{"paper_id":"372da864-6e7c-40e0-b9b6-d3f910984e55","body_text":"Suicide-related perspectives and life experiences of nurses in Türkiye who attempted suicide: A phenomenological study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Suicide-related perspectives and life experiences of nurses in Türkiye who attempted suicide: A phenomenological study Ozlem Kackin, Mehmet Kenan Erol This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8491955/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background: In recent years, suicide rates among nurses have risen to an alarming level, underscoring the urgent need to understand the underlying causes within this professional group. Aim: This study aimed to explore the perspectives and lived experiences related to suicide among nurses in Türkiye who have attempted suicide. Methods: The research was conducted between September 2, 2024, and January 6, 2025, using a hermeneutic phenomenological approach. The study sample consisted of 11 nurses who had previously attempted suicide and voluntarily participated in the research. Data was collected through a structured questionnaire and semi-structured, in-depth interviews. The data was then analyzed using the interpretive phenomenological analysis method. Results: The findings were organized into four main themes: (1) Reasons Leading to Suicide; (2) The Process of Deciding and Attempting Suicide; (3) The Reconstruction Process Following a Suicide Attempt; (4) Metaphors Describing the Suicide Experience. This study underscores the complex interplay of psychological, professional, social, and cultural factors influencing the suicide experiences of nurses in Türkiye. Conclusions: Participants’ narratives revealed not only personal struggles but also systemic challenges within the healthcare system that exacerbate these difficulties. Recovery following a suicide attempt necessitates strong emotional, social, and institutional support. Consequently, comprehensive prevention strategies should be implemented, including the promotion of a supportive work environment and the improvement of working conditions within the nursing profession. Interventions must prioritize mental health awareness, early identification of psychological distress, and the provision of accessible psychosocial services tailored to the specific needs of nurses. lived experiences mental health nurses phenomenological study suicide Figures Figure 1 Introduction Suicide is a significant public health issue that not only results in personal tragedies but also has profound implications for societies and healthcare systems. According to the World Health Organization (WHO), approximately 720,000 individuals die by suicide each year, equivalent to nearly 80 people per minute. In 2021, suicide was identified as the third leading cause of death among individuals aged 15–29 [ 1 ]. Importantly, suicide is not confined to the general population; it is also prevalent among individuals working in the healthcare sector, particularly among nurses [ 2 – 4 ]. Available statistics indicate that nurses experience higher suicide rates than both the general population and certain other occupational groups [ 5 ]. For instance, Davis et al. (2021) reported that between 2007 and 2018, nurses were 18% more likely to die by suicide than the general population [ 6 ]. Similarly, the first national longitudinal study conducted in the United States found that nurses were more likely to die by suicide compared to the general population [ 7 ]. In a study conducted in Hong Kong, 14.9% of nurses reported having suicidal thoughts, and 2.9% had attempted suicide in the past year [ 4 ]. These alarming statistics underscore the elevated risk of severe mental health problems among nurses, calling for immediate intervention [ 8 ]. Psychiatric and mental health nurses play a critical role in identifying early warning signs and implementing preventative strategies tailored to the specific needs of healthcare professionals [ 9 ]. In Türkiye, the prevalence and underlying dynamics of suicide among healthcare professionals—including nurses—have not been adequately researched or systematically documented. Consequently, the causes and risk factors of suicide in this group remain largely unidentified [ 10 ]. There is currently no official body in Türkiye that systematically monitors, collects, and analyzes suicide data related to healthcare workers. In many instances, these incidents are underreported, vaguely documented, or entirely excluded from official records [ 10 ], limiting public awareness and policy responses to this serious issue. Additionally, Türkiye lacks the implementation of comprehensive preventative programs to address suicide within the healthcare workforce [ 11 ]. Since the post-pandemic period, the psychological burden on nurses has continued to intensify [ 12 ]. However, in the absence of concrete policies and robust scientific research, efforts to prevent suicide in this vulnerable group remain insufficient. Although nurses are widely recognized as a high-risk group, most existing studies have focused on factors such as occupational stress, burnout, access to lethal means, and psychosocial challenges [ 4 , 5 ]. Notably, there is a lack of qualitative research that explores the lived experiences of nurses who have attempted suicide—research that would shed light on how these individuals interpret their life experiences and the internal and external mechanisms that either lead them toward or deter them from suicide. This gap in the literature may result in the development of prevention and intervention strategies based on theoretical assumptions rather than grounded in real-life experiences. The personal narratives of nurses who have attempted suicide offer essential insights into potential points of intervention, the absence of effective support systems, and the factors that contributed to their survival. Therefore, the present study aimed to explore the suicide-related perspectives and life experiences of nurses in Türkiye who have attempted suicide. A phenomenological approach was employed, as it provides a rigorous and empathetic framework for understanding deeply personal and emotionally charged experiences such as suicide. This approach allows for the identification of shared patterns and meanings among participants, offering a comprehensive understanding of the phenomena under investigation. This study is among the first in Türkiye to directly examine the suicide attempt process, related experiences, and contributing factors from the perspectives of nurses themselves. By offering an in-depth analysis of their lived experiences, the findings have the potential to inform the development of more effective and evidence-based individual and institutional strategies for suicide prevention within the healthcare sector. Methods Design This qualitative study employed a hermeneutic phenomenological approach. Hermeneutic phenomenology emphasizes understanding the lived experiences individuals within broader social, cultural, political, and historical contexts, and aims to identify common interpretations of these experiences [ 13 ]. This methodological framework was chosen to foreground the shared perspectives and life experiences of nurses who had attempted suicide and to explore the meanings they attributed to the phenomenon. Setting and Time Data collection was carried out between September 2, 2024, and January 6, 2025, using an online video conferencing platform. This method provided flexibility for participants across various regions of Türkiye while ensuring privacy and comfort during the interview process. Sampling method A purposive sampling strategy was employed. In phenomenological research, it is essential that participants have directly experienced the phenomenon under investigation in all its dimensions [ 13 ]. Accordingly, nurses who met the following inclusion criteria were purposefully selected: (1) being over the age of 18, (2) having attempted suicide while actively working as a nurse, (3) voluntarily agreeing to participate in the study, and (4) having no diagnosed psychiatric disorders that might interfere with participation. An invitation to participate was disseminated via email to addresses listed in the Ministry of Health's registry. The email provided detailed information about the study’s purpose, procedures, and the researchers’ areas of expertise. Initially, 13 nurses across Türkiye expressed willingness to participate. One individual was unable to attend due to scheduling conflicts, and another participated only in the pilot phase. Data saturation was observed beginning with the tenth interview, indicating that no new themes were emerging. However, to enhance the reliability and stability of the identified themes, an eleventh interview was conducted. While this final interview did not yield additional themes, it contributed to the expressive diversity and content richness of the existing data. Therefore, a total of 11 nurses were included in the final analysis. The sociodemographic characteristics of the participants are presented in Table 1 . Table 1 Characteristics of the Participants Nurses' code Age Gender Level of education Years of professional experience Totalnumber of suicide attempts Methods of suicide attempts N1 35 Female Licence 12 years 2 Drug overdose N2 27 Female High School 9 years 1 Pesticide poisoning N3 32 Male Licence 12 Years 1 Jumping from height N4 38 Female Licence 17 Years 1 Drug overdose N5 30 Female Licence 10 Years 1 Drug overdose N6 41 Female High School 18 Years 2 Herbicide poisoning N7 29 Female Licence 6 Years 1 Drug overdose N8 28 Female Licence 4 Years 1 Drug overdose N9 37 Female Licence 15 Years 1 Drug overdose N10 26 Female Licence 3 Years 1 Drug overdose N11 44 Female Licence 22 Years 1 Drug overdose (Please Insert Table 1 here) Measures Data was collected using a semi-structured interview guide and a brief questionnaire, both developed by the research team based on a review of the relevant literature and expert consultation [ 4 , 14 , 15 ]. The questionnaire collected demographic and background information, while the interview guide consisted of the four following open-ended questions designed to elicit rich, detailed narratives of participants’ experiences: Could you please tell us about the process leading up to your suicide attempt? Could you please describe when and how you began thinking about attempting suicide? Could you please share your experience during the suicide attempt? Could you please describe the process you went through following the suicide attempt? This semi-structured format allowed participants to freely express their thoughts and emotions, while ensuring consistency across interviews. Throughout the research process, team members maintained a continuous reflexive approach, acknowledging how their personal and professional experiences could impact the research objectivity. Reflexive diary-keeping and peer debriefing sessions were utilized to critically analyze personal assumptions, biases, and emotional reactions that could influence data interpretation. The researchers had no prior relationship with the participants, who were informed only of their professional roles, the purpose of the study, and the procedures. Data Collection Data was collected through individual in-depth interviews, a method chosen for its capacity to elicit comprehensive, detailed insights into the structural determinants and personal experiences shaping participants’ thoughts, feelings, beliefs, and