Patients and nurses’ perceptions of ward environmental factors and support systems in the care of suicidal patients

Aims. The aims of this paper are to present and discuss the findings that emerged from a qualitative study exploring nurses and patients’ views of the acute psychiatric ward (the context) and the type of care received (the intervening conditions). Background. The phenomenon of suicide and the nursing care of people who are suicidal have previously been investigated. However, literature demonstrates that there is a dearth of information exploring the importance of the ward context in the care of suicidal patients and the intervening conditions that are used by professionals in the care of suicidal patients. Method. Qualitative research using the grounded theory approach. Data collection and analysis. Fifteen patients who had either suicidal ideas or had attempted suicide and 15 psychiatric nurses were interviewed and observed. Data were analysed using open, axial and selective coding. Findings. A substantive theory of suicide‐nursing care was developed. For the purpose of this paper, the two categories that emerged in the ‘context’ element of the paradigm model are explored. They were: team working and the psychiatric ward environment. In addition, the four categories from the ‘intervening conditions’ are discussed. They were: nurses’ attitudes and beliefs have an effect on caring, barriers to caring, patients’ negative thoughts and feelings about the care provided and support systems. Conclusion. The findings indicated that the context of the ward environment and the intervening conditions used by nurses in the nursing care of suicidal patients helped to define some of the complex dynamics that impacted on the development of a therapeutic relationship within the practice of suicide‐nursing care. Relevance to clinical practice. Environmental factors as well as the nurses’ knowledge and skills and the type of support patients receive impact on the care of suicidal patients. These findings could help to enhance and advance suicide‐nursing care.