Safe clinical practice for patients hospitalised in mental health care during a suicidal crisis is situated within a dynamic, non-linear and uncertain context. Under such complex conditions, the adaptive capacity is considered vital to handling challenges and changes in clinical care. This study aimed to explore safe clinical practice for suicidal patients hospitalised in mental health wards through understanding healthcare professionals’ (HCPs’) capacities to adapt to challenges and changes in clinical care. This study applied a qualitative design with focus group and individual interviews. Twenty-five HCPs participated in the focus groups, and 18 participated in individual interviews. The study was conducted in open and locked wards in a university hospital in Norway providing specialised mental health services for patients with mental illness. HCPs described their adaptive capacities for clinical practice relative to three themes. 1) HCPs used expertise to make sense of suicidal behaviour to support complex decision making. Their strategies included setting aside forms and checklists to prioritise trust and making judgements based on more than just patients’ spoken words. They improved their understanding by seeking others’ perspectives through collaborative sense-making processes involving the healthcare team and patient. 2) HCPs individualised the therapeutic milieu to address the diversity of patients with suicidal behaviour by creating individual clinical pathways, making trade-offs between under- and over-protection and adjusting observations. 3) HCPs described managing uncertainty as necessary for providing safe clinical practice. They managed uncertainty as a team by developing mutual collegial trust and support and creating a shared understanding. HCPs’ adaptive capacities are vital to the complex set of practices involved in safe clinical practice for patients hospitalised during a suicidal crisis. By using expertise, individualising the therapeutic milieu, and managing uncertainty, HCPs individually and collectively develop their capacities to adapt to challenges and changes in clinical care. HCPs cannot easily ensure safe clinical practice by following standards; safe clinical practice depends on HCPs’ adaptations. Ward systems that ensure collegial trust and support, as well as arenas that foster shared understanding and situational awareness, are needed.

中文翻译：

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自杀危机期间住院患者安全临床实践的适应能力：一项定性研究。

自杀危机期间住院精神卫生保健患者的安全临床实践处于动态、非线性和不确定的背景下。在如此复杂的条件下，适应能力被认为对于应对临床护理中的挑战和变化至关重要。本研究旨在通过了解医疗保健专业人员 (HCP) 适应临床护理挑战和变化的能力，探索精神健康病房住院自杀患者的安全临床实践。这项研究采用了焦点小组和个人访谈的定性设计。25 名 HCP 参加了焦点小组，18 名 HCP 参加了个人访谈。这项研究是在挪威一所大学医院的开放式和上锁病房中进行的，该医院为精神疾病患者提供专门的心理健康服务。HCP 描述了他们对与三个主题相关的临床实践的适应能力。1) HCP 利用专业知识来理解自杀行为，以支持复杂的决策。他们的策略包括搁置表格和清单，优先考虑信任，并不仅仅根据患者的口头语言做出判断。他们通过医疗团队和患者的协作意义构建过程寻求他人的观点，从而提高了理解。2) HCP 通过创建个体临床路径、在保护不足和过度保护之间进行权衡以及调整观察结果，个性化治疗环境，以解决自杀行为患者的多样性。3) HCP 表示，管理不确定性是提供安全临床实践所必需的。他们作为一个团队通过建立相互的信任和支持以及建立共同的理解来管理不确定性。医护人员的适应能力对于自杀危机期间住院患者的安全临床实践所涉及的一系列复杂实践至关重要。通过利用专业知识、个性化治疗环境和管理不确定性，HCP 可以单独和集体发展其适应临床护理挑战和变化的能力。HCP 无法轻易通过遵循标准来确保安全的临床实践；安全的临床实践取决于 HCP 的适应。需要确保同事信任和支持的病房系统，以及促进共同理解和态势感知的场所。