Fairman Nathan, Thomas Lori P Montross, Whitmore Stephanie, Meier Emily A, Irwin Scott A
1 Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine , Sacramento, California.
J Palliat Med. 2014 Jul;17(7):832-6. doi: 10.1089/jpm.2013.0391. Epub 2014 Apr 9.
Patient suicides can affect clinicians both personally and professionally, with frequent reports of psychological and behavioral changes occurring in response to this type of patient death. Although hospice clinicians have regular exposure to dying patients, the impact of patient suicide on this group has been understudied.
This study examined the personal and professional impact of patient suicides among hospice clinical staff, the coping strategies used by this group, and their recommendations for staff support after a patient suicide.
Utilizing an online survey, 186 hospice staff qualitatively described the impact of patient suicides on them as people and professionals, their resulting coping strategies, and any recommendations for supporting others. Three study investigators coded all of the staff responses at a paragraph level and summarized the most common emergent themes using grounded theory procedures.
SETTING/SUBJECTS: One hundred eighty-six clinical staff members who worked in an academic nonprofit hospice setting.
An open-ended, qualitative survey was used to gather data about demographics, clinical experience, exposure to known or suspected suicides, recommendations for support in the event of a patient suicide, the personal and professional impacts of suicide, and coping strategies.
The themes expressed by the hospice staff in reaction to patient suicides included: psychological responses such as feelings of guilt and self-doubt, changes in professional attitudes, and changes in clinical practice such as greater sensitivity to signs of suicide. When coping with a patient suicide, hospice staff described the use of team-based support strategies, debriefings, and personal spiritual practices. Recommendations for future support included facilitated debriefings, individual counseling, spiritual practices, leaves of absence, self-care activities, and educational interventions.
Data from this small study may help clinicians and administrators more fully understand the impact of patient suicides on hospice staff and may serve as a foundation for the development of effective strategies to support staff after a patient suicide.
患者自杀会对临床医生产生个人和职业上的影响，经常有报告称，临床医生会因这类患者死亡而出现心理和行为上的变化。尽管临终关怀临床医生经常接触濒死患者，但患者自杀对这一群体的影响却鲜有研究。
本研究调查了患者自杀对临终关怀临床工作人员的个人和职业影响、该群体所采用的应对策略，以及他们对患者自杀后员工支持的建议。
通过在线调查，186名临终关怀工作人员定性描述了患者自杀对他们个人及职业的影响、他们采取的应对策略，以及对他人提供支持的任何建议。三名研究调查员在段落层面编码了所有工作人员的回复，并运用扎根理论程序总结了最常见的新出现主题。
设置/研究对象：在一家学术性非营利临终关怀机构工作的186名临床工作人员。
采用开放式定性调查收集有关人口统计学、临床经验、已知或疑似自杀事件的接触情况、患者自杀时支持建议、自杀的个人和职业影响以及应对策略的数据。
临终关怀工作人员对患者自杀的反应所表达的主题包括：心理反应，如内疚感和自我怀疑；职业态度的变化；临床实践的变化，如对自杀迹象更加敏感。在应对患者自杀时，临终关怀工作人员描述了采用基于团队的支持策略、汇报会和个人精神修行。对未来支持的建议包括组织汇报会、个别咨询、精神修行、休假、自我护理活动和教育干预。
这项小型研究的数据可能有助于临床医生和管理人员更全面地了解患者自杀对临终关怀工作人员的影响，并可能为制定患者自杀后支持工作人员的有效策略奠定基础。
