Bakgrund: De senaste åren har antalet suicid och suicidförsök ökat. Livsvärlden i relation till hälsa och ohälsa var bärande begrepp i denna studie då detta ansågs vara av vikt för både hur sjuksköterskan och patienten kom att uppleva mötet efter ett suicidförsök. I bakgrunden beskrevs dessutom vikten av stöd för sjuksköterskan samt vilken roll hon eller han hade gentemot patienter som gjort ett suicidförsök. Syfte: Syftet var att beskriva sjuksköterskans upplevelser i mötet med patienter efter ett suicidförsök. Metod: Vald metod var en litteraturöversikt. Artiklar söktes via databaserna CINAHL och MEDLINE, vilket genererade i 153 träffar totalt. Av dessa användes fem artiklar till studiens resultat. Resterande sex artiklar framkom via frisökning. Resultat: Resultatet presenterades genom tre kategorier, vilka delades in i sju underkategorier. Kategorierna benämndes som Upplevelsen av negativa känslor i mötet, Upplevelsen av positiva känslor i mötet samt Faktorer som påverkar upplevelsen av mötet. Diskussion: För att sjuksköterskans upplevelser skulle bli så bra som möjligt i mötet med patienten var det viktigt att denne inte påverkade hur mötet kom att bli genom sin egen negativa inställning. Reflektion sågs som ett viktigt hjälpmedel för att sjuksköterskans upplevelser av mötet skulle bli goda. / Background: In recent years, the numbers of suicides and suicide attempts increased. Lifeworld in relation to health and disease is bearing concept in this study, as it´s considered to be of importance for how both the nurse and the patient experienced the meeting after an attempted suicide. In this essay a description of the importance of support for the nurse as much as her/his role towards patient who attempted suicide. Aim: The purpose is to describe nurses´ experiences in meeting with patients after suicide attempt. Method: This study is a literature review. The articles were searched via the databases CINAHL and MEDLINE, which generated a total of 153 hits. Five of these articles were used for the study results. The six rest where found from a free search. Results: The result is introduced throw three different categories, which was divided into seven subcategories. The categories were named as The experience of negative emotions in the meeting, The experience of positive emotions in the meeting and Factors that affect the experiences of the meeting. Discussion: For a nurses´ experiences to be as good as possible in a meeting with patient who attempted suicide, it´s important that the nurses´ own negative impression don´t effects. Reflection is seen as an important accessibility for the nurses’ experience to become good.

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Inledning: Psykisk ohälsa och missbruksproblem utgör betydande riskfaktorer för suicid i vårt samhälle. Psykoterapeuters erfarenheter och upplevelser kring att bedöma suicidrisk hos patienter är ett viktigt bidrag för överlevnad och till vidare forskning för att minska antalet självmord. Syftet var att få ta del av ett antal psykoterapeuters upplevelser kring att bedöma suicidrisk hos patienter. Frågeställningarna fokuserade på terapeuternas upplevelser av att i mötet med patienter bedöma risken för suicid och vilka faktorer som enligt deras erfarenheter påverkat deras upplevelser. Metod: Datainsamling gjordes genom intervjuer med sex psykoterapeuter. Studien hade en induktiv kvalitativ forskningsansats och tillämpade en tematisk analysmetod. Resultat: Studien visar att själva samtalet och etablerandet av allians med patienten är avgörande för bedömningsarbetet. Patientens upplevelser av meningslöshet och tomhet ses som främsta riskfaktorer, liksom missbruk. Gränsen mellan psykoterapi och psykiatri upplevs ibland som otydlig, vilket kan påverka de terapeutiska ramarna. Familj och närstående beskrivs som en alltför outnyttjad resurs. Oro för att göra en felaktig bedömning, tvivel på den egna kompetensen, oro att bli ifrågasatt och granskad är personliga upplevelser som terapeuterna beskriver. Handledning och kollegialt erfarenhetsutbyte upplevs som främsta stödet i arbetet. Diskussion: Resultatet visar att terapeuterna upplever suicidriskbedömning som en viktig del i patientarbetet. Möjligt att bedöma är graden av suicidalitet hos patienten. Att kunna förutsäga ett faktiskt självmord är omöjligt. / Mental health problems and addiction problems are the two main risk factors for suicide in our society. The experiences psychotherapists have made in assessing the risk of patients committing suicide are important to further research in order to decrease the suicide numbers. The purpose of this study was to look into the experiences psychotherapists have made in assessing the risk of suicide in patients. The questions focused on the experiences of assessing the risk of suicide and which factors that might have had an influence on these experiences. Data was collected by interview with six psychotherapists. The study had an inductive qualitative approach and thematic analysis was used as method for analysis of data. Results show that the conversation and establishing of an alliance with the patient is decisive for the assessment. Feelings of meaninglessness and emptiness in the patient are seen as the main risk factors along with addiction. The sometimes indistinct borderline between psychotherapy and psychiatry may affect the therapeutic framework. Family and relatives are described as an unutilized resource. The risk of making a false assessment can at times create worries in the therapists and doubts about their own ability. Supervision and exchanging experiences with colleagues are mentioned as the main support in the work. Discussion: The results show that the therapists sees assessment of suicidal risk in the patient as an important part of the work. It is possible to assess the suicidality in the patient. It is impossible to predict an actual suicide. Further research is required to increase knowledge in the subject.

