The inner door: toward an understanding of suicidal patients

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Aims and objectives.To describe the suicide care dilemmas that psychiatric nurses experience and how they respond to suicidal patients.Background.Psychiatric nurses play a major role in helping patients after suicide attempts. Little is known, however, about the ways nurses resolve their suicide care dilemmas.Design.Focused ethnography was used to describe the meanings and patterns of actions of psychiatric nurses in a medical centre in Taipei, Taiwan.Methods.Fieldwork included two years of participant observation and individual interviews with 18 psychiatric nurses. Data from transcripts of observation field notes and interviews were transcribed verbatim and analysed.Results.An important factor, the inner door (an invisible door inside the nurse's mind), determined the nurse's ability to understand the inner worlds of suicidal patients and the nurse himself or herself. In the absence of such understanding, nurses felt discouraged, labelled the patients and even restrained them, thus closing their inner doors. On the other hand, the nurses' willingness to reflect on their own experiences and receive the patients' teaching helped them understand the defensive patients and nurses themselves, thus opening the inner doors and enabling them to treat patients as their family or friends.Conclusions.The opening and closing of the inner door is a dynamic process. Nurses need to understand the essential meaning of a suicide experience to develop the insight to open the door and keep it open.Relevance to clinical practice.The concept of an inner door helps nurses better understand why they distance themselves from patients when they encounter clinical dilemmas and offers a way to resolve their inner conflicts through self-reflection and appreciation of the patient's experiences.

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