What did I miss? A qualitative assessment of the impact of patient suicide on hospice clinical staff.

BACKGROUND: Patient suicides can affect clinicians both personally and professionally, with frequent reports of psychological and behavioral changes occurring in response to this type of patient death. Although hospice clinicians have regular exposure to dying patients, the impact of patient suicide on this group has been understudied.
OBJECTIVES: This study examined the personal and professional impact of patient suicides among hospice clinical staff, the coping strategies used by this group, and their recommendations for staff support after a patient suicide.
DESIGN: Utilizing an online survey, 186 hospice staff qualitatively described the impact of patient suicides on them as people and professionals, their resulting coping strategies, and any recommendations for supporting others. Three study investigators coded all of the staff responses at a paragraph level and summarized the most common emergent themes using grounded theory procedures. SETTING/
SUBJECTS: One hundred eighty-six clinical staff members who worked in an academic nonprofit hospice setting. MEASUREMENTS: An open-ended, qualitative survey was used to gather data about demographics, clinical experience, exposure to known or suspected suicides, recommendations for support in the event of a patient suicide, the personal and professional impacts of suicide, and coping strategies.
RESULTS: The themes expressed by the hospice staff in reaction to patient suicides included: psychological responses such as feelings of guilt and self-doubt, changes in professional attitudes, and changes in clinical practice such as greater sensitivity to signs of suicide. When coping with a patient suicide, hospice staff described the use of team-based support strategies, debriefings, and personal spiritual practices. Recommendations for future support included facilitated debriefings, individual counseling, spiritual practices, leaves of absence, self-care activities, and educational interventions.
CONCLUSION: Data from this small study may help clinicians and administrators more fully understand the impact of patient suicides on hospice staff and may serve as a foundation for the development of effective strategies to support staff after a patient suicide.