observations related to suicide. Prior to data collection, participants were informed about the objectives of the study, and written consent was obtained via email. Interview schedules were then arranged according to each participant’s preferences. A pilot interview was conducted with one nurse to assess the clarity and applicability of the data collection instruments. Based on this feedback, the fourth question in the semi-structured interview guide was revised to enhance clarity and depth. All interviews were conducted via an online video conferencing platform and lasted between 54 and 75 minutes. Participants’ verbal expressions were audio-recorded with consent, while non-verbal cues were documented through written field notes. Interview transcripts were sent to participants for members to check in two phases. Initially, the full transcribed version of each interview was emailed to the respective participant for feedback. In the second phase, anonymized transcriptions and a summary of the preliminary findings were shared with participants for validation. This two-step verification process enhanced the accuracy and credibility of the data. Data Analysis All transcribed interviews were analyzed using MAXQDA 20.0 software. Interpretative Phenomenological Analysis (IPA) was employed to explore the participants’ lived experiences and the meanings they assigned to suicide [ 16 ]. The analysis was conducted by researchers (O.K) and (M.K.E) , alongside an expert academician (E.C) , to ensure analytical rigor. The transcripts were read multiple times to develop familiarity with the content. Initial notes and reflections were documented electronically in MAXQDA. Key statements directly related to the phenomenon were extracted and interpreted. These meaningful units were grouped, compared, and synthesized into emergent themes, sub-themes, and categories based on shared meanings. Inter-coder reliability was established through collaborative comparison of codes and themes among the researchers. Discrepancies were resolved through discussion, and a consensus was reached. To further ensure credibility, the identified themes were presented to participants for validation. An independent expert academician, not involved in the research process, reviewed the findings and confirmed the consistency between the participants’ narratives and the identified thematic structure. The richness of the data is demonstrated through direct participant quotations in the Results section. Data Trustworthiness The trustworthiness of the study was ensured by applying Lincoln and Guba’s (1985) four criteria: credibility, transferability, dependability, and confirmability [ 17 ]. Credibility was achieved through rigorous data analysis using MAXQDA 20.0, participant validation of transcripts and coding, and regular team meetings for reflection throughout the research process. Transferability was enhanced by clearly describing the research sample, setting, procedures, and including direct quotations from participants to support findings. Dependability was ensured through inter-coder agreement, with coding and theme development independently reviewed and confirmed by an external expert. Confirmability was established through triangulation of data collection methods, reflective commentary during interviews, and involvement of multiple researchers in the data analysis process. Research Team and Reflexivity Recognizing that researchers’ individual characteristics may influence the research process [ 13 ], a reflexive approach was adopted to maintain transparency and enhance interpretive accuracy. The research team followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines [ 18 ], ensuring methodological rigor throughout the study. The first author (O.K.; female), a registered nurse and psychologist with a Ph.D., brought a dual disciplinary perspective and clinical sensitivity, enabling empathetic and nuanced data collection and interpretation. The second author (M.K.E; male and MD), an associate professor in anesthesiology and critical care, contributed his experience with critically ill and suicidal patients, offering valuable medical and psychological insights. Throughout the research, the team maintained a continuous reflexive stance. Personal assumptions and potential biases were regularly discussed during peer debriefing sessions and documented in reflexive diaries. These practices helped to critically evaluate the researchers’ emotional responses and positionality, minimizing subjective influence on data interpretation. No prior relationships existed between the researchers and participants. Participants were informed solely of the researchers’ professional roles, the study's objectives, and its procedures. Ethical Approval Harran University Non-Pharmaceutical Clinical Research Ethics Committee approval was obtained before starting the study (HRU/24.12.37). At the beginning of the interviews, the participants were informed in line with the provisions of the 1995 Helsinki Declaration (as revised in Brazil, 2013). Written and verbal consent was obtained from each participant. The utmost confidentiality was maintained during data collection through the anonymization of personal data and the assignment of codes to participants during the transcription and analysis of data. Audio recordings, transcripts and interview notes were computerized, and password protected. It is the intention of the researchers to destroy all data five years after the completion and publication of this study. Results This section summarizes the thoughts and life experiences of nurses in Türkiye who attempted suicide. The participants used various metaphors to express their common experiences, which vividly reflect the unique challenges they faced within the Turkish context. Four main themes were generated through a rigorous process of coding and analysis: Reasons Leading to Suicide, The Process of Deciding and Performing the Suicide Act, The Reconstruction Process after Suicide Attempt, and Metaphors describing the suicide process (Figure I). (Insert Figure I here) Theme 1: Reasons leading to suicide This theme discusses the factors that led participants to attempt suicide. They reported experiencing psychological, physical, professional, social, political and financial problems, which convinced them to commit suicide. This theme is further divided into 6 sub-themes. Psychological factors The findings show that the cumulative impacts of various predominant psychological factors which led nurses to commit suicide included intense stress, burnout, helplessness, loneliness, and hopelessness. They neglected their own needs, suppressed their emotions to maintain a facade of strength, and ultimately became caught up in a self-sacrificing professional identity. As a result, these experiences manifested inwardly as feelings of anhedonia, existential emptiness and emotional numbness. Additionally, the lack of social support and deepening interpersonal isolation amid ongoing social interaction contributed significantly to the deterioration of their psychological well-being. Past traumatic experiences and existential questioning further intensified suicidal ideation and increased feelings of disconnection from life. It is reflected in the narrative of one participant: \"There was no one who understood me, and when I tried to explain, everyone told me that I had to be strong. As they told me so, I would shut up and go away” (N5). \"Everything was the same, I was the same, I didn't enjoy anything anymore, I couldn't feel anything, I couldn't be happy, I couldn't be sad, it was like I was thrown into the void inside me” (N2). \"Although I was in the midst of people, it was as if I did not exist” (N1). \"Even if I screamed, no one heard me” (N9). \"There was an earthquake, everyone died, I was all alone, I wanted to die too” (N7). \"Sometimes I think about death. This does not scare me. On the contrary, I am more afraid of life and what I have experienced in the past, so I was feeling closer to death\" (N11). Physical factors Physical burnout emerges as a key factor driving nurses to suicide. It includes chronic fatigue, insomnia, long working hours, lack of rest, and an unhealthy lifestyle. Physical exhaustion results in depersonalization after some time. It is reflected in the statements of participants: \"After my work was over, my body was petrifying, I felt as if concrete had been poured on me” (N3). \"Insomnia started not to hurt me anymore, because I got used to it, it became my normal” (N1). Additionally, dietary irregularities and health problems made it difficult for individuals to care for themselves. One participant expresses this situation in the following words: \"I was following the patients' medications and mealtimes, but I was not eating. After a certain point, my body stopped feeling hunger, like my soul” (N6). \"I was stuck between shifts day and night, my body was giving up, but I had to keep going because I was working in intensive care” (N10). Occupational factors The findings reveal that occupational factors contribute to suicidal ideation among nurses including intense workload, work-life imbalance, bullying, hierarchical pressure, and professional burnout. Such circumstances blur the boundaries between work and personal life leading to a profound sense of alienation, diminished sense of belonging, and emotional exhaustion. Traumatic events in the workplace, frequent exposure to death, and lack of management support further exacerbated feelings of professional isolation. Additionally, the conflict between personal identity and professional roles foster a deep sense of depersonalization, where individuals perceive themselves as functioning solely to fulfill professional obligations. The nurses described these situations as follows: \"There was no boundary between my work and my life, as if I existed in this world only to work “(N2). \"No one was protecting us. When a patient was lost or a mistake was made, all the responsibility was placed on us, no one asked how we were affected psychologically” (N1). \" \"It was as if I was only a nurse. I forgot I was human. I was just like a machine. I didn't remember who I was, what I thought” (N3). \"There was no boundary between my work and my life, as if I existed in this world only to work” (N2). \"Patients expected me to be strong and perfect, but no one realized that I was a human being, and I was tired. I didn't want to do my job anymore” (N7). Social factors Social factors contributing to the suicide process among nurses include the devaluation of the profession, violence against health workers, negative cultural judgments about suicide and religious attitudes. Participants described these situations as follows: \"I was trying to do my job in the best way possible, but the worthlessness and ill-treatment I received from both patients and their relatives sometimes became unbearable” (N5). \"When a patient's relative shouted and threatened me, no one intervened, everyone just watched. At that moment I realized that no one cares about me and us” (N9). \"Whenever I told them about the darkness inside me, they said, \"...don't say such things, it is a sin, God will punish you\". So, I kept quiet. The more I kept silent, the deeper I sunk” (N11).