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Aim: The aim of this study is to illuminate psychiatric nurses' experiences of suicide assessment in their daily work of a psychiatric inpatient ward. Background: The majority of all suicides are committed by people with some kind of psychiatric diagnosis and suicides within psychiatric hospital departments are increasing. In more than half of the cases where patients have committed suicide in the psychiatric hospital, the patient's suicidal risk assessment has failed and the patient has been able to leave the department and commit suicide. Previous research suggests that suicide risk assessments are important and nurses need more skills and time to be able to pay attention to patients' behavior. Design: This is a qualitative descriptive study based on eight individual semi-structured interviews that have been analyzed using qualitative content analysis by Lundman and Hällgren Graneheim (2012). Method: Data analysis was based on Lundman and Hällgren Graneheim (2012) description of qualitative content analysis. Semi-structured interviews with the addition of narrative questions was conducted. The participants were eight registered psychiatric nurses from four different psychiatric departments at a hospital in Västra Götaland. A male psychiatric nurse and seven female psychiatric nurses participated with at least one years of experience participated. Results: The results showed that the psychiatric nurses had difficulties defining a general suicide behavior. On the other hand, different behavior patterns were identified as more suicidal. Such patterns could be rapid twists in emotional state, strong anxiety, impulsivity and backwardness. Three categories emerged during the analysis process: Clinical Glance, Alliance Work and Experiences Collaboration and Knowledge, and all three had three related subcategories. Conclusion: The suicidal process is complex and the difficulty lies in identifying where in the process the patient is. Psychiatric nurses have responsibility identifying early signs considered by psychiatric nurses to be an important part of suicide assessment. Experience about the patient and knowledge of suicide is something that psychiatric nurses experience as significant to be able to make good suicide risk assessments.

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Bakgrund: Suicid är ett folkhälsoproblem som har nått epidemiska mått globalt. Suicidala tankar kan kopplas till känslor av hopplöshet och ambivalens, ensamhet, brist på självvärde och otillräcklig förmåga att hantera sitt liv. Specialistsjuksköterskan utför suicidriskbedömningar för att förebygga och förhindra suicid i den psykiatriska öppenvården. Utförandet av suicidriskbedömningar är en komplex uppgift för specialistsjuksköterskan och det är viktigt att det finns möjlighet att kunna reglera känslor och balansera engagemang. Syfte: Syftet med studien var att beskriva specialistsjuksköterskors erfarenheter av att genomföra suicidriskbedömningar i psykiatrisk öppenvård. Metod: Induktiv ansats användes och materialet analyserades med kvalitativ innehållsanalys. Specialistsjuksköterskor inom vuxenpsykiatrisk öppenvård i Region Skåne intervjuades. Tio semistrukturerade intervjuer genomfördes. Resultat: I resultatet framkom tre kategorier: betydelsen av tillit till egen intuition, vikten av tilltro till organisationens stödjande struktur och värdet av förtroende i kommunikationen med patienten. Slutsats: Genom att ha insikt om vad arbetets utmaningar innebär för specialistsjuksköterskan, genom lyhördhet, god kommunikation, fungerande rutiner och kollegial samverkan optimeras förutsättningarna för att utföra en trygg suicidriskbedömning.Resultatet kan användas i utbildningssyfte och som diskussionsunderlag i klinisk verksamhet för att öka kunskap, kompetens och självmedvetenhet vid suicidriskbedömningar. Vidare forskning om suicidpreventivt arbeteutifrån patientens perspektiv skulle vara till nytta. / Background: Suicide is a public health problem that has reached epidemic proportions globally. Suicidal thoughts can be linked to feelings of hopelessness and ambivalence, loneliness, lack of self-worth, and insufficient ability to manage one's life. The specialist nurse performs suicide risk assessments to prevent suicide in psychiatric outpatient care.Carrying out suicide risk assessments is a complex task for the specialist nurse, and it is important that there is an opportunity to regulate emotions and balance commitment. Aim: The aim of the study was to describe specialist nurses' experiences of carrying out suicide risk assessments in psychiatric outpatient care. Method: An inductive approach was used, and the material was analyzed with qualitative content analysis. Specialist nurses in adult psychiatric outpatient care in Region Skåne were interviewed. Ten semi-structured interviews were conducted. Results: The results revealed three categories: The importance of trust in one's own intuition, The importance of trust in the supportive structure of the organization and the Value of trust in communication with the patient.Conclusion: By having insight into what the challenges of the work mean for the specialist nurse, through responsiveness and good communication, functioning routines and collegial collaboration, the conditions for performing a suicide risk assessment safely are optimized. The result can be used for educational purposes and as a basis for discussion in clinical practice to increase knowledge, competence and self-awareness in suicide risk assessments. Further research on suicide risk prevention from the patient´s perspective would be beneficial.

Introduction: Over 800,000 people die by suicide each year, and despite being a global public health issue, limited research exists exploring suicide risk assessment practices in emergency departments. The current thesis investigated emergency department suicide risk assessment practices and clinician experiences in Scotland, to develop guidance to inform the development of a clinically meaningful and feasible suicide risk assessment for these settings which is theoretically underpinned. Methods: A mixed-method triangulation approach was utilised. Two systematic reviews were conducted to update the risk and protective factor literature. This was followed by a national survey of suicide risk assessment practices in emergency departments. Fifty-one clinicians across 17 emergency departments participated, and six clinicians participated in follow-up semi-structured interviews to investigate their experiences, which were analysed using thematic analysis. Findings of the thesis were triangulated using the ‘following-a-thread' method, to develop guidance for informing the development of future risk assessment for use in emergency departments. Results: The systematic reviews identified emerging risk and protective factors including, sexual orientation and internet usage. The survey identified substantial variation in practice between emergency department clinicians. Only 35 (68.6%) participants reported using a suicide risk assessment tool. Importantly, variation was found not only across clinicians and departments, but also within departments, with clinicians based within the same department reporting differing risk assessment practices, indicating both inter- and intra-department suicide risk assessment practice differences. The qualitative analysis of clinician experience established four major themes (current experiences; components of suicide risk assessment; clinical decision-making; suicide risk assessment needs). Triangulation of findings developed recommendations for suicide risk assessment tools and training for emergency departments. Discussion: The risk and protective factor literature has evolved due to societal changes, and there is substantial variation in suicide risk assessment practices, both across and within emergency departments. Clinicians also find suicide risk assessment challenging. There is a need for consistent training, appropriate and helpful guidelines, and the improvement of risk assessment tools to improve practice. It is recommended that suicide risk assessment tools are developed to align to clinicians' needs, while taking into account research from the health domain and from related psychological research domains.