Although the amount of interest and research on college student suicide has increased in recent years, there remains a paucity of knowledge focused on issues of suicide for college students from diverse racial and ethnic backgrounds. This study aimed to expand the limited knowledge of Asian American college student suicide using archival data from a larger national study titled The Nature of Suicidal Crisis in College Students. The survey was administered collaboratively online by the National Research Consortium of Counseling Centers in Higher Education and included 70 U.S. colleges and universities. Guided by the interpersonal-psychological theory of attempted and completed suicide and a cultural frame salient to Asian Americans, this study employed qualitative research methods to capture the lived experience of fifty-eight Asian American suicidal college students. More specifically, the present investigation explored the factors that positively and negatively influenced Asian American college students with serious suicide ideation from progressing to behaviors with higher risk of lethality, such as suicide attempts and completions. Findings from a culturally grounded phenomenological analysis of participants’ narrative responses revealed protective factors including:(a) a desire not to hurt or burden others, (b) social support, (c) fear, (d) self reliance and assistance, and (e) insight and meaning. Factors that participants found least helpful in resolving their suicidal crisis were (a) academics (b) lack of social support and (c) experiences with mental health providers. The results of this study provides information that should be of interest to mental health practitioners working with Asian American college students as well as have the potential to contribute towards the formulation of a theory for this specific ethnic minority group. Additionally, it is the intention that these findings will enable design of both culturally appropriate prevention and intervention programs. / text

Titel: Kunskap – nyckeln för att se och vårda personen bakom suicidförsöket Bakgrund: Suicidförsök är en personlig tragedi inte bara för patienten utan också för de närstående och har likaså en stor inverkan på personalen. Därför är det viktigt att personalen har en positiv attityd till denna patientgrupp för att ge en så trygg och personcentrerad omvårdnad som möjligt. Syfte: Syftet var att undersöka faktorer som påverkar vårdpersonalens attityder till patienter som behöver sjukhusvård till följd av suicidförsök. Metod: En litteraturstudie innehållande 10 kvantitativa artiklar genomfördes. Artiklarna granskades, analyserades och sammanställdes i ett resultat. Resultat: Vårdpersonalens attityder till patienter som gjort suicidförsök var övervägande positiva. Faktorer som bidrog till positiva attityder var bland annat högre utbildningsnivå och längre erfarenhet inom yrket. Faktorer som bidrog till negativa attityder var bland annat liten erfarenhet av patientgruppen och mindre utbildning i att vårda patienter som gjort suicidförsök. Konklusion: Resultatet visar att vårdpersonalens attityder är övervägande positiva men att ytterligare utbildning krävs för att ytterligare förbättra attityderna och skapa en mer personcentrerad och tryggare vårdmiljö för denna patientgrupp. Nyckelord: attityd, patient, sjukhus, suicidförsök, vårdpersonal / Title: Knowledge – the key to see and care for the person behind the suicide attempt Background: Attempted suicide is a personal tragedy not only for the patient but also the family and likewise has a major impact on the health care personnel. Therefore, it is important that the personnel have a positive attitude to this patient group to provide as safe and person-centered care as possible. Aim: The purpose of this study was to investigate the factors that contribute to the attitudes of the health care personnel to the patients who need hospitalised care following a suicide attempt. Methods: A literature study containing 10 quantitative articles was conducted. The articles were examined, analyzed and compiled in a result.  