“ Political factors Political factors also drive nurses to suicide. These factors include inadequate health policies, lack of professional protection, lack of union support, merit and administrative injustices. Participants stated that nurses were excluded from decision-making mechanisms in the health system and could not make their voices heard. Participants expressed the following regarding the subject: \"We do not have a say in any decision taken about our profession, we are just helpless people who fulfil the rules that need to be implemented...We were already dead as nurses...” (N2). \"I worked very hard for years, but I never got a promotion because I didn't have connections. There was no justice...This was very humiliating. Unions are more interested in favoring the government than defending our rights, there is no place to claim our rights” (N5). Financial factors Financial factors contributing to the suicide process among nurses include low salary, livelihood difficulties, the need for extra work, and financial uncertainty. Participants explained this situation with the following words: \"I was doing additional work to survive, but I was about to lose my life” (N6). \"I had years of education, I was trying to save human lives, but my salary did not even give me the right to live humanely” (N3). \"I wanted to make a therapist appointment, but when I saw the fees, I gave up. At that moment, I realized that even getting better is a financial luxury” (N8). Theme 2: The Process of Deciding and Attempting Suicide This theme describes the process of deciding and attempting to carry out the suicide act. The theme is divided into 3 sub-themes: Formation of Suicide Idea, Decision Making Process and Suicide Attempt and Realization Moment. Formation of suicidal ideation Suicidal ideation arises from multiple factors, including overwhelming emotional pain, loneliness, helplessness, and a strong desire to escape. Participants reported feeling misunderstood and lacking support systems to share their feelings. Over time, this led them to question the meaning of life. Additionally, the feeling of personal and professional failure caused them to feel incompetent, fostering the thought of death as a last resort. One participant expressed this situation in the following words: \"I tried to do everything right in my life, but still nothing was going right. Maybe it was my fault...maybe I had to leave this life (N10)\". Persistent preoccupation with death or fantasies of escape often signifies an individual's profound sense of being trapped or at an impasse. One participant expressed this process as follows: \"I was no longer afraid of death. It even gave me peace when I thought about it. I wanted to escape from that helplessness and pain” (N7). Decision making process The findings reveal that the decision to commit suicide arises from the progressive consolidation of recurrent negative cognitions, culminating in the internalization of suicide as a perceived rational and inevitable solution to persistent psychological distress. Participants’ narratives revealed a gradual progression from passive suicidal thoughts to active planning, as shown by behaviors, such as researching suicide methods. Interestingly, the emergence of a paradoxical sense of emotional calmness following the decision indicated a psychological disengagement from internal conflict. However, the frequent ambivalence and final-stage internal negotiations observed among participants highlights the dynamic, non-linear, and emotionally complex nature of the suicidal decision-making process. This echoes in the following narratives of participants: “At first it was just a thought, but then it seemed like the most logical option” (N5). “Even when I was researching how to do it, I was emotionless, as if I was planning for someone else. I was a nurse; I already had the drugs at hand” (N1). \"When I decided to jump, I was very peaceful because I had an end, I didn't have to struggle anymore” (N3). \"I was going to die, and everyone would think about it...Death seemed like a beautiful end, but at the last moment a little voice inside me asked 'are you sure?” (N6). Suicide attempt and the moment of realization The findings reveal that the moment of the suicide attempt was influenced by a combination of survival instincts, loss of consciousness, and external intervention. Some participants reported experiencing last-minute ambivalence that temporarily interrupted their actions, while others described complete dissociation or loss of consciousness during the attempt. Additionally, unexpected external interventions were noted to have played a critical role in preventing some suicide attempts, highlighting the fragile and dynamic nature of this critical phase. It is reflected in the following statements: \"Everything was ready, I was just going to throw myself down, but a momentary hesitation appeared in me, did I really want to do that?” (N3). \" At that moment, my mind was completely silenced. I was not even aware of what I was doing. When I opened my eyes, I was in the hospital” (N5). \"Everything was over, but my brother found me. At first, I was disappointed, but then I thought that someone realized my pain” (N2). Theme 3: The reconstruction process following a suicide attempt This theme explores the process of recovery, search for meaning, and transformation in the physical, psychosocial, and professional dimensions of nurses who survived suicide. The theme is divided into four sub-themes: a) Shock Due to Physical and Psychological Causes, b) Struggle with Stigmatization, c) Psychosocial Reconstruction, and d) Vocational Reconstruction. Physical and psychological shock Survivors of suicide attempts reported experiencing both physical and psychological shock. Conflicting emotions such as confusion, emptiness, guilt, anger, and regret emerged as they confronted the reality of survival. The dissonance between the intent to die and the outcome of surviving generated complex reactions, as illustrated by participant reflections: “I was supposed to die, but I was there. I was shocked” (N6). “ The first thing I felt when I was rescued wat disappointment. Then I felt ashamed” (N10). Physical injuries from the attempt also served as constant reminders, compounding emotional distress: “The pain in my stomach went away, but the emptiness inside me grew bigger” (N9). Combating stigmatization Following their attempts, participants encountered social stigmatization and exclusion. Societal narratives that frame suicide as a sign of weakness or moral failure intensified their psychological burden. Many felt further alienated by dismissive or moralizing responses from their families and communities: “Everyone was looking at me as if I was not a normal person”(N1). “Even my own family tried to close the subject by telling me, ‘You are weak, you should endure, you should pray’” (N3). “My relatives said others have gone through worse things than you, but they still endured. There was no one who understood my pain... I kept silent” (N4). Psychosocial reconstruction Despite the initial despair, several participants described processes of recovery, renewed meaning-making, and post-traumatic growth. Psychosocial support and therapeutic interventions facilitated emotional healing and a re-evaluation of life: “I did not die, so maybe I can change something” (N1). “First I questioned why I was alive, but then I searched for the meaning of living” (N3). “I used to feel only exhaustion, but now I rewrote my destiny and learned to live” (N7). Improved interpersonal relationships, rediscovery of support systems, and transformed identities were common outcomes during this stage. Professional reconstruction Participants reflected deeply on their professional roles after surviving their attempts. This led to redefinitions of career purpose, decisions to continue or leave nursing, and the setting of new goals: “Nursing had exhausted me, but I started again... I continued and tried to improve” (N8). “When I came back, my perspective on nursing changed- I restructured everything” (N4). Theme 4: Metaphors Describing the Suicide Experience This theme captures the metaphors used by nurses to articulate their internal states and experiences throughout the suicide process. These are categorized into two sub-themes: Self-alienation and Internal Conflict and Professional, Social, and Cultural Stagnation. Self-Alienation and internal conflict Participants often described a sense of losing their identity and emotional connection to themselves. Metaphors such as “robot,” “masked face,” “empty shell,” “sinking ship,” and “spectator of my own life” illustrated a fragmented sense of self: “I was just an empty shell; I had lost my feelings” (N2). “I was smiling, but it was just my mask” (N4). “Sometimes it was as if I was watching my own life from the outside. I was doing something, but nothing belonged to me” (N6). Professional, social, and cultural stagnation Participants also expressed a sense of entrapment and invisibility in their professional and societal roles. They used metaphors such as “never-ending bleeding,” “invisible handcuffs,” “shadow people,” “cage,” and “a boat in the middle of the sea without a paddle”: “No matter how much I worked at home and at work, it was never-ending. People at work, outside, and at home were constantly demanding something. I was stuck—life was a cage” (N9). “No one could see what I was going through. I was a shadow” (N11). “At that time, it was as if I was bleeding non-stop. I was bleeding everywhere—at home, at work” (N11). Discussion This study explored the suicide-related perspectives and lived experiences of nurses in Türkiye who had survived a suicide attempt. It is among the first qualitative studies to comprehensively examine the factors leading to, accompanying, and following a suicide attempt within this professional group. By foregrounding nurses’ personal narratives, this study offers critical insights that can inform the design of realistic and effective suicide prevention strategies in healthcare settings. The findings demonstrate that suicide among nurses is not the result of a single cause, but rather a convergence of psychological, physical, occupational, social, political, and financial stressors. This aligns with previous studies [5, 19, 20], which have shown that psychological distress and emotional fatigue significantly contribute to nurses’ detachment from life over time. Burnout, high emotional labor, and empathy fatigue—long recognized in the literature as occupational hazards—were confirmed here as critical precursors to suicidal ideation. Depression and anxiety have been found to increase suicide risk by 3.8 and 7.6 times, respectively, among nurses [19]. The current study also emphasizes the role of physical exhaustion, long working hours, and unhealthy lifestyle habits in the development of suicidal behavior. These findings support earlier studies, which indicate that physical strain and neglect of self-care significantly heighten suicide risk [5, 21]. Furthermore, this research confirms that occupational and systemic issues—such as low wages, insufficient administrative support, workplace bullying, and exclusion from decision-making—are major contributors to psychological distress among nurses [4, 22]. Inadequate health policies, lack of union representation, and political neglect further intensify the burden. Violence against healthcare professionals, negative societal perceptions of nursing, and religious and cultural taboos about suicide exacerbate feelings of isolation and prevent nurses from seeking help [14, 23]. In contrast to earlier assumptions that suicide is often an impulsive act [24], this study found that the path from ideation to action is gradual, involving