Gaps in Suicide Assessment and Management Among Accident and Emergency Nurses in Kenyatta National Hospital: a Qualitative Study

This qualitative study was conducted using key informant interviews with Accident and Emergency and Mental Health staff at Nairobi’s Kenyatta National Hospital to examine the current state of suicide assessment and management care at the Department. The interviews probed whether protocols were in place and if the key personnel were aware of these procedures and to what extent evidence-based protocol was used in managing suicidal patients at A&E. We interviewed eight key informants who rotated in the Accident and Emergency Department and Mental Health Department, and they were interviewed using a semi-structured interview guide. We included clinicians and administrators in addition to the nurses. Using NVivo Pro 11 software, themes and subthemes were derived with the final code system having patient assessment and patient management, as well as protocol and care gaps and further recommendations as the key themes. With regard to patient assessment, all the interviews identified stressful life situations, substance use, and violence as being the dominant presenting complaints in patients with suicidal tendencies who were seen at A&E. Five out of eight interviews with our key respondents mentioned depressive symptoms as a clinical presentation for suicidal patients. Six out of eight respondents also shared that there were no protocols for assessing and managing suicidal patients with some reporting that they used what they learnt in Nursing and Medical School to offer management in that point of time. Most of our respondents mentioned that clinical management of suicidal patients was mostly done with the use of force to deal with violent and resistant patients. Psychological management was essentially an ex post facto issue left to the very few counselors within the Department. Most of our respondents did not have information on their patients after discharge raising questions about patient safety and well-being. Our analyses of these interviews led us to the conclusion that there were significant gaps in assessment as patients were not routinely screened for suicidal ideation despite suicidal intent and psychological problems being undercurrent issues. Psychological management was sparse with most of it being left to very few staff. Training in suicide assessment for all patients and management we felt was critical in increasing the self-efficacy of nurses in Accident and Emergency Department in handling medical emergencies that are prompted due to mental health issues and suicidal and self-harming behaviors.