Nurses’ interest in the care of patients who have attempted suicide in hospital-based emergency care settings: a grounded theory study

BACKGROUND: Emergency nurses caring for patients who have attempted suicide face ethical dilemmas and negative emotions that hinder empathetic care. Existing studies have mainly reported emotional burden and mixed attitudes, with limited research examining nurses' internal interest processes. Therefore, this study aimed to clarify the structure and processes underlying nurses' interest in caring for these patients in hospital-based emergency care settings, using a grounded theory approach. METHOD: Data were collected through semi-structured interviews with 25 nurses experienced in emergency care in Japan who had provided care to patients who had attempted suicide. Interviews were conducted from August 2022 to December 2023 and analyzed using constant comparative analysis. RESULTS: Six major categories emerged: "Attention towards care," "Being influenced by one's inner self," "Welling up emotions," "Focusing on attention," "Deciding the direction of care," and "Taking a meta-perspective on oneself within the situation." Nurses' beliefs and values were profoundly challenged by the gravity of suicide attempts, eliciting complex emotional responses combining a sense of moral responsibility, discomfort, and conflicting feelings. CONCLUSIONS: Emergency nurses maintained an interest in patient care despite emotional conflict and a destabilized sense of self. Self-awareness and situational awareness, particularly taking a meta-perspective, supported professional caring and decision-making.