cognitive and emotional phases. Persistent negative thoughts, internalized distress, and a growing sense of entrapment were found to precede a suicide attempt. For many participants, death was perceived as an escape from unbearable psychological pain [14]. In some cases, a last-minute internal conflict or survival instinct interrupted the attempt—underscoring the complex, non-linear nature of suicidal behavior [25]. Ambivalence and emotional fluctuation were common across participant accounts. In fact, 85.4% of 888 individuals who attempted suicide reported uncertainty about whether they truly wanted to die [26]. This echoes the findings of other studies that emphasize the dynamic and conflicted emotional state that often characterizes suicidal crises [14, 27]. Importantly, nurses who survived their suicide attempts described undergoing profound psychological, social, and professional transformation. While some experienced lasting shame, regret, and social exclusion—known obstacles to recovery attempt [28, 29]—others found the experience to be a catalyst for meaning-making and growth. This dichotomy is consistent with prior findings that suicide survival does not automatically equate with recovery. Without adequate support, individuals are at high risk of relapse into hopelessness and isolation [29]. Therefore, it is essential to establish comprehensive support systems for nurses at both the individual and institutional levels [30]. Improving working conditions, enhancing job satisfaction, and offering confidential, accessible mental health services are crucial for suicide prevention and recovery [7]. The findings reveal that nurses experienced profound psychological and emotional oppression during the suicide process, stemming from identity erosion, professional pressures, and rigid social expectations. This study differs from previous research by highlighting how nurses used metaphors—rather than direct language—to express their emotional and existential breakdown. Metaphors such as “robotization,” “sinking ship,” and “living with masks” reflect the emotional numbness and mental exhaustion experienced by nurses who continued to function physically but felt internally depleted. Metaphors like “invisible handcuffs,” “a boat without oars in the middle of the sea,” and “repressed identity” emphasize that suicide is not merely an individual act, but one shaped and intensified by systemic professional, social, and cultural constraints. These layered stressors deepen the sense of hopelessness and entrapment. Participants reported being assigned duties beyond their specialization, transferred between departments without consultation, and treated as invisible extensions of the healthcare system—often seen as mere assistants to physicians. While previous studies have addressed these issues from a psychological or occupational stress lens [31, 32], the present study underscores how professional devaluation and social disregard can lead nurses toward existential collapse. These findings reinforce the necessity of not only providing emotional support to nurses but also re-evaluating their roles and working conditions within the healthcare system [7]. Conclusion and Recommendations This study explored the experiences of nurses in Türkiye who had attempted suicide and found that these attempts were shaped by a confluence of psychological, physical, occupational, social, political, and financial factors. It further revealed that nurses often expressed their emotional suffering through metaphoric language, which conveyed feelings of professional, social, and cultural entrapment. Following a suicide attempt, participants experienced psychological and physical shock, stigmatization, social isolation, and a challenging process of psychosocial and professional reconstruction. These findings underscore the urgent need for comprehensive interventions targeting the mental health and working conditions of nurses. Healthcare institutions must take proactive steps to strengthen psychological support systems, regulate workloads, and prevent workplace bullying and burnout. Policies should aim to enhance the professional recognition, autonomy, and job satisfaction of nurses. Psychiatric and mental health nurses should play a central role in designing and implementing suicide prevention and post-crisis support programs tailored specifically to the needs of high-risk nurses. Integrating these professionals into peer support networks and workplace mental health initiatives can aid in the early detection of distress and facilitate timely intervention. In parallel, broader societal efforts must focus on eliminating stigma, addressing violence against healthcare workers, and promoting public awareness to foster a more open dialogue around mental health. Future research should aim to develop nurse-specific suicide prevention frameworks and evaluate their effectiveness across different healthcare systems. Limitations This study has several limitations. Due to the sensitive nature of the topic, some participants may have withheld parts of their experiences, influenced by cultural and social stigma associated with suicide. Additionally, the study was conducted exclusively in Türkiye, which may limit the transferability of findings to other countries or healthcare systems with differing cultural, institutional, and social dynamics. To address these limitations, future studies should involve larger and more diverse samples and employ mixed methods approaches across various cultural and clinical settings to broaden the understanding of suicide among nurses globally. Abbreviations IPA Interpretative Phenomenological Analysis COREQ Consolidated Criteria for Reporting Qualitative Research Declarations Ethics Approval and Consent to Participate: Ethical approval was obtained from the Harran University Non-Pharmaceutical Clinical Research Ethics Committee prior to the commencement of the study (Approval Number: HRÜ/24.12.37). At the beginning of the interviews, the participants were informed in line with the provisions of the 1995 Declaration of Helsinki (as revised in Brazil, 2013). Written and verbal consent was obtained from each participant. Consent for publication: Not Applicable Availability of data and materials: The data that support the findings of this study are available from the corresponding author upon reasonable request. Due to the sensitive nature of the data, access is restricted to protect participant anonymity. Competing Interests: There is no between authors in this research. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions: OK: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Validation, Visualization,Writing – original draft, Writing – review & editing. MKE: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Supervision, Validation, Visualization,Writing – original draft, Writing – review & editing Acknowledgments: We would like to express our sincere gratitude to the nurses who participated in this study, as well as to Mary Ellen TOFFLE, Emre ÇIYDEM, and Abdul HADI, who provided invaluable support throughout. References World Health Organization. Suicide prevention. 2024. https://www.who.int/health-topics/suicide#tab=tab_1. Accessed 12 May 2025. Wolf LA, Delao AM, Perhats C, Clark PR, Edwards C, Frankenberger WD. Traumatic stress in emergency nurses: Does your work environment feel like a war zone? International Emergency Nursing. 2020;52 July:100895. https://doi.org/10.1016/j.ienj.2020.100895. Guille C. Rate of suicide among women nurses compared with women in the general population before the COVID-19 global pandemic. JAMA Psychiatry. 2021;78:597. https://doi.org/10.1001/jamapsychiatry.2021.0141. Cheung T, Lee PH, Yip PSF. Suicidality among Hong Kong nurses: Prevalence and correlates. Journal of Advanced Nursing. 2016;72:836–48. https://doi.org/10.1111/jan.12869. Groves S, Lascelles K, Hawton K. Suicide, self-harm, and suicide ideation in nurses and midwives: A systematic review of prevalence, contributory factors, and interventions. Journal of Affective Disorders. 2023;331 March:393–404. https://doi.org/10.1016/j.jad.2023.03.027. Davis MA, Cher BAY, Friese CR, Bynum JPW. Association of US nurse and physician occupation with risk of suicide. JAMA Psychiatry. 2021;78:651. https://doi.org/10.1001/jamapsychiatry.2021.0154. Davidson JE, Proudfoot J, Lee K, Terterian G, Zisook S. A longitudinal analysis of nurse suicide in the United States (2005–2016) with recommendations for action. Worldviews on Evidence-Based Nursing. 2020;17:6–15. https://doi.org/10.1111/wvn.12419. Lee KA, Friese CR. Deaths by suicide among nurses: A rapid response call. Journal of Psychosocial Nursing and Mental Health Services. 2021;59:3–4. https://doi.org/10.3928/02793695-20210625-01. American Psychiatric Nurses Association. APNA Position: Youth Suicide Prevention. 2024. https://www.apna.org/news/apna-position-youth-suicide-prevention/#:~:text=It is the position of,suicide screening%2C risk assessment%2C and. Yıldırım MŞ, Akçan R, Alemdar MZ. Rising health problem of Türkiye, healthcare professionals’ suicides in media. Health Sciences Quarterly. 2023;3:27–33. https://doi.org/10.26900/hsq.1868. Pirkis J, Dandona R, Silverman M, Khan M, Hawton K. Preventing suicide: a public health approach to a global problem. The Lancet Public Health. 2024;9:e787–95. https://doi.org/10.1016/s2468-2667(24)00149-x. Ariapooran S, Ahadi B, Khezeli M. Depression, anxiety, and suicidal ideation in nurses with and without symptoms of secondary traumatic stress during the COVID-19 outbreak. Archives of Psychiatric Nursing. 2022;37 January 2021:76–81. https://doi.org/10.1016/j.apnu.2021.05.005. Creswell J. Qualitative inquiry and research design: Choosing among five approaches. Ankara: Siyasal Publisher; 2020. Marzetti H, McDaid L, O’Connor R. A qualitative study of young people’s lived experiences of suicide and self-harm: intentionality, rationality and authenticity. Child and Adolescent Mental Health. 2023;28:504–11. https://doi.org/10.1111/camh.12641. Davidson J, Mendis J, Stuck AR, DeMichele G, Zisook S. Nurse Suicide: Breaking the Silence. NAM Perspectives. 2018;8. https://doi.org/10.31478/201801a. Smith JA, Larkin M, Flowers P. Interpretative phenomenological analysis: Theory, method and research. 2nd edition. Sage Publication; 2021. Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills: CA: Sage Publication; 1985. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007;19:349–57. https://doi.org/10.1093/intqhc/mzm042. Kavaliauskas P, Kazlauskas E, Smailyte G. Psychological distress, suicidality and resilience of Lithuanian nurses. BMC Nursing. 2024;23. https://doi.org/10.1186/s12912-024-02632-2. Basu N, Barinas J, Williams K, Clanton C, Smith PN. Understanding nurse suicide using an ideation-to-action framework: An integrative review. Journal of Advanced Nursing. 2023;79:4472–88. https://doi.org/10.1111/jan.15681. Choflet A, Davidson J, Lee KC, Ye G, Barnes A, Zisook S. A comparative analysis of the substance use and mental health characteristics of nurses who complete suicide. Journal of Clinical Nursing. 2021;30:1963–72. https://doi.org/10.1111/jocn.15749. Chin WS, Chen YC, Ho JJ, Cheng NY, Wu HC, Shiao JSC. Psychological work environment and suicidal ideation among nurses in Taiwan. Journal of Nursing Scholarship. 2019;51:106–13. https://doi.org/10.1111/jnu.12441. Hajiyousouf II, Bulut S. Mental health, religion and suicide. Open Journal of Medical Psychology. 