Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, N-4036, Stavanger, Norway.
Clinics of Adult Mental Health Care, Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway.
BMC Health Serv Res. 2022 Jul 29;22(1):967. doi: 10.1186/s12913-022-08282-x.
The prevailing patient safety strategies in suicide prevention are suicide risk assessments and retrospective reviews, with emphasis on minimising risk and preventing adverse events. Resilient healthcare focuses on how everyday clinical practice succeeds and emphasises learning from practice, not from adverse events. Yet, little is known about resilient practices for suicidal inpatients. The aim of the study is to draw upon the perspectives of patients and healthcare professionals to inform the conceptual development of resilient practices in inpatient suicide prevention.
A narrative synthesis was conducted of findings across patients and healthcare professionals derived from a qualitative case study based on interviews with patients and healthcare professionals in addition to a systematic literature review.
Three sub-themes categorise resilient practices for healthcare professionals and for patients hospitalised with suicidal behaviour: 1) interactions capturing non-verbal cues; 2) protection through dignity and watchfulness; and 3) personalised approaches to alleviate emotional pressure. The main theme, the establishment of relationships of trust in resilient practices for patients in suicidal crisis, is the foundation of their communication and caring.
Clinical practice for patients hospitalised with suicidal behaviour has characteristics of complex adaptive systems in terms of dynamic interactions, decision-making under uncertainty, tensions between goals solved through trade-offs, and adaptations to patient variability and interpersonal needs. To improve the safety of patients hospitalised with suicidal behaviour, variability in clinical practice should be embraced.
预防自杀的主要患者安全策略是自杀风险评估和回顾性审查，重点是降低风险和预防不良事件。弹性医疗侧重于日常临床实践如何成功，并强调从实践中学习，而不是从不良事件中学习。然而，对于住院自杀患者的弹性实践知之甚少。本研究旨在从患者和医疗保健专业人员的角度出发，为住院自杀预防中弹性实践的概念发展提供信息。
对基于患者和医疗保健专业人员访谈的定性案例研究以及系统文献综述中患者和医疗保健专业人员的发现进行了叙述性综合。
三个子主题将弹性实践分类为医疗保健专业人员和因自杀行为住院的患者：1）捕捉非言语线索的互动；2）通过尊严和警惕进行保护；3）缓解情绪压力的个性化方法。主要主题是在有自杀危机的患者的弹性实践中建立信任关系，这是他们沟通和关爱的基础。
就动态互动、不确定条件下的决策、通过权衡解决目标之间的紧张关系以及适应患者变异性和人际需求而言，因自杀行为住院的患者的临床实践具有复杂适应系统的特征。为了提高因自杀行为住院的患者的安全性，应接受临床实践中的变异性。