Results: The attitudes of health care personnel to the patients who have made suicide attempt were mainly positive, contributing factors as to why it was satisfactory included higher level of education and longer experience in the profession. Contributing factors to the opposite attitude included little experience of this patient group and less education in caring for patients who have made suicide attempt. Conclusion: The results show that the attitude amongst health care personnel to patients who have made suicide attempt is mainly good but more education in caring for this patient group is essential to create a safer and more person-centered nursing environment. Keywords: attitudes, attempted suicide, health care personnel, hospital, patient

Möte med suicidpatienter kan ske på olika avdelningar beroende på deras behov avsomatisk sjukvård efter suicidförsök. Det behövs bredare tvärprofessionellt samarbeteoch kunskap kring mötet och vårdandet av suicidala patienter, då låg erfarenhet inomområdet kan medföra risk för sämre förståelse och bemötande av denna patientgrupp.Sjuksköterskans okunskap och rädsla att möta denna patientgrupp hindrar adekvatomvårdnad. Syftet var att belysa vilka kunskaper sjuksköterskor behöver vidvårdandet av patienter på somatiska avdelningar som överlevt suicidförsök. Enlitteraturstudie användes som metod och innefattade fem kvalitativa och fyrakvantitativa artiklar, som resulterade i två teman och sex kategorier. Första tematFörhållningssätt i vårdande av patienter efter suicidförsök hade underkategorierna:utstråla hopp och empati; reflektera över egna inställningar, barriärer och yrkesrollen;förstå vikten av god kommunikation. Andra temat Individanpassad holistisk vård förprevention mot nytt suicidförsök hade underkategorierna: se hela människan;kartlägga stressorer och riskfaktorer; finna resurser för viljan att leva. Resultatet kangenom implementering i klinisk praxis förse sjuksköterskor med ökad kunskap ochförståelse om bemötande, anpassad vägledning, patientsäkerhet och prevention motytterligare suicidförsök. Det finns ett tydligt behov av uppdaterade riktlinjer, förslagpå fortsatt eftervård och vidare forskning om hur suicidala patienter bör bemötas i vården. / The encounter with suicidal patients can occur in different departments depending ontheir need for somatic health care after suicide attempts. There is a need for broaderinterdisciplinary collaboration and knowledge about the encounter and care ofsuicidal patients as low experience in this area can create a risk of poor understandingand treatment of this patient. The nurses’ ignorance and fear to meet these patientsimpede adequate care. The aim was to highlight what knowledge nurses need to carefor patients in somatic departments who have survived suicide attempts. A literaturereview was used as method and included five qualitative and four quantitative articlesthat resulted in two themes and six categories. The first theme Approach in care ofpatients after attempted suicide had the subcategories: radiate hope and empathy;reflect on ones own attitudes, barriers and professional role; understand theimportance of good communication. The second theme Individualized holistic carefor prevention of further suicide attempts had the subcategories: see the whole person;identify risk factors and stressors; find resources for the will to live. The result can bethe implemented in clinical practice to provide nurses with greater knowledge andunderstanding of treatment, personalized guidance, patient safety and the preventionof further suicide attempts. There is an obvious need for updated guidelines,suggestions for continuing aftercare and further research on how suicidal patientsshould be treated in health care.