2022;11:12–27. https://doi.org/10.4236/ojmp.2022.111002. Lim M, Lee S, Park JI. Differences between impulsive and non-impulsive suicide attempts among individuals treated in emergency rooms of South Korea. Psychiatry Investigation. 2016;13:389–96. https://doi.org/10.4306/pi.2016.13.4.389. Macintyre VG, Mansell W, Pratt D, Tai SJ. The psychological pathway to suicide attempts: A strategy of control without awareness. Frontiers in Psychology. 2021;12 March. https://doi.org/10.3389/fpsyg.2021.588683. Kim H, Kim B, Kim SH, Park CHK, Kim EY, Ahn YM. Classification of attempted suicide by cluster analysis: A study of 888 suicide attempters presenting to the emergency department. Journal of Affective Disorders. 2018;235 April:184–90. https://doi.org/10.1016/j.jad.2018.04.001. Abdollahpour Ranjbar H, Parhoon H, Mohammadkhani S, Munawar K, Moradi AR, Jobson L. Investigating cognitive control and cognitive emotion regulation in Iranian depressed women with suicidal ideation or suicide attempts. Suicide and Life-Threatening Behavior. 2021;51:586–95. https://doi.org/10.1111/sltb.12735. Wiklander M, Samuelsson M, Åsberg M. Shame reactions after suicide attempt. Scandinavian Journal of Caring Sciences. 2003;17:293–300. https://doi.org/10.1046/j.1471-6712.2003.00227.x. Botha K-J, Guilfoyle A, Botha D. Beyond normal grief: A critical reflection on immediate post-death experiences of survivors of suicide. Australian e-Journal for the Advancement of Mental Health. 2009;8:37–47. https://doi.org/10.5172/jamh.8.1.37. Fayaz I. Posttraumatic growth experiences in suicide survivors: a qualitative inquiry in conflict zone. Psychology, Health and Medicine. 2024;29:442–7. https://doi.org/10.1080/13548506.2022.2124524. Dall’Ora C, Ball J, Reinius M, Griffiths P. Burnout in nursing: A theoretical review. Human Resources for Health. 2020;18:1–17. https://doi.org/10.1186/s12960-020-00469-9. Despotović MM, Ignjatović Ristić D, Banković D, Milovanović D, Stepanović Ž, Despotović M, et al. Suicidality, resilience and burnout in a population of oncology nurses. Scientific Reports. 2025;15:3251. https://doi.org/10.1038/s41598-025-87677-2. Additional Declarations No competing interests reported. Supplementary Files COREQChecklist.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 22 Feb, 2026 Reviewers agreed at journal 31 Jan, 2026 Reviewers agreed at journal 30 Jan, 2026 Reviewers invited by journal 29 Jan, 2026 Editor invited by journal 07 Jan, 2026 Editor assigned by journal 05 Jan, 2026 Submission checks completed at journal 05 Jan, 2026 First submitted to journal 31 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8491955\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":583697030,\"identity\":\"fc6b943c-c47b-4d7c-8726-598185a2ac2e\",\"order_by\":0,\"name\":\"Ozlem Kackin\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIie3RsUrEMBzH8X8I1CW1a0Lk+goJBUUQnyVy4BRQOHA50R6F3CLOldN3aSnUpegaOBHRVaFw4HIgVodD8C7n6JDvGPiQkB+Az/cvwylAAUAxoJfFIXEStCA4+UnoegIQ8D+RKCpHz7bZj9k4rIfHp49H0SRFT28GznbS5YSlZZZo25cTvHk4zevBbv5QYHljgG4Vy4koR4brFqseJttTEigBVgU87Miql4kKjee6Pf8mA/KhRGzVxtxJamSwtpXiHcGhUUJ0t2AXYRco47q5lVcZSXh4qYS0Bxm7vqMsX/ljVTnT9TCm942ckXclerZftq8ne5FjmF99LeVa0ufz+Xxr+wRZSVFK/+JqAQAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Harran University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Ozlem\",\"middleName\":\"\",\"lastName\":\"Kackin\",\"suffix\":\"\"},{\"id\":583697032,\"identity\":\"b7d89b7c-ccf0-49cc-85f6-50f882fd183a\",\"order_by\":1,\"name\":\"Mehmet Kenan Erol\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Harran University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Mehmet\",\"middleName\":\"Kenan\",\"lastName\":\"Erol\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-12-31 19:38:14\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8491955/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8491955/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":101786687,\"identity\":\"0791f5c8-6aa2-4bf1-8e05-7ac6f133711f\",\"added_by\":\"auto\",\"created_at\":\"2026-02-03 15:42:22\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":68045,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eFour main themes and associated sub-themes.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8491955/v1/76a08dd30a89e8455e8f770c.png\"},{\"id\":101786741,\"identity\":\"a2d44f4b-8d28-4677-be38-29623c796186\",\"added_by\":\"auto\",\"created_at\":\"2026-02-03 15:42:27\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":888977,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8491955/v1/7a8d3600-7d6d-4529-b898-ae9137b34e86.pdf\"},{\"id\":101786673,\"identity\":\"b0d518bb-3b9b-4510-9a2c-42270edd35e2\",\"added_by\":\"auto\",\"created_at\":\"2026-02-03 15:42:17\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":67627,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"COREQChecklist.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8491955/v1/2c54915520ebb284631afb22.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Suicide-related perspectives and life experiences of nurses in Türkiye who attempted suicide: A phenomenological study\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eSuicide is a significant public health issue that not only results in personal tragedies but also has profound implications for societies and healthcare systems. According to the World Health Organization (WHO), approximately 720,000 individuals die by suicide each year, equivalent to nearly 80 people per minute. In 2021, suicide was identified as the third leading cause of death among individuals aged 15\\u0026ndash;29 [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. Importantly, suicide is not confined to the general population; it is also prevalent among individuals working in the healthcare sector, particularly among nurses [\\u003cspan additionalcitationids=\\\"CR3\\\" citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eAvailable statistics indicate that nurses experience higher suicide rates than both the general population and certain other occupational groups [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. For instance, Davis et al. (2021) reported that between 2007 and 2018, nurses were 18% more likely to die by suicide than the general population [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. Similarly, the first national longitudinal study conducted in the United States found that nurses were more likely to die by suicide compared to the general population [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. In a study conducted in Hong Kong, 14.9% of nurses reported having suicidal thoughts, and 2.9% had attempted suicide in the past year [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. These alarming statistics underscore the elevated risk of severe mental health problems among nurses, calling for immediate intervention [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003ePsychiatric and mental health nurses play a critical role in identifying early warning signs and implementing preventative strategies tailored to the specific needs of healthcare professionals [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. In T\\u0026uuml;rkiye, the prevalence and underlying dynamics of suicide among healthcare professionals\\u0026mdash;including nurses\\u0026mdash;have not been adequately researched or systematically documented. Consequently, the causes and risk factors of suicide in this group remain largely unidentified [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. There is currently no official body in T\\u0026uuml;rkiye that systematically monitors, collects, and analyzes suicide data related to healthcare workers. In many instances, these incidents are underreported, vaguely documented, or entirely excluded from official records [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e], limiting public awareness and policy responses to this serious issue. Additionally, T\\u0026uuml;rkiye lacks the implementation of comprehensive preventative programs to address suicide within the healthcare workforce [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eSince the post-pandemic period, the psychological burden on nurses has continued to intensify [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. However, in the absence of concrete policies and robust scientific research, efforts to prevent suicide in this vulnerable group remain insufficient. Although nurses are widely recognized as a high-risk group, most existing studies have focused on factors such as occupational stress, burnout, access to lethal means, and psychosocial challenges [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Notably, there is a lack of qualitative research that explores the lived experiences of nurses who have attempted suicide\\u0026mdash;research that would shed light on how these individuals interpret their life experiences and the internal and external mechanisms that either lead them toward or deter them from suicide.\\u003c/p\\u003e \\u003cp\\u003eThis gap in the literature may result in the development of prevention and intervention strategies based on theoretical assumptions rather than grounded in real-life experiences. The personal narratives of nurses who have attempted suicide offer essential insights into potential points of intervention, the absence of effective support systems, and the factors that contributed to their survival.\\u003c/p\\u003e \\u003cp\\u003eTherefore, the present study aimed to explore the suicide-related perspectives and life experiences of nurses in T\\u0026uuml;rkiye who have attempted suicide. A phenomenological approach was employed, as it provides a rigorous and empathetic framework for understanding deeply personal and emotionally charged experiences such as suicide. This approach allows for the identification of shared patterns and meanings among participants, offering a comprehensive understanding of the phenomena under investigation.\\u003c/p\\u003e \\u003cp\\u003eThis study is among the first in T\\u0026uuml;rkiye to directly examine the suicide attempt process, related experiences, and contributing factors from the perspectives of nurses themselves. By offering an in-depth analysis of their lived experiences, the findings have the potential to inform the development of more effective and evidence-based individual and institutional strategies for suicide prevention within the healthcare sector.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eDesign\\u003c/h2\\u003e\\n \\u003cp\\u003eThis qualitative study employed a hermeneutic phenomenological approach. Hermeneutic phenomenology emphasizes understanding the lived experiences individuals within broader social, cultural, political, and historical contexts, and aims to identify common interpretations of these experiences [\\u003cspan class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. This methodological framework was chosen to foreground the shared perspectives and life experiences of nurses who had attempted suicide and to explore the meanings they attributed to the phenomenon.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003ch3\\u003eSetting and Time\\u003c/h3\\u003e\\n\\u003cp\\u003eData collection was carried out between September 2, 2024, and January 6, 2025, using an online video conferencing platform. This method provided flexibility for participants across various regions of T\\u0026uuml;rkiye while ensuring privacy and comfort during the interview process.