A personal-recovery-oriented caring approach to suicidality

Abstract: Persons who are subject to care due to suicidal thoughts and/or acts, are in a vulnerable situation, struggling with issues related to life and death as well as experiences of hopelessness and powerlessness. They may also experience themselves as a burden for their relatives. The relatives’ struggle for contributing to the loved person’s survival, can involve experiences of taking responsibility for things that are outside their control. Although research considering how suicidal persons and their relatives can be supported, when the person receives care in a psychiatric inpatient setting is sparse. There is also a need for research to form the basis for mental health nurses to enable caring interventions, with the potential of acknowledging the uniqueness of each individual person and their experiences. This thesis is based on a perspective of recovery as a process, where the persons experience themselves as capable of managing both challenges and possibilities in life and incorporate meaning into it. Experiences of being capable of managing problems in living are vital for this process. Thus, it is necessary to acknowledge the lifeworld as essential for personal recovery.The overall aim of this research  was to develop, introduce and evaluate a caring intervention, to support suicidal patients’ recovery and health, and to support patients’ and their relatives’ participation in the caring process. Considering the complexity of such a caring intervention and the importance of recognizing multiple aspects of the phenomenon (i.e., recovery in a suicidal crisis), this research was conducted from a lifeworld perspective based on phenomenological philosophy. Two studies with reflective lifeworld research approach (I, II), a Delphi study (III), and a single case study with QUAL>quan mixed methods research approach (IV) were conducted.The developed caring intervention is characterized by “communicative togetherness”. This means that the nurse and the patient together explore how the patient’s recovery can be supported, as a way for the patient to reconnect with self and important others, and thereby being strengthened when challenged by problems in living. It was also concluded that it is more appropriate to acknowledge this as a caring approach, rather than describe it as a specific caring intervention. The final description of the findings comprise a preliminary guide to a personal-recovery-oriented caring approach to suicidality (PROCATS). This description highlights six core aspects of the caring approach. The overall aim of the PROCATS is to support suicidal patients’ recovery and health processes, even at the very edge of life. Although the findings indicate that the caring approach has potential to support suicidal patients’ recovery as well as support their relatives’ participation, there is a need for further evaluation of the PROCATS in a wider context.