Free Nursing Dissertations - A Critical Evaluation Of Vrale G.b. & Steen E.(2005) Journal Of Psychiatric
A critical evaluation of VRALE G.B. & STEEN E.(2005) Journal of Psychiatric and Mental Health Nursing 12, 513-518
The dynamic between structure and flexibility in constant observation of psychiatric inpatients with suicidal ideation.
2005 Blackwell Publishing Ltd
An essay
VRÅLE G. B. & STEEN E. (2005) Journal of Psychiatric and Mental Health Nursing12, 513
The Vrale & Steen paper in question is an apparently qualitative consideration of the interplay of dynamics of the nursing staff who are the prime points of contact with psychiatric inpatients on a day-to-day basis. The study itself draws rather broad and sweeping conclusions from a comparatively small data base, namely a series of interviews with five nurses. It has to be said that to some extent, the paper states the obvious: (Birchwood et al 1998)
In summary, the findings show that constant observation of inpatients with suicidal ideation seems to consist of two main aspects. One refers to its phases and consists primarily of assessing the need for control and controlling the patient from self-harm. The other aspect refers to the relationship between the nurse and the patient during a period of constant observation.
We can clearly demonstrate from examination of other literature that there is little doubt that the patient with suicidal ideation is clearly at significantly enhanced risk of suicide. (Sandor & Courtnay 2002)
The thrust of this paper, as the title implies, is that there is a dynamic balance to be achieved between structure and flexibility. What it seems to imply, but doesn’t explicitly say, is that there is a control element which relates to the structure of a therapeutic environment and its demands of constant observation and the flexibility aspect that appears to refer to the development of a therapeutic relationship between the patient and the nurse as the demands of the constant observation take their natural course. (Jorgensen et al 2000)
In order to make sense of these findings we have to consider the evidence base for the rationale of the study (Sackett, 1996).
Suicide in inpatients is not a minor problem. (Nordentoft et al 2002). One could be forgiven for thinking that if a patient was in a secure, constantly monitored environment, that the risk, or even the possibility of suicide would be very small indeed. The reality is that this is actually a long way short of the truth. (Peveler et al 2002)
If we consider the report by Appleby (Appleby 2000) which considered the conclusions from the report of the National Confidential Enquiry into suicide, we can see that about 25% of suicides had contact with the psychiatric services in the year before death.
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