\\u003c/p\\u003e\\n\\u003ch3\\u003eSampling method\\u003c/h3\\u003e\\n\\u003cp\\u003eA purposive sampling strategy was employed. In phenomenological research, it is essential that participants have directly experienced the phenomenon under investigation in all its dimensions [\\u003cspan class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Accordingly, nurses who met the following inclusion criteria were purposefully selected: (1) being over the age of 18, (2) having attempted suicide while actively working as a nurse, (3) voluntarily agreeing to participate in the study, and (4) having no diagnosed psychiatric disorders that might interfere with participation.\\u003c/p\\u003e\\n\\u003cp\\u003eAn invitation to participate was disseminated via email to addresses listed in the Ministry of Health\\u0026apos;s registry. The email provided detailed information about the study\\u0026rsquo;s purpose, procedures, and the researchers\\u0026rsquo; areas of expertise.\\u003c/p\\u003e\\n\\u003cp\\u003eInitially, 13 nurses across T\\u0026uuml;rkiye expressed willingness to participate. One individual was unable to attend due to scheduling conflicts, and another participated only in the pilot phase. Data saturation was observed beginning with the tenth interview, indicating that no new themes were emerging. However, to enhance the reliability and stability of the identified themes, an eleventh interview was conducted. While this final interview did not yield additional themes, it contributed to the expressive diversity and content richness of the existing data. Therefore, a total of 11 nurses were included in the final analysis. The sociodemographic characteristics of the participants are presented in Table\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\n \\u003cdiv align=\\\"char\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\n \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\n \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\n \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\n \\u003cdiv align=\\\"char\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\n \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\"\\u003e\\u003cbr\\u003e\\u003c/div\\u003e\\u0026nbsp;\\u003ctable id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eCharacteristics of the Participants\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003ccolgroup cols=\\\"7\\\"\\u003e\\u003c/colgroup\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNurses\\u0026apos; code\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAge\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eGender\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLevel of education\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYears of professional experience\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eTotalnumber of suicide attempts\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMethods of suicide attempts\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eN1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLicence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e12 years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDrug overdose\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eN2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e27\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHigh School\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e9 years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePesticide poisoning\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eN3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLicence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e12 Years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eJumping from height\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eN4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e38\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLicence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e17 Years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDrug overdose\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eN5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLicence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e10 Years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDrug overdose\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eN6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHigh School\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e18 Years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHerbicide poisoning\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eN7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e29\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLicence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e6 Years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDrug overdose\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eN8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e28\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLicence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e4 Years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDrug overdose\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eN9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e37\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLicence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e15 Years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDrug overdose\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eN10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLicence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3 Years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDrug overdose\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eN11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLicence\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e22 Years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDrug overdose\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e(Please Insert\\u003c/em\\u003e Table\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e \\u003cem\\u003ehere)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003ch3\\u003eMeasures\\u003c/h3\\u003e\\n\\u003cp\\u003eData was collected using a semi-structured interview guide and a brief questionnaire, both developed by the research team based on a review of the relevant literature and expert consultation [\\u003cspan class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. The questionnaire collected demographic and background information, while the interview guide consisted of the four following open-ended questions designed to elicit rich, detailed narratives of participants\\u0026rsquo; experiences:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003col\\u003e\\n \\u003cli\\u003e\\u003cspan\\u003e\\n \\u003cul\\u003e\\n \\u003cli\\u003e\\n \\u003cp\\u003eCould you please tell us about the process leading up to your suicide attempt?\\u003c/p\\u003e\\n \\u003c/li\\u003e\\n \\u003c/ul\\u003e\\n \\u003c/span\\u003e\\u003cspan\\u003e\\n \\u003cul\\u003e\\n \\u003cli\\u003e\\n \\u003cp\\u003eCould you please describe when and how you began thinking about attempting suicide?\\u003c/p\\u003e\\n \\u003c/li\\u003e\\n \\u003c/ul\\u003e\\n \\u003c/span\\u003e\\u003cspan\\u003e\\n \\u003cul\\u003e\\n \\u003cli\\u003e\\n \\u003cp\\u003eCould you please share your experience during the suicide attempt?\\u003c/p\\u003e\\n \\u003c/li\\u003e\\n \\u003c/ul\\u003e\\n \\u003c/span\\u003e\\u003cspan\\u003e\\n \\u003cul\\u003e\\n \\u003cli\\u003e\\n \\u003cp\\u003eCould you please describe the process you went through following the suicide attempt?\\u003c/p\\u003e\\n \\u003c/li\\u003e\\n \\u003c/ul\\u003e\\n \\u003c/span\\u003e\\u003c/li\\u003e\\n\\u003c/ol\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis semi-structured format allowed participants to freely express their thoughts and emotions, while ensuring consistency across interviews. Throughout the research process, team members maintained a continuous reflexive approach, acknowledging how their personal and professional experiences could impact the research objectivity. Reflexive diary-keeping and peer debriefing sessions were utilized to critically analyze personal assumptions, biases, and emotional reactions that could influence data interpretation. The researchers had no prior relationship with the participants, who were informed only of their professional roles, the purpose of the study, and the procedures.\\u003c/p\\u003e\\n\\u003ch3\\u003eData Collection\\u003c/h3\\u003e\\n\\u003cp\\u003eData was collected through individual in-depth interviews, a method chosen for its capacity to elicit comprehensive, detailed insights into the structural determinants and personal experiences shaping participants\\u0026rsquo; thoughts, feelings, beliefs, and observations related to suicide. Prior to data collection, participants were informed about the objectives of the study, and written consent was obtained via email. Interview schedules were then arranged according to each participant\\u0026rsquo;s preferences. A pilot interview was conducted with one nurse to assess the clarity and applicability of the data collection instruments. Based on this feedback, the fourth question in the semi-structured interview guide was revised to enhance clarity and depth. All interviews were conducted via an online video conferencing platform and lasted between 54 and 75 minutes. Participants\\u0026rsquo; verbal expressions were audio-recorded with consent, while non-verbal cues were documented through written field notes.\\u003c/p\\u003e\\n\\u003cp\\u003eInterview transcripts were sent to participants for members to check in two phases. Initially, the full transcribed version of each interview was emailed to the respective participant for feedback. In the second phase, anonymized transcriptions and a summary of the preliminary findings were shared with participants for validation. This two-step verification process enhanced the accuracy and credibility of the data.\\u003c/p\\u003e\\n\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003eData Analysis\\u003c/h2\\u003e\\n \\u003cp\\u003eAll transcribed interviews were analyzed using MAXQDA 20.0 software. Interpretative Phenomenological Analysis (IPA) was employed to explore the participants\\u0026rsquo; lived experiences and the meanings they assigned to suicide [\\u003cspan class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. The analysis was conducted by researchers \\u003cem\\u003e(O.K)\\u003c/em\\u003e and \\u003cem\\u003e(M.K.E)\\u003c/em\\u003e, alongside an expert academician \\u003cem\\u003e(E.C)\\u003c/em\\u003e, to ensure analytical rigor.\\u003c/p\\u003e\\n \\u003cp\\u003eThe transcripts were read multiple times to develop familiarity with the content. Initial notes and reflections were documented electronically in MAXQDA. Key statements directly related to the phenomenon were extracted and interpreted. These meaningful units were grouped, compared, and synthesized into emergent themes, sub-themes, and categories based on shared meanings.\\u003c/p\\u003e\\n \\u003cp\\u003eInter-coder reliability was established through collaborative comparison of codes and themes among the researchers. Discrepancies were resolved through discussion, and a consensus was reached. To further ensure credibility, the identified themes were presented to participants for validation. An independent expert academician, not involved in the research process, reviewed the findings and confirmed the consistency between the participants\\u0026rsquo; narratives and the identified thematic structure. The richness of the data is demonstrated through direct participant quotations in the Results section.