Negotiating meaning within healthcare to improve suicide prevention

Date18 February 2020
Publication Date18 February 2020
AuthorSusanna Doyle
SubjectHealth & social care,Vulnerable groups,Adult protection,Safeguarding,Sociology,Sociology of the family,Abuse
Negotiating meaning within healthcare to
improve suicide prevention
Susanna Doyle
Purpose A framework for ‘‘negotiating meaning’’ was applied to a healthcare service to achieve a
collaborativelydeveloped suicide preventionclinical pathway.
Design/methodology/approach The framework was originally developed during a previous study that
drew on the theory of philosophical hermeneutics to enable a researcher to better understand the experience
of older people. This approach was then applied to a healthcare setting and the development of a suicide
prevention clinical pathway. Clinical front-line staff engaged effectively and meaningfully with each other,
consumers, family members and management to develop a clinical guideline that reflected best practice and
improved care provision. An additional outcome involved establishing a supportive culture in which the
shared meanings underpinning the experience of working with people expressing suicidality were explored.
Findings An evidence-based suicideprevention clinical pathway was developed collaboratively with
clinicians taking the lead in the process, and leading to the agreement being reached on the final
guideline and processesestablished. The negotiation process broughtthe perspectives of the different
parties together enabling the sharing of underlying meaning inherent in the experience of losing a
consumer tragically to suicide. A commitment to taking joint action to reduce the likelihood of further
incidentsoccurring also grew from the shared understandingthat developed.
Originality/value This paper describes the approach that was applied to facilitate engagement
processes betweenclinicians and service management that also challengedthe power differentials that
usually exist within healthcare and led to positive engagement that supported the safety and quality
Keywords Mental health, Participation, Clinical pathway, Suicide prevention, Negotiating meaning,
Clinician led, Philosophical hermeneutics
Paper type Conceptual paper
1. Introduction
The framework for “negotiatingmeaning” with participants of a research study was raised in
a previous article by Doyle (2017), who described the processes undertaken by the
researcher to achieve what was termed a “fusion of horisons” in research (Doyle, 2017). A
“fusion of horisons” was achieved when, through a period of in-depth interaction between
the researcher and participants, each person’s understanding moved to become more
closely aligned with that of other parties. This enabled a deeper sharing of knowledge and
an understanding of the original intended meanings contained within the participant’s
The original study undertaken was developed to better understand the lived experiences of
older people, normally viewed as a vulnerable group within Australian society, receiving a
discrete type of community aged care (community aged care packages). Strategies used
were aimed at the researcher becoming more sensitised to the experience and point of
view of the older participants, to better understand the impact of care on them as
individuals. The article proposed applying the same approach withinhealth care settings as
a way of building a greater understanding of the experience of health care for individual
Susanna Doyle is based at
Mental Health and
Addictions Service,
Sunshine Coast Hospital
and Health Service,
Birtinya, Australia.
Received 5 October 2019
Revised 8 December 2019
22 December 2019
6 January 2020
Accepted 7 January 2020
The author would like to
acknowledge the significant
contribution to the project by
the lived experience, consumer
and carer representatives; the
members of the toward zero
suicide steering committee; the
clinicians of the mental health
and addiction services; and the
zero suicide champions and
who participated in the toward
zero suicide project (from the
first phase of the pilot: Cameron
Holt, Tracey-Lee Stirling, Anne
Humbert and Susan Stuart).
The author would also like to
acknowledge the contributions
of Fiona Jarrett, Team Leader;
Dr Chris Lilley, the Clinical
Director, and the Executive
Sponsor, Karlyn Chettleburgh,
the Chief Operations Officer.
The project could not have
been completed without their
contribution and commitment to
saving the lives of the
consumers presenting to the
DOI 10.1108/JAP-10-2019-0034 VOL. 22 NO. 2 2020, pp. 103-112, ©Emerald Publishing Limited, ISSN 1466-8203 jTHE JOURNAL OF ADULT PROTECTION jPAGE 103

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