Trying to keep alive a non-traumatizing memory of the deceased: A meta-synthesis on the interpretation of loss in suicide-bereaved family members, their coping strategies and the effects on them.

WHAT IS KNOWN ON THE SUBJECT?: Losing a family member due to suicide has been described as a traumatic experience, as suicide-bereaved relatives grapple to accept the particular character of death and the core elements of guilt, self-criticism and stigma it inflicts. There are long-term consequences for those who bereave due to the suicide of their beloved on, a high risk for mental and physical health problems included. Feelings of guilt and self-stigma influence help-seeking behaviour among suicide-bereaved individuals. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Coping mechanisms adopted by suicide-bereaved individuals mediate the impact of suicide on their family, and especially on the quality of relationships among them. Supporting others in need can help alleviate guilt and self-blame for the suicide while it enables the bereaved to fulfil their need to keep a non-traumatizing, or even positive bond with the deceased. WHAT THE IMPLICATIONS FOR PRACTICE ARE?: Nursing interventions to facilitate suicide-bereaved family members' participation in self-help support groups and promote their engagement in supporting others in need are important. Mental health nurses need to facilitate the replacement of dysfunctional coping strategies, such as substance use or self-blame with more adaptive ones focused on the personal needs of the bereaved, in order to help them embrace a non-traumatizing memory of the deceased while being in peace with the social environment. Screening for mental health problems and management of shame, self-stigma and guilt during the grieving period needs to be a priority in nursing interventions. ABSTRACT: INTRODUCTION: Losing a family member to suicide is a traumatic experience which includes guilt and self-stigma. Yet, there is lack of data synthesis on the survivors' experience. AIM: A meta-synthesis of qualitative data on the interpretation of loss in suicide-bereaved family members, their coping strategies and the effects on family. METHOD: A meta-ethnographic synthesis following a systematic literature search and evaluation of the methodological quality of the selected studies was applied. RESULTS: The narratives of 326 individuals (parents/siblings/children/spouses) reported in sixteen studies were analysed. Trying to achieve a balance between keeping alive a non-traumatizing memory of the deceased, destigmatizing and liberating themselves from self-blame, self-criticism and guilt while being able to transform this experience into support towards others in need, was identified as the essence of the experience of the bereaved. DISCUSSION: Although suicide within a family is a traumatic experience, spiritual and existential implications among the bereaved have been reported; their coping mechanisms mediate the impact of suicide on family sustainability. IMPLICATIONS FOR PRACTICE: Nursing interventions to facilitate adoption of coping strategies centred on keeping a non-traumatizing memory of the deceased among the bereaved and promote their participation in self-help groups and activities to support others in need are important.

Association between illegal use of substances and suicidal behavior in school students: An integrative review of empirical data.

PURPOSE: Investigation of the association between type of suicidal behavior and type and frequency of illegal use of substances (IUS) among school students (aged between 12 and 18 years), with a focus on gender differences. DESIGN AND METHODS: A systematic review in PubMed, CINAHL, PsychINFO, and Scopus was performed. Identified articles were published between 2007 and 2018. RESULTS: Twenty empirical studies confirmed the association between IUS and suicidality, strongly differentiated between males and females, highlighting the importance of gender-specific mediating factors. CONCLUSIONS: Mental health nurses need to document gender factors, frequency, and motivation of IUS when screening adolescents experiencing suicidal behavior and IUS.

A Phenomenological Investigation of the Interplay Among Professional Worth Appraisal, Self-Esteem and Self-Perception in Nurses: The Revelation of an Internal and External Criteria System.

Nurses' professional self-concept is strongly associated with professional worth appraisal, which encompasses their feelings and perceptions regarding their task efficacy and value of input to clinical outcomes. Professional self-concept and professional worth appraisal are incorporated in one's overall professional role perception. Data show that the way nurses think and feel about themselves personally and professionally, is associated with their well-being, the quality of provided patient care, their job satisfaction and retention. Although researchers indicate that professional self-concept is a different entity from personal self-concept, however, a clear differentiation and possible interaction between these constructs has not been yet adequately described in nursing literature. Personal self-concept mirrors the way people interpret them-selves, incorporating their self-awareness and personal effectiveness. Following purposeful sampling and informed consent, a phenomenological approach based on Munhall's methodology was employed to explore the living experience of professional role perception in 16 critical and emergency nurses, with special focus on their perceptions and feelings about personal and professional-role worth appraisal. Data and theoretical saturation criteria were implemented, along with all nine Munhall's criteria for the rigor and trustworthiness of phenomenological studies. The participants' narratives suggested a possible interaction between professional attitude and personality traits, illuminating as the core theme an interplay among self-perception, personal and professional worth appraisal process. Additionally, the present study emphasized the way self-evaluation criteria system may be associated with the personal and professional self-concept in nurses. In particular, it was highlighted that the way nurses think and feel about themselves is associated with the way they experience their professional role and vice versa, and that professional role-based self-concept and professional worth perception can be linked with their well-being. Furthermore, positive feelings about the self and personal competencies seemed to enhance the perception of effectiveness in clinical settings and adequacy of professional skills, resulting in empowered professional identity and vice versa. Overall, the present findings are discussed in relation to nurses' experience of work-related stressors and relevant interventions. Further exploration of the effectiveness of interventions for facilitating adaptive personal and professional self-appraisal are suggested.

Perceptions of professional role in community mental health nurses: The interplay of power relations between nurses and mentally ill individuals.

Nurses' professional role perception is related to the quality and safety of care. Limited data exist regarding professional role perception in community mental health nurses (CMHNs). The aim of the present study was to investigate the living experience of Greek-Cypriot CMHNs of their professional role. A phenomenological approach based on Munhall's methodology was applied. According to purposive sampling, five Greek-Cypriot CMHNs participated, following informed consent. The interplay of power relations between participants and mentally ill individuals during CMHNs' house calls was revealed as the core theme contributing to the perception of their status within their professional role. Participants' perception of their status as visitors in patients' homes rather than authoritative figures, an image held within hospital mental health services, was deemed as the greatest challenge of their professional role. Moreover, the necessity for autonomous and rapid decision-making during home visits was described as an absolute prerequisite for professional effectiveness. Overall, the main themes were grouped as follows: professional role perceptions, perception of self within professional role, feelings and expectations about professional role. Non-power relations between participants and patients, along with efficacy, control and adequate clinical autonomy for effective professional practice were highlighted as major prerequisites during house calls. Interventions towards nurses' psychosocial and organizational empowerment, as well as strengthening patients' self-determination are proposed.