Experiences of general home visiting nurses regarding patients with suicidal ideation in Japan: Results from semi-structured interviews.

WHAT IS KNOWN ON THE SUBJECT?: The leading reason for suicide attempts in Japan is health problems, among which depression is the most common, followed by physical illnesses. Patients with physical illness and suicide ideation are not rare among patients receiving home-based care. General home visiting nurses (GHVNs) without knowledge, skills or experience in psychiatric care are required to provide care for patients with physical illness who are at risk of suicide in Japan. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: More detailed understanding of GHVNs' experiences and perspectives on working with suicidal patients in home care. This study enriches our understanding of how suicide prevention strategies should be developed for GHVNs. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Focusing education on therapeutic communication skills and meanings with relationships with patients is required by GHVNs. Training for suicide risk assessment and guidelines appropriate to GHVNs' situation is crucial. Establishing a liaison service system with a multidisciplinary team, including psychiatric home-visiting nurses, is necessary for home healthcare to achieve continuity of care. ABSTRACT: Introduction In Japan, even a general home visiting nurse (GHVN) lacking psychiatric experience and training can provide home nursing care to patients at risk of suicide. Little attention is given to nursing care for suicide by GHVNs who care for patients with physical illness. However, these patients with suicidal ideation for home care are surprisingly common. Aim/Question We explored the experiences of GHVNs who cared for patients with suicidal ideation and focused on the nurses' perceptions and interactions. Method We conducted semi-structured interviews with 15 GHVNs. We discussed the nurses' experiences caring for patients with suicidal ideation, their perceptions during these interactions and their response. Results General home visiting nurses were perplexed upon learning of the patient's suicidal ideation. They interacted with such patients by 'avoiding the core of the matter' while focusing on maintaining a relationship with them. Discussion Not addressing the patient's suicidal thoughts will not only disable the suicide risk assessment but also lead to patient isolation. Suicide prevention care needs to consider the unique characteristics of home care. Implications for Practice General home visiting nurses require training in suicide risk assessment and communication skills. Establishing a liaison service, including psychiatric home visiting nurses, is necessary to achieve continuity of care.