O suicídio é um fenômeno complexo, considerado problema de saúde pública devido às altas taxas de tentativas e consequentes óbitos. O contato inicial com o paciente que tentou o suicídio, na maioria das vezes, ocorre no pronto-socorro do hospital geral, sendo, fundamental analisar o relacionamento entre os membros da equipe de saúde e o paciente com comportamento suicida para entender como o cuidado está sendo oferecido. Este estudo teve como objetivo compreender como profissionais de saúde, que atuam no pronto-socorro, vivenciam a assistência prestada ao paciente que tentou suicídio. A pesquisa teve caráter qualitativo e a coleta de dados foi realizada por meio de entrevistas abertas. O material obtido a partir dos depoimentos foi avaliado por meio da técnica da análise temática. As respostas dadas pelos colaboradores foram agrupadas em temas comuns: conceituação do suicídio; importância do atendimento multiprofissional; diferenças entre o SUS e o sistema privado; as distintas posturas dos profissionais de saúde; relação família-paciente; medicamentos como forma de cuidado e tentativa de suicídio; sofrimento psíquico entre os profissionais. A presente investigação apontou que a assistência ao paciente que tentou o suicídio no pronto-socorro é inadequada, marcada pela falta de preparo e fragmentação do cuidado. Evita-se o contato com o sofrimento intenso relacionado com o ato suicida e o cuidado a esse paciente é redirecionado aos profissionais da saúde mental. Os fatores que influenciam na assistência precisam ser reconhecidos e reformulados para que haja melhoria na qualidade dos atendimentos possibilitando um cuidado integral à pessoa com ideação e tentativa de suicídio / Suicide is a complex phenomenon, considered a public health problem given high resultant mortality rates. In the majority of cases, initial contact with patients who attempted suicide occurs in the emergency room of a general hospital. As a result, analyzing the relationship between members of the healthcare team and the patient with suicidal behavior is paramount to understanding how care is being provided. The objective of this study was to understand health care professionals experiences in treating attempted suicide patients while working in the E.R. The study was qualitative in nature and data were collected via open interviews. The data obtained from the depositions were analyzed using thematic analysis. The responses given by the interviewees were grouped into topics: the concept of suicide; the importance of multidisciplinary care; differences between the public and private health systems; the different postures of health care professionals; the patient-family relationship; medication as both a form of treatment and a manner for attempted suicide; and psychic suffering among health care professionals. The present study found that care for patients provided in the E.R. after attempting suicide is inadequate, defined by a lack of preparation on part of the health care professionals and fragmented care. Health care professionals avoid contact with the intense suffering related with the act of suicide and these patients are redirected to mental health professionals. The diverse factors that influence care should be recognized and reconsidered so that the quality of care is improved, which would provide for holistic care of the patient with suicidal thoughts or attempted suicide

A tentativa de suicídio é uma causa muito freqüente de atendimento em urgências psiquiátricas. O presente estudo relacionou o fenômeno do suicídio com a adolescência, que é um período de conflitos e de grande vulnerabilidade. Teve como objetivo traçar um perfil epidemiológico descritivo de adolescentes, admitidos em uma unidade de emergência psiquiátrica, diagnosticados como Tentativa de Suicídio. Para isso, foram examinados todos os atendimentos de adolescentes na faixa etária entre 10 e 19 anos, admitidos na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, com o diagnóstico referido, no ano de 2002, obtidos através do Serviço de Arquivo Médico deste Hospital. Os dados foram analisados de forma quantitativa-descritiva. Os resultados mostraram que (77,8%) dos casos de tentativa de suicídio pertencem ao sexo feminino, a maioria está na faixa etária entre 15 e 19 anos com predominância do estado civil solteiro, a cor branca e estudantes, com residência em bairros de baixo nível sócio-econômico. O método mais utilizado foi a ingestão de drogas (medicamentos) e as maiores freqüências foram encontradas nos meses de fevereiro e agosto. A segunda-feira foi o dia da semana preferido e o maior número de atendimentos foi constatado no horário entre as 18 e 24 horas. Esses resultados são semelhantes aos descritos na literatura e sugerem maior atenção a esse problema de saúde pública. / Suicide attempts are a very frequent cause of psychiatric urgency assistance. This study established a relation between the suicide phenomenon and adolescence, which is a period characterized by conflicts and great vulnerability. We aimed to outline a descriptive epidemiological profile of adolescents admitted at a psychiatric emergency unit who were diagnosed as Suicide Attempt. Thus, we examined the assistance given to adolescents between 10 and 19 years, who were admitted at the Emergency Unit of the University of São Paulo at Ribeirão Preto Medical School Hospital das Clínicas, Brazil, with the above mentioned diagnosis, in 2002. This information was obtained through the Medical Record Service of this Hospital. Data were analyzed quantitatively and descriptively. Results demonstrated that (77,8%) of suicide attempt cases refer to women, most of which are between 15 and 19 years old, predominantly single, white and students, while live in low class neighborhoods. The most frequently used method was drugs (medication) intake and the highest frequency rates were found in February and August. Monday was the most preferred day of the week and most assistance was delivered between 18 and 24 hours. These results are similar to what is found in literature and suggest that greater attention should be given to this public health problem.