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003ch3\\u003eData Trustworthiness\\u003c/h3\\u003e\\n\\u003cp\\u003eThe trustworthiness of the study was ensured by applying Lincoln and Guba\\u0026rsquo;s (1985) four criteria: credibility, transferability, dependability, and confirmability [\\u003cspan class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. Credibility was achieved through rigorous data analysis using MAXQDA 20.0, participant validation of transcripts and coding, and regular team meetings for reflection throughout the research process. Transferability was enhanced by clearly describing the research sample, setting, procedures, and including direct quotations from participants to support findings. Dependability was ensured through inter-coder agreement, with coding and theme development independently reviewed and confirmed by an external expert. Confirmability was established through triangulation of data collection methods, reflective commentary during interviews, and involvement of multiple researchers in the data analysis process.\\u003c/p\\u003e\\n\\u003ch3\\u003eResearch Team and Reflexivity\\u003c/h3\\u003e\\n\\u003cp\\u003eRecognizing that researchers\\u0026rsquo; individual characteristics may influence the research process [\\u003cspan class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e], a reflexive approach was adopted to maintain transparency and enhance interpretive accuracy. The research team followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines [\\u003cspan class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e], ensuring methodological rigor throughout the study.\\u003c/p\\u003e\\n\\u003cp\\u003eThe first author (O.K.; female), a registered nurse and psychologist with a Ph.D., brought a dual disciplinary perspective and clinical sensitivity, enabling empathetic and nuanced data collection and interpretation. The second author (M.K.E; male and MD), an associate professor in anesthesiology and critical care, contributed his experience with critically ill and suicidal patients, offering valuable medical and psychological insights.\\u003c/p\\u003e\\n\\u003cp\\u003eThroughout the research, the team maintained a continuous reflexive stance. Personal assumptions and potential biases were regularly discussed during peer debriefing sessions and documented in reflexive diaries. These practices helped to critically evaluate the researchers\\u0026rsquo; emotional responses and positionality, minimizing subjective influence on data interpretation. No prior relationships existed between the researchers and participants. Participants were informed solely of the researchers\\u0026rsquo; professional roles, the study\\u0026apos;s objectives, and its procedures.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eEthical Approval\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eHarran University Non-Pharmaceutical Clinical Research Ethics Committee approval was obtained before starting the study (HRU/24.12.37). At the beginning of the interviews, the participants were informed in line with the provisions of the 1995 Helsinki Declaration (as revised in Brazil, 2013). Written and verbal consent was obtained from each participant. The utmost confidentiality was maintained during data collection through the anonymization of personal data and the assignment of codes to participants during the transcription and analysis of data. Audio recordings, transcripts and interview notes were computerized, and password protected. It is the intention of the researchers to destroy all data five years after the completion and publication of this study.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eThis section summarizes the thoughts and life experiences of nurses in T\\u0026uuml;rkiye who attempted suicide. The participants used various metaphors to express their common experiences, which vividly reflect the unique challenges they faced within the Turkish context. Four main themes were generated through a rigorous process of coding and analysis: Reasons Leading to Suicide, The Process of Deciding and Performing the Suicide Act, The Reconstruction Process after Suicide Attempt, and Metaphors describing the suicide process (Figure I).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e(Insert Figure I here)\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eTheme\\u0026nbsp;1:\\u0026nbsp;Reasons\\u0026nbsp;leading\\u0026nbsp;to suicide\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis theme discusses the factors that led participants to attempt suicide. They reported experiencing psychological, physical, professional, social, political and financial problems, which convinced them to commit suicide. This theme is further divided into 6 sub-themes.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003ePsychological\\u0026nbsp;factors\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe findings show that the cumulative impacts of various predominant psychological factors which led nurses to commit suicide included intense stress, burnout, helplessness, loneliness, and hopelessness. They neglected their own needs, suppressed their emotions to maintain a facade of strength, and ultimately became caught up in a self-sacrificing professional identity. As a result, these experiences manifested inwardly as feelings of anhedonia, existential emptiness and emotional numbness. Additionally, the lack of social support and deepening interpersonal isolation amid ongoing social interaction contributed significantly to the deterioration of their psychological well-being. Past traumatic experiences and existential questioning further intensified suicidal ideation and increased feelings of disconnection from life. It is reflected in the narrative of one participant: \\u003cem\\u003e\\u0026quot;There\\u0026nbsp;was\\u0026nbsp;no\\u0026nbsp;one\\u0026nbsp;who\\u0026nbsp;understood\\u0026nbsp;me,\\u0026nbsp;and\\u0026nbsp;when\\u0026nbsp;I\\u0026nbsp;tried\\u0026nbsp;to\\u0026nbsp;explain,\\u0026nbsp;everyone\\u0026nbsp;told\\u0026nbsp;me that I\\u0026nbsp;had to be\\u0026nbsp;strong. As they\\u0026nbsp;told me so, I\\u0026nbsp;would shut up and go away\\u0026rdquo;\\u0026nbsp;\\u003c/em\\u003e(N5).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;Everything was the same, I was the same, I didn\\u0026apos;t enjoy anything anymore, I couldn\\u0026apos;t feel anything, I couldn\\u0026apos;t be happy, I couldn\\u0026apos;t be sad, it was like I was thrown into the void inside me\\u0026rdquo; (N2).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;Although I\\u0026nbsp;was\\u0026nbsp;in\\u0026nbsp;the\\u0026nbsp;midst\\u0026nbsp;of\\u0026nbsp;people,\\u0026nbsp;it\\u0026nbsp;was\\u0026nbsp;as\\u0026nbsp;if\\u0026nbsp;I\\u0026nbsp;did\\u0026nbsp;not\\u0026nbsp;exist\\u0026rdquo;\\u0026nbsp;(N1).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;Even if I screamed, no one heard me\\u0026rdquo; (N9).\\u003c/em\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;There was an earthquake, everyone died, I was all alone, I wanted to die too\\u0026rdquo;\\u0026nbsp;\\u003c/em\\u003e(N7).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;Sometimes I think about death. This does not scare me. On the contrary, I am more afraid of life and what I have experienced in the past, so I was feeling closer to death\\u0026quot; (N11).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003ePhysical factors\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePhysical burnout emerges as a key factor driving nurses to suicide. It includes chronic fatigue, insomnia, long working hours, lack of rest, and an unhealthy lifestyle. Physical exhaustion results in depersonalization after some time. It is reflected in the statements of participants:\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;After my work was over, my body was petrifying, I felt as if concrete had been poured on me\\u0026rdquo; (N3).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;Insomnia started not to hurt me anymore, because I got used to it, it became my normal\\u0026rdquo; (N1).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAdditionally, dietary irregularities and health problems made it difficult for individuals to care for themselves. One participant expresses this situation in the following words: \\u003cem\\u003e\\u0026quot;I was\\u0026nbsp;following the patients\\u0026apos; medications and mealtimes,\\u0026nbsp;but\\u0026nbsp;I\\u0026nbsp;was\\u0026nbsp;not\\u0026nbsp;eating.\\u0026nbsp;After\\u0026nbsp;a\\u0026nbsp;certain\\u0026nbsp;point,\\u0026nbsp;my\\u0026nbsp;body\\u0026nbsp;stopped\\u0026nbsp;feeling hunger, like\\u0026nbsp;my\\u0026nbsp;soul\\u0026rdquo; (N6).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;I was stuck between shifts day and night, my body was giving up, but I had to keep going because I was working in intensive care\\u0026rdquo; (N10).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eOccupational\\u0026nbsp;factors\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe findings reveal that occupational factors contribute to suicidal ideation among nurses including intense workload, work-life imbalance, bullying, hierarchical pressure, and professional burnout. Such circumstances blur the boundaries between work and personal life leading to a profound sense of alienation, diminished sense of belonging, and emotional exhaustion. Traumatic events in the workplace, frequent exposure to death, and lack of management support further exacerbated feelings of professional isolation. Additionally, the conflict between personal identity and professional roles foster a deep sense of depersonalization, where individuals perceive themselves as functioning solely to fulfill professional obligations.\\u0026nbsp;The nurses described these situations as follows:\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;There\\u0026nbsp;was\\u0026nbsp;no\\u0026nbsp;boundary\\u0026nbsp;between\\u0026nbsp;my\\u0026nbsp;work\\u0026nbsp;and\\u0026nbsp;my\\u0026nbsp;life,\\u0026nbsp;as\\u0026nbsp;if\\u0026nbsp;I\\u0026nbsp;existed\\u0026nbsp;in\\u0026nbsp;this world only to work \\u0026ldquo;(N2).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;No one\\u0026nbsp;was protecting us. When a patient was lost or a mistake\\u0026nbsp;was\\u0026nbsp;made,\\u0026nbsp;all\\u0026nbsp;the\\u0026nbsp;responsibility\\u0026nbsp;was placed\\u0026nbsp;on\\u0026nbsp;us,\\u0026nbsp;no\\u0026nbsp;one\\u0026nbsp;asked\\u0026nbsp;how\\u0026nbsp;we\\u0026nbsp;were\\u0026nbsp;affected psychologically\\u0026rdquo; (N1).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot; \\u0026quot;It was as if I was only a nurse. I forgot I was human. I was just like a machine. I didn\\u0026apos;t remember who I was, what I thought\\u0026rdquo; (N3).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;There\\u0026nbsp;was\\u0026nbsp;no\\u0026nbsp;boundary\\u0026nbsp;between\\u0026nbsp;my\\u0026nbsp;work\\u0026nbsp;and\\u0026nbsp;my\\u0026nbsp;life,\\u0026nbsp;as\\u0026nbsp;if\\u0026nbsp;I\\u0026nbsp;existed\\u0026nbsp;in\\u0026nbsp;this world only to work\\u0026rdquo; (N2).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;Patients expected me to be strong and perfect, but no one realized that\\u0026nbsp;I\\u0026nbsp;was\\u0026nbsp;a\\u0026nbsp;human\\u0026nbsp;being,\\u0026nbsp;and\\u0026nbsp;I\\u0026nbsp;was\\u0026nbsp;tired.\\u0026nbsp;I\\u0026nbsp;didn\\u0026apos;t\\u0026nbsp;want\\u0026nbsp;to\\u0026nbsp;do\\u0026nbsp;my\\u0026nbsp;job\\u0026nbsp;anymore\\u0026rdquo;\\u0026nbsp;(N7).