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A personal-recovery-oriented caring approach to suicidality
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (Care, Recovery and Health)ORCID iD: 0000-0002-8306-0521
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Västerås: Mälardalen University , 2017.
Series
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 245
Keyword [en]
Dialogue, hermeneutics, lifeworld, mental health nursing, participation, patient’s perspective, person-centred care, phenomenology, recovery, reflective lifeworld research, reflective understanding, relative’s perspective, suicidality, suicide prevention
National Category
Medical and Health Sciences
Research subject
Care Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-37213ISBN: 978-91-7485-358-2 (print)OAI: oai:DiVA.org:mdh-37213DiVA: diva2:1154808
Public defence
2017-12-15, Beta, Mälardalens högskola, Västerås, 13:15
Opponent
Supervisors
Available from: 2017-11-06 Created: 2017-11-05 Last updated: 2017-11-16Bibliographically approved
List of papers
1. Reconnecting with oneself while struggling between life and death: The phenomenon of recovery as experienced by persons at risk of suicide
Open this publication in new window or tab >>Reconnecting with oneself while struggling between life and death: The phenomenon of recovery as experienced by persons at risk of suicide
2017 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 26, no 2, 200-207 p.Article in journal (Refereed) Published
Abstract [en]

The body of knowledge regarding health and recovery as experienced by patients at risk of suicide is limited. More research is needed into the meaning of recovery and what strengthens the desire to live. The aim of this study was to describe the phenomenon of recovery in a context of nursing care as experienced by persons at risk of suicide. In line with a reflective lifeworld research approach, 14 patients from a psychiatric clinic in Sweden participated in phenomenon-oriented interviews. Data were analyzed to describe the essence of the phenomenon. The results reveal that the phenomenon of recovery means ‘reconnecting with oneself while struggling between life and death’. Three meaning constituents emerged: being in an expressive space and giving voice to oneself, regaining dignity through nurturing connectedness, and finding a balance in the tension between life and death. In conclusion, the meaning of recovery is to experience the ability to manage one's own life. Professional caregivers need to acknowledge patients' lifeworlds, in a way that enable patients to experience themselves as capable of managing their own lives. Professional caregivers should also facilitate the involvement of supportive relatives.

Keyword
attempted suicide, mental health nursing, phenomenology, psychiatry, recovery
National Category
Health Sciences
Research subject
Care Sciences
Identifiers
urn:nbn:se:mdh:diva-32590 (URN)10.1111/inm.12249 (DOI)000398124700011 ()2-s2.0-84994071505 (Scopus ID)
Available from: 2016-09-06 Created: 2016-08-19 Last updated: 2017-11-09Bibliographically approved
2. To be present, share and nurture: a lifeworld phenomenological study of relatives' participation in the suicidal person's recovery
Open this publication in new window or tab >>To be present, share and nurture: a lifeworld phenomenological study of relatives' participation in the suicidal person's recovery
Show others...
2017 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 12, 1287985Article in journal (Refereed) Published
Abstract [en]

In today's health care, participation is acknowledged as important. However, there is limited research on how relatives of patients at risk of suicide experience their opportunities to participate in care during periods when their close ones are subject to inpatient care. The aim of this study was to describe the phenomenon of participation, as experienced by relatives of persons who are subject to inpatient psychiatric care due to a risk of suicide. The study was conducted through a reflective lifeworld research (RLR) approach, based on phenomenological philosophy. Eight relatives of patients receiving care from professionals in a psychiatric specialist health care context in Sweden participated in phenomenon-oriented interviews. Data were analysed to elucidate a meaning structure of the phenomenon. The findings show that the phenomenon of participation was more associated with patients' recovery processes than with the caring process, and means "being actively involved in a process in which the person regains the desire to live". The meaning of participation is further described by its meaning constituents: struggling for being able to be present for the person at risk of suicide, being able to share everyday life, and nurturing sources for vitality. These insights into the meaning of participation highlight the importance of allowing supportive relatives to be a part of the patient's life, while the person is cared for in an inpatient hospital setting. Thus, participation enables relatives to be acknowledged as resourceful human beings in the patient's recovery process, and thereby facilitates a sense of being able to manage and share life itself together with the person. This means that mental health nurses need to recognize individual variations of relatives' participation processes, and take on the responsibility of acknowledging relatives' lifeworlds.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2017
Keyword
Caring science, interpersonal relationships, lived body, mental health nursing, person-centred care, phenomenology, psychiatry, relatives' experiences, suicidality, vitality
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-35130 (URN)000396166400001 ()28245364 (PubMedID)2-s2.0-85027697273 (Scopus ID)
Available from: 2017-04-06 Created: 2017-04-06 Last updated: 2017-11-09Bibliographically approved
3. Caring for the suicidal person: A Delphi study of what characterizes a recovery-oriented caring approach
Open this publication in new window or tab >>Caring for the suicidal person: A Delphi study of what characterizes a recovery-oriented caring approach
(English)Manuscript (preprint) (Other academic)
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-37227 (URN)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2017-11-09Bibliographically approved
4. Experiences of a recovery-oriented caring approach to suicidality: A single case study
Open this publication in new window or tab >>Experiences of a recovery-oriented caring approach to suicidality: A single case study
2017 (English)Manuscript (preprint) (Other academic)
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-37226 (URN)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2017-11-09Bibliographically approved

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The full text will be freely available from 2017-11-24 08:00
Available from 2017-11-24 08:00

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