Submitted by admin tede (tede@pucgoias.edu.br) on 2017-02-23T18:38:39Z No. of bitstreams: 1 Alexandre Castelo Branco Herênio.pdf: 578480 bytes, checksum: 6948b5c1fb497cf043352d677461cbc9 (MD5) / Made available in DSpace on 2017-02-23T18:38:39Z (GMT). No. of bitstreams: 1 Alexandre Castelo Branco Herênio.pdf: 578480 bytes, checksum: 6948b5c1fb497cf043352d677461cbc9 (MD5) Previous issue date: 2016-02-03 / Suicide is a phenomenon present in all stages of life, however, the World Health Organization points to a significant increase in suicide rates among teenagers. Adolescence can be understood as a cultural phenomenon that marks the transition of roles and responsibilities from childhood to adulthood. The literature reports that the typical events of adolescence may contribute to the occurrence of suicide at this time of life. The purpose of this dissertation is to describe aspects related to suicide rates, and identify the incidence of ideations and suicide attempts among adolescents living in the city of Goiânia. For this purpose, three chapters will be presented organized in article format. The first chapter deals with a systematic review of the literature on suicide in adolescence. In this study, we analyzed 9 articles, 2 theses and 2 dissertations. It could be observed that the list of factors associated with suicide is extensive. The second chapter aims to describe the suicide rates of teenagers living in Goiânia from 2003 to 2013, and to investigate associated factors. For this purpose, the data of 10 to 19 yearold subjects provided by the Mortality Information System were analyzed - SIM, part of Ministry of Health responsible for the provision of information on mortality in Brazil. The results indicate a higher incidence of suicide among adolescents between 15-19 years old. However, it emphasizes a trend of increasing suicide among adolescent males between 10-14 years old. The third chapter aims to carry out an assessment of the prevalence of suicidal ideation and attempted suicide among teenagers in the city of Goiania in 2013. Also in this chapter, we evaluate the relationship between ideation and attempted suicide with self-reported problems behaviors through the Youth Self Report - YSR. The results indicate an association between ideation and suicide attempt with all behavioral problems. We also found that attempted suicide rates are higher than the rates of suicidal ideation among adolescents in this county. It is emphasized the importance of studies that understand the variables involved in suicidal behavior of adolescents, since it is the first step for the implementation of contention measures for this phenomenon. / O suicídio é um fenômeno presente em todas as etapas da vida, entretanto, a Organização Mundial de Saúde chama a atenção para um aumento significativo nas taxas de suicídio entre os adolescentes. A adolescência pode ser compreendida como um fenômeno cultural que marca a troca de papéis e responsabilidades da infância para os papéis e responsabilidades típicos da vida adulta. A literatura relata que os acontecimentos típicos da adolescência podem contribuir para a ocorrência do suicídio neste momento da vida. A proposta desta dissertação é descrever aspectos relacionados às taxas de suicídio, bem como identificar a incidência de ideações e tentativas de suicídio entre adolescentes residentes na cidade de Goiânia. Para tanto, serão apresentados três capítulos organizados no formato de artigo. O primeiro capítulo trata de uma revisão sistemática da literatura sobre o suicídio na adolescência. Neste estudo, foram analisados 9 artigos, 2 teses e 2 dissertações. Foi possível observar que é vasta a lista de fatores associados ao suicídio. O segundo capítulo tem por objetivo descrever as taxas de suicídio de adolescentes residentes na cidade de Goiânia durante o período de 2003 a 2013, bem como investigar características associadas. Para tanto, foram analisados os dados sobre suicídio de sujeitos de 10 a 19 anos disponibilizados pela Sistema de Informações sobre Mortalidade - SIM, órgão do Ministério da Saúde responsável pela disponibilização das informações sobre mortalidade no Brasil. Os resultados indicam uma maior incidência do suicídio entre os adolescentes de 15 a 19 anos. Entretanto, ressalta-se uma tendência de aumento do suicídio entre adolescentes do sexo masculino de 10 a 14 anos. O terceiro capítulo tem por objetivo realizar uma avaliação da prevalência de ideação e tentativa de suicídio entre os adolescentes da cidade de Goiânia no ano de 2013. Ainda neste capítulo, avalia-se a relação entre ideação e tentativa de suicídio com o autorrelato de problemas de comportamentos por meio do Youth Self Report - YSR. Os resultados indicam uma associação entre ideação e tentativa de suicídio com todos os problemas de comportamento. Encontraram-se também taxas de tentativa de suicídio superiores às taxas de ideação suicida entre adolescentes deste município. Ressalta-se a importância de estudos que compreendam as variáveis envolvidas no comportamento suicida de adolescentes, uma vez que este é o primeiro passo para que medidas de contenção deste fenômeno sejam implementadas.