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eSocial factors\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSocial\\u0026nbsp;factors\\u0026nbsp;contributing to the suicide process among nurses include the\\u0026nbsp;devaluation\\u0026nbsp;of\\u0026nbsp;the profession, violence against health workers, negative cultural judgments about suicide and religious\\u0026nbsp;attitudes.\\u0026nbsp;Participants described these situations as follows:\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;I was trying\\u0026nbsp;to\\u0026nbsp;do\\u0026nbsp;my\\u0026nbsp;job\\u0026nbsp;in\\u0026nbsp;the best\\u0026nbsp;way\\u0026nbsp;possible, but\\u0026nbsp;the\\u0026nbsp;worthlessness\\u0026nbsp;and\\u0026nbsp;ill-treatment\\u0026nbsp;I received from\\u0026nbsp;both\\u0026nbsp;patients\\u0026nbsp;and\\u0026nbsp;their\\u0026nbsp;relatives\\u0026nbsp;sometimes\\u0026nbsp;became\\u0026nbsp;unbearable\\u0026rdquo;\\u0026nbsp;(N5).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;When a patient\\u0026apos;s relative shouted and threatened me, no one intervened, everyone\\u0026nbsp;just\\u0026nbsp;watched.\\u0026nbsp;At\\u0026nbsp;that\\u0026nbsp;moment\\u0026nbsp;I\\u0026nbsp;realized\\u0026nbsp;that\\u0026nbsp;no\\u0026nbsp;one\\u0026nbsp;cares\\u0026nbsp;about\\u0026nbsp;me\\u0026nbsp;and\\u0026nbsp;us\\u0026rdquo;\\u0026nbsp;(N9).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;Whenever\\u0026nbsp;I\\u0026nbsp;told\\u0026nbsp;them\\u0026nbsp;about\\u0026nbsp;the\\u0026nbsp;darkness\\u0026nbsp;inside\\u0026nbsp;me,\\u0026nbsp;they\\u0026nbsp;said,\\u0026nbsp;\\u0026quot;...don\\u0026apos;t\\u0026nbsp;say\\u0026nbsp;such\\u0026nbsp;things, it\\u0026nbsp;is\\u0026nbsp;a\\u0026nbsp;sin,\\u0026nbsp;God\\u0026nbsp;will\\u0026nbsp;punish\\u0026nbsp;you\\u0026quot;.\\u0026nbsp;So,\\u0026nbsp;I\\u0026nbsp;kept\\u0026nbsp;quiet.\\u0026nbsp;The\\u0026nbsp;more\\u0026nbsp;I\\u0026nbsp;kept\\u0026nbsp;silent,\\u0026nbsp;the\\u0026nbsp;deeper\\u0026nbsp;I\\u0026nbsp;sunk\\u0026rdquo; (N11).\\u0026ldquo;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003ePolitical factors\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePolitical factors also drive nurses to suicide. These factors include inadequate\\u0026nbsp;health\\u0026nbsp;policies,\\u0026nbsp;lack\\u0026nbsp;of\\u0026nbsp;professional protection,\\u0026nbsp;lack\\u0026nbsp;of\\u0026nbsp;union\\u0026nbsp;support,\\u0026nbsp;merit and administrative injustices. Participants stated that nurses were excluded from decision-making mechanisms in the health system and could not make their voices heard. Participants expressed the following regarding the subject:\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;We do not have a say in any decision taken about our profession, we are just helpless people who fulfil the rules that need to be implemented...We were already dead as nurses...\\u0026rdquo; (N2).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;I worked very hard for years, but I never got a promotion because I didn\\u0026apos;t have connections. There\\u0026nbsp;was\\u0026nbsp;no\\u0026nbsp;justice...This\\u0026nbsp;was\\u0026nbsp;very humiliating. Unions\\u0026nbsp;are more interested in favoring the government than defending our rights, there is no place to claim our rights\\u0026rdquo; (N5).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eFinancial factors\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFinancial factors contributing to the suicide process among nurses include low salary, livelihood difficulties, the need for extra work, and financial uncertainty. Participants explained this situation with the following words:\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;I\\u0026nbsp;was doing additional work to survive, but I was about to lose my life\\u0026rdquo; (N6).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026nbsp;\\u0026quot;I had years of education,\\u0026nbsp;I\\u0026nbsp;was\\u0026nbsp;trying\\u0026nbsp;to\\u0026nbsp;save\\u0026nbsp;human\\u0026nbsp;lives,\\u0026nbsp;but\\u0026nbsp;my\\u0026nbsp;salary\\u0026nbsp;did\\u0026nbsp;not\\u0026nbsp;even\\u0026nbsp;give\\u0026nbsp;me\\u0026nbsp;the\\u0026nbsp;right\\u0026nbsp;to\\u0026nbsp;live humanely\\u0026rdquo; (N3).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026nbsp;\\u0026quot;I wanted to make a therapist appointment, but when I saw the fees, I gave up. At that moment, I realized that even getting better is a financial luxury\\u0026rdquo; (N8).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eTheme\\u0026nbsp;2:\\u0026nbsp;The Process of Deciding and Attempting Suicide\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis\\u0026nbsp;theme\\u0026nbsp;describes\\u0026nbsp;the\\u0026nbsp;process\\u0026nbsp;of\\u0026nbsp;deciding\\u0026nbsp;and\\u0026nbsp;attempting to carry out\\u0026nbsp;the\\u0026nbsp;suicide\\u0026nbsp;act.\\u0026nbsp;The\\u0026nbsp;theme\\u0026nbsp;is\\u0026nbsp;divided into 3 sub-themes: Formation of Suicide Idea, Decision Making Process and Suicide Attempt and Realization Moment.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eFormation\\u0026nbsp;of suicidal ideation\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSuicidal ideation arises from multiple factors, including overwhelming emotional pain, loneliness, helplessness, and a strong desire to escape. Participants reported feeling misunderstood and lacking support systems to share their feelings. Over time, this led them to question the meaning of life. Additionally, the feeling of personal and professional failure caused them to feel incompetent, fostering the thought of death as a last resort. One participant expressed this situation in the following words:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;I tried to do everything right in my\\u0026nbsp;life,\\u0026nbsp;but still\\u0026nbsp;nothing\\u0026nbsp;was going right.\\u0026nbsp;Maybe\\u0026nbsp;it was my\\u0026nbsp;fault...maybe I had to leave this life (N10)\\u0026quot;.\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePersistent preoccupation with death or fantasies of escape often signifies an individual\\u0026apos;s profound sense of being trapped or at an impasse. One participant expressed this\\u0026nbsp;process\\u0026nbsp;as\\u0026nbsp;follows: \\u003cem\\u003e\\u0026quot;I was no longer afraid of death. It even gave me peace when I thought about it. I wanted to escape from that helplessness and pain\\u0026rdquo; (N7).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eDecision\\u0026nbsp;making process\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe findings reveal that the decision to commit suicide arises from the progressive consolidation of recurrent negative cognitions, culminating in the internalization of suicide as a perceived rational and inevitable solution to persistent psychological distress. Participants\\u0026rsquo; narratives revealed a gradual progression from passive suicidal thoughts to active planning, as shown by behaviors, such as researching suicide methods. Interestingly, the emergence of a paradoxical sense of emotional calmness following the decision indicated a psychological disengagement from internal conflict. However, the frequent ambivalence and final-stage internal negotiations observed among participants highlights the dynamic, non-linear, and emotionally complex nature of the suicidal decision-making process. This echoes in the following narratives of participants:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;At first it was just a thought, but then it seemed like the most logical option\\u0026rdquo; (N5).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;Even when\\u0026nbsp;I\\u0026nbsp;was\\u0026nbsp;researching\\u0026nbsp;how\\u0026nbsp;to\\u0026nbsp;do\\u0026nbsp;it,\\u0026nbsp;I\\u0026nbsp;was\\u0026nbsp;emotionless,\\u0026nbsp;as\\u0026nbsp;if\\u0026nbsp;I\\u0026nbsp;was\\u0026nbsp;planning\\u0026nbsp;for\\u0026nbsp;someone else.\\u0026nbsp;I\\u0026nbsp;was\\u0026nbsp;a\\u0026nbsp;nurse;\\u0026nbsp;I\\u0026nbsp;already\\u0026nbsp;had\\u0026nbsp;the\\u0026nbsp;drugs\\u0026nbsp;at\\u0026nbsp;hand\\u0026rdquo; (N1).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;When I decided to jump,\\u0026nbsp;I\\u0026nbsp;was\\u0026nbsp;very\\u0026nbsp;peaceful\\u0026nbsp;because\\u0026nbsp;I\\u0026nbsp;had\\u0026nbsp;an\\u0026nbsp;end,\\u0026nbsp;I\\u0026nbsp;didn\\u0026apos;t\\u0026nbsp;have\\u0026nbsp;to\\u0026nbsp;struggle\\u0026nbsp;anymore\\u0026rdquo; (N3).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;I was going to die, and everyone would think about it...Death seemed like a beautiful end, but at the last moment a little voice inside me asked \\u0026apos;are you sure?\\u0026rdquo; (N6).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eSuicide\\u0026nbsp;attempt and the\\u0026nbsp;moment of\\u0026nbsp;realization\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe findings reveal that the moment of the suicide attempt was influenced by a combination of survival instincts, loss of consciousness, and external intervention. Some participants reported experiencing last-minute ambivalence that temporarily interrupted their actions, while others described complete dissociation or loss of consciousness during the attempt. Additionally, unexpected external interventions were noted to have played a critical role in preventing some suicide attempts, highlighting the fragile and dynamic nature of this critical phase. It is reflected in the following statements:\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;Everything was ready, I was just going to throw myself down, but a momentary hesitation appeared in me, did I really want to do that?\\u0026rdquo; (N3).\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;\\u003c/em\\u003e \\u003cem\\u003eAt that moment, my mind was completely silenced. I was not even aware of what I was doing. When I opened my eyes, I was in the hospital\\u0026rdquo; (N5).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026quot;Everything was over, but my brother found me. At first, I was disappointed, but then I thought that someone realized my pain\\u0026rdquo; (N2).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eTheme 3:\\u0026nbsp;\\u003c/em\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e\\u003cem\\u003eThe reconstruction process following a suicide attempt\\u0026nbsp;\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis theme explores the process of recovery, search for meaning, and transformation in the physical, psychosocial, and professional dimensions of nurses who survived suicide. The theme is divided into four sub-themes: a) Shock Due to Physical and Psychological Causes, b) Struggle with Stigmatization, c) Psychosocial Reconstruction, and d) Vocational Reconstruction.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003ePhysical and psychological shock\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eSurvivors of suicide attempts reported experiencing both physical and psychological shock. Conflicting emotions such as confusion, emptiness, guilt, anger, and regret emerged as they confronted the reality of survival. The dissonance between the intent to die and the outcome of surviving generated complex reactions, as illustrated by participant reflections:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;I was supposed to die, but I was there. I was shocked\\u0026rdquo; (N6).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo; The first thing I felt when I was rescