Gay Matias
IWK Children's Hospital, Halifax, Nova Scotia, Canada.
J Psychiatr Ment Health Nurs. 2025 Mar 18. doi: 10.1111/jpm.13168.
Suicide prevention within nursing has historically been dominated by biomedical models that emphasize risk assessment and symptom management. While these frameworks offer structure and liability reduction, they often fail to capture the deeply personal and existential dimensions of suicidality. The reliance on predictive tools with modest accuracy, such as the Columbia-Suicide Severity Rating Scale (C-SSRS), has led to a gap between assessment and meaningful intervention. Critics argue that this model fosters a procedural approach that discourages patient disclosure and limits therapeutic engagement. In contrast, person-centered care (PCC) emphasizes relational trust, individualized understanding, and the integration of patient narratives into clinical decision-making. This paper examines the need to shift from standardized, symptom-focused approaches toward a dynamic, patient-centered framework.
This paper critically evaluates the limitations of biomedical suicide prevention strategies by synthesizing theoretical contributions from key suicidologists, including Edwin Shneidman, Antoon Leenaars, Konrad Michel, Igor Galynker, and David Jobes. Evidence-based, person-centered models such as the Collaborative Assessment and Management of Suicide (CAMS) and the Narrative Crisis Model (NCM) are explored in contrast to traditional suicide risk assessments. Additionally, barriers to implementing PCC in nursing-such as time constraints, administrative demands, and gaps in professional training-are examined.
While biomedical models provide standardized risk management strategies, their over-reliance on quantifiable indicators fails to address suicidality's multidimensional nature. The predictive limitations of suicide screening tools often lead to overestimation or underestimation of risk, increasing the likelihood of missed intervention opportunities. Furthermore, systemic factors such as high-acuity environments and compassion fatigue contribute to nurses' challenges in engaging with person-centered interventions. Models like CAMS and NCM have demonstrated greater efficacy in fostering trust, enhancing clinical engagement, and addressing the subjective experiences of suicidal individuals, ultimately improving outcomes.
The limitations of traditional biomedical approaches underscore the necessity of integrating person-centered care into nursing practice. Suicide prevention should not be dictated solely by standardized risk assessments but should instead prioritize therapeutic alliance, empathy, and the co-construction of meaning. Nurses, given their frontline role in patient care, are uniquely positioned to transform suicide prevention through narrative-based interventions and compassionate engagement. However, achieving this paradigm shift requires institutional support, expanded nursing education, and systemic recognition of the importance of relational care. This paper advocates for a holistic approach that moves beyond risk prediction toward meaningful, person-centered interventions that address the lived experiences and psychological distress of individuals at risk for suicide.
护理领域内的自杀预防历来由强调风险评估和症状管理的生物医学模式主导。虽然这些框架提供了结构并降低了责任风险，但它们往往无法捕捉自杀行为中深刻的个人和存在维度。对预测准确性有限的工具（如哥伦比亚自杀严重程度评定量表（C-SSRS））的依赖，导致了评估与有意义的干预之间存在差距。批评者认为，这种模式促成了一种程序化的方法，不利于患者披露信息，并限制了治疗参与度。相比之下，以患者为中心的护理（PCC）强调关系信任、个性化理解以及将患者的叙述纳入临床决策。本文探讨了从标准化的、以症状为重点的方法转向动态的、以患者为中心的框架的必要性。
本文通过综合包括埃德温·施奈德曼、安托恩·莱纳尔斯、康拉德·米歇尔、伊戈尔·加林克和大卫·乔贝斯等关键自杀学专家的理论贡献，批判性地评估生物医学自杀预防策略的局限性。与传统自杀风险评估形成对比，探讨了基于证据的、以患者为中心的模式，如自杀协作评估与管理（CAMS）和叙事危机模型（NCM）。此外，还研究了在护理中实施PCC的障碍，如时间限制、行政要求和专业培训方面的差距。
虽然生物医学模式提供了标准化的风险管理策略，但其对可量化指标的过度依赖未能解决自杀行为的多维度性质。自杀筛查工具的预测局限性往往导致对风险的高估或低估，增加了错过干预机会的可能性。此外，诸如高急症环境和同情疲劳等系统因素，也给护士参与以患者为中心的干预带来了挑战。像CAMS和NCM这样的模式在促进信任、增强临床参与度以及解决自杀个体的主观体验方面已显示出更大的效果，最终改善了结果。
传统生物医学方法的局限性凸显了将以患者为中心的护理纳入护理实践的必要性。自杀预防不应仅由标准化风险评估决定，而应优先考虑治疗联盟、同理心以及意义的共同构建。护士因其在患者护理中的一线角色，在通过基于叙事的干预和富有同情心的参与来转变自杀预防方面具有独特的地位。然而，实现这种范式转变需要机构支持、扩大护理教育以及对关系护理重要性的系统性认可。本文倡导一种整体方法，超越风险预测，转向有意义的、以患者为中心的干预，以解决有自杀风险个体的生活经历和心理困扰。