La prévention du suicide en prison a fait l’objet d’études et expertises nationales et internationales permettant d’obtenir des informations épidémiologiques, de rechercher des profils à risque et de proposer des mesures pour les programmes de prévention. Elle manque notamment de travaux sur la clinique du suicide en prison, sur l’évaluation des mesures de prévention. Notre étude s’appuie sur une approche évaluative des mesures de prévention du suicide dans une maison d’arrêt. Nous avons proposé un entretien à des personnes incarcérées depuis 1 mois. Elles ont évalué l’utilité des 12 mesures de prévention avec une échelle de Likert en 5 points, émis des commentaires libres et indiqués au préalable si elles connaissaient le dispositif de prévention et y avaient eu recours. De plus, ont été complétés : le degré d’urgence suicidaire à J0, J7 et J28 et les facteurs l’ayant influencé, l’inventaire des raisons de vivre de Linehan (IRVL), le Mini International Neuropsychiatric Interview. Vingt des 53 participants ont été suicidaires au cours du 1er mois ; seuls 15 ont déclaré connaître l’existence d’un dispositif de prévention. Huit mesures étaient perçues comme significativement utiles. Quatre ont obtenu un résultat ambivalent : limitation des points d’attache, doublement en cellule, surveillance spéciale et cellule de protection d’urgence. La recherche de corrélations a retrouvé différents liens selon les mesures avec l’état suicidaire, le recours au dispositif, l’IRVL, les troubles psychiatriques dépistés. Nous discutons comment les outils psychologiques peuvent être utiles pour l’évolution de chacune des mesures de prévention, pour l’adaptation du programme de prévention dans son ensemble, notamment en intégrant une participation des personnes incarcérées. De plus, préserver des espaces de parole dans l’application des mesures est apparu de manière interstitielle comme une attente essentielle des participants. Des propositions de mesures ont été formulées par ces derniers et offrent des perspectives pour l’avenir. / National and international studies and reports about preventing suicide in jail have been published, giving information about epidemiology, suicide risk profiles. They also provide prevention measures. More researches are required to improve knowledge of clinical aspects of suicidal behaviors in prison and to evaluate prevention programs. The study consisted in an assessment of 12 measures of a local preventing suicide program. We asked prisoners who had been jailed since one month for an interview. First they had to tell if they knew about the existence of a prevention program. Second, they evaluated the usefulness of each measure in (5 points - Likert scale). They freely explained their choices. We asked them about suicidal ideation’s presence since they had arrived in jail, their urgency degree at D0, D8 and D28, and the factors that contributed to these states. They filled the Reasons for Living Inventory of Linehan (RLIL) and the Mini International Neuropsychiatric Interview. Twenty of the 53 participants have had suicidal thoughts during the first month ; only 15 told they knew there was a suicide prevention program. Eight measures were noted as significantly useful. Four of them obtained a middle score : limitation of hanging points, cell doubling, special monitoring, special protection cell. The search for correlations have found different combinations of links between some measures, the suicidal states, use of the program, the RLIL and psychiatric disorders. We discuss about how psychological tools can be helpful to the evolution of each measure, to the adaptation of the global prevention program. Notably, the prisoners’ participation is in particular proposed. Moreover, preserving speaking time with freedom of expression in the application of the program was expected by the participants. At last, they proposed innovative methods that could serve as a lead for followup works.