Drawing attention? Going through judgments regarding child and adolescent suicide attempts in emergency rooms from a professional perspective

Souza, Danton Matheus de; Guedes, Danila Maria Batista; Boska, Gabriella de Andrade; Miranda, Niflyer Costa; Rossato, Lisabelle Mariano

doi:10.1590/1980-220X-REEUSP-2023-0281en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 57 • 2023 • https://doi.org/10.1590/1980-220X-REEUSP-2023-0281en copy

Drawing attention? Going through judgments regarding child and adolescent suicide attempts in emergency rooms from a professional perspective

¿Llamar la atención? Recorriendo juicios sobre intentos de suicidio de niños y adolescentes en urgencias desde una perspectiva profesional

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To understand the perceptions of the multidisciplinary team of an emergency department regarding the care of children and adolescents who have attempted suicide.

Method:

An exploratory-descriptive, qualitative study, in light of the Symbolic Interactionism theoretical framework. Thirteen professionals from the multidisciplinary team from two emergency rooms (children and adults) of a secondary hospital in São Paulo participated. Data were collected between August and September 2018 using semi-structured interviews, analyzed using thematic content analysis complemented by the IRAMUTEQ^® software.

Results:

Two central categories emerged: Multidisciplinary team perceptions regarding attempted suicide care; and Multidisciplinary team perceptions regarding the possibilities for improving attempted suicide care. From these, professional perceptions of care, risk factors, emotional reactions, limitations of emergency rooms and strategies for improving practice were observed.

Conclusion:

Professionals perceived suicide attempt care from a biomedical and reductionist perspective, with an approach marked by stigma, judgment and lack of preparation.

DESCRIPTORS
Suicide, Attempt; Emergencies; Child Health; Child; Adolescent; Health Personnel

Category: Multidisciplinary team perceptions regarding attempted suicide care
Subcategory 1: Beware of attempted suicide: lack of preparation and the crossing of personal values
Here it is perfect. It has a humanized team. (...) doctors save a lot. (NT10) In the emotional part, we have no tools. Everyone acts the way they think is best. (...) there are professionals who treat SA as a problem, but others say that it is a lack of shame, of being beaten, of pulling the ear. (N2) It is hard. It’s not the best service you like to give. We like to serve people who are really suffering from an illness, something that you seek to remedy. For someone who attempts suicide, you (professional) will only take action to get them out of the chaos they find themselves in. But it’s not a satisfaction, you say, “Damn, you came here brought by someone who is distressed”. It is a lack of responsibility by adolescents. A total alienation of the implications. (...) you provide care out of obligation, because it is your job. (D11) I always talk to myself: both an old man with an incurable disease fighting to live and a child, who has his whole life ahead of him, wanting to take his own life. (N2) I observe and approach the children. I see it as something integral to my role. Accept this type of complaint. It is an emotional pain that deserves respect and adequate care. (N13)
Subcategory 2: “Drawing attention”: judgments or risk factors?
I don’t have that knowledge of basic psychology to be able to differentiate whether the child has an ideation or is attracting attention. (D7) We went to talk to the mother. She said it wasn’t the first time, that the adolescent always did this to get attention. (NT10) The triggering factors alleged by the child are banal. (D7) It cannot be classified as SA; in fact, it is closer to ‘attempting to attract attention’. They (adolescents) warn, say what they did, and those who want to commit suicide don’t do that. (D11) I think there is a lack of attention from the family. (N2)

Category: Multidisciplinary team perceptions regarding attempted suicide care
Subcategory 3: Meaning of care: emotional repercussions experienced by professionals
I confess that I didn’t understand why people would go to a hospital if they wanted to die, because here we are working to save lives, and those who want to take their lives come. This made me uncomfortable, because I was busy with other demands. (N13) At first, it was really annoying, I was angry. (...) I would enter the emergency room irritated, “What the hell, life is so good and this person is going to destroy life”. (N6) It’s frustrating. Service means that several things failed to get there. (D7) It makes quite an impact. (...) it doesn’t cause me suffering, because I’m already prepared, I’ve handled situations like this for many years, giving me structures to deal with. (SW4)
Subcategory 4: Limitation of punctual care in a longitudinal demand
We do what an emergency room can do. (...) we will carry out the procedures and then we will provide welcoming if the scenario allows. (N13) The adolescent has a first visit to the emergency room, and that’s it. Theoretically, this is what he needs here (clinical care). (NT8) Network interconnection is important. They are treated in the emergency room, but it is punctual. (SW4)

Category: Multidisciplinary team perceptions regarding the possibilities for improving attempted suicide care

Subcategory 5: Giving new meaning to care: institutional or personal changes?

I think something had to be done to assess the extent to which this person actually has suicidal ideation or is drawing attention in a wrong way. (D7)

Here we work very much based on protocols. (NT9)

A protocol with interdisciplinary involvement is needed. (...) so that you can be a little more certain that, when you leave, there will be no new attempts. (N3)

We have a lack of preparation in many areas. I may be unprepared to make a bandage, respond to a stop, but I train and I can improve. What I notice in practice is that people don’t care about learning what they can do. So, it depends more on her to raise awareness empirically and take the precautions that everyone should. (N13)

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Danton Matheus de Souza, Av. Valdemar Ferreira, 150, Butantã, 05501-000 – São Paulo, SP, Brazil danton_souza@usp.br