G. The mystery of being. Faith and reality. Vol. 2. New York: University Press of America, 1979.
- 23 The law of psychiatric treatment, 28 April 1961. The Department of Health and Social Security: Oslo Norway.
- 24 Cissna KNL, Sieburg E. Patterns of interactional confirmation and disconfirmation. In: C Wilder-Mott, JH Weakland, editors. Rigor and imagination. Essays from the legacy of Gregory Bateson. New York: Praeger Press, 1981; 258.
- 25 Lewis S, McDowell W, Gregory RJ. Saving the suicidal patient from himself. Registered Nurse 1986; 49: 26–8.
- 26 Lindseth A. Gabriel Marcel's design to a phenomenology of “TO HAVE”. Dyade 1976; 8: 28–37. (In Norwegian).
- 27 Marcel G. Presence and immortality. Pittsburgh: Duquesne University Press, 1967.
- 28 Marcel G. The mystery of being. I. Reflection and mystery. London: The Harvill Press Ltd., 1950.
- 29 Norberg A, Udén G. Gender differences in moral reasoning among physicians, registered nurses and enrolled nurses, engaged in geriatric and surgical care. Nurs Ethics 1995; 2: 233–42.
- 30 Søderberg A, Norberg A. Intensive care: situations of ethical difficulty. J Adv Nurs 1993; 18: 2008–14.
- 31 Little JD. Staff response to inpatient and outpatient suicide: what happened and what do we do? Aust N Z J Psychiatry 1992; 26: 162–7.
- 32 Grad OT, Zavasnik A, Groleger U. Suicide of a patient: gender differences in bereavement reactions of therapists. Suicide Life Threat Behav 1997; 27: 379–86.
- 33 Tappan MB, Brown LM. Stories told and lessons learned. Towards a narrative approach to moral development and moral education. Harvard Educational Review 1989; 59: 182–205.
- 34 Vitz PC. The use of stories in moral development. New psychological reasons for an old education method. Am Psychol 1990; 45: 709–20.
- 35 Repstad P. Between closeness and distance. Qualitative methods in social work. Oslo: Universitetsforlaget, 1991. (In Norwegian).
- 36 Sandelowski M. The problem of rigor in qualitative research. Adv Nurs Sci 1986; 8: 27–37.
- 37 Dehlholm-Lambertsen B, Maunsbach M. Philosophy and use of science. Nord Med 1997; 112: 24–7. (In Swedish).
- 38 Marcel G. Being and having. (French original 1935, translated by Black A and C). London: Collins, The Fontana Library, 1965.
- 39 Kaye NS, Soreff SM. The psychiatrist's role, responses, and responsibilities when a patient commits suicide. Am J Psychiatry 1991; 148: 739–43.
