Nurses' Psychosocial Barriers to Suicide Risk Management

Suicide remains a serious health care problem and a sentinel event tracked by The Joint Commission. Nurses are pivotal in evaluating risk and preventing suicide. Analysis of nurses' barriers to risk management may lead to interventions to improve management of suicidal patients. These data emerged from a random survey of 454 oncology nurses' attitudes, knowledge of suicide, and justifications for euthanasia. Instruments included a vignette of a suicidal patient and a suicide attitude questionnaire. Results. Psychological factors (emotions, unresolved grief, communication, and negative judgments about suicide) complicate the nurse's assessment and treatment of suicidal patients. Some nurses ( ) indicated that euthanasia was never justified and 11 were unsure of justifications and evaluated each case on its merits. Justifications for euthanasia included poor symptom control, poor quality of life, incurable illness or permanent disability, terminal illness, and terminal illness with inadequate symptom control or impending death, patient autonomy, and clinical organ death. The nurses indicated some confusion and misconceptions about definitions and examples of euthanasia, assisted suicide, and double effect. Strategies for interdisciplinary clinical intervention are suggested to identify and resolve these psychosocial barriers. 1. Psychosocial Barriers to Suicide Risk Management Patients facing a life-threatening illness such as cancer have an increased risk of suicide, and this study examines the nurse’s psychosocial barriers to managing suicide risk. Nurses have a major role to play in patient safety when they recognize the warning signs, monitor the patient’s emotional state, provide a therapeutic relationship, and take precautions to prevent suicide. Although 70% of people warn providers of their suicidal impulses, clinicians often fail to take these warnings seriously [1]. Therapeutic intervention can often effectively help alleviate the pain, symptoms, or depression and reduce suicide risk. Psychosocial barriers such as the nurse’s emotions, beliefs, knowledge, or attitudes can impair risk management. This paper describes content analysis of oncology nurses’ narratives about psychosocial barriers in managing suicide risk. People with cancer have higher than average rates of suicide. Rates of suicide have been estimated to be as high as 31.4/100,000 person-years among people with cancer or AIDS. [2]. Misono et al. found an age-, sex-, and race-adjusted rate of 31.4/100,000 person-years which is almost twice the general suicide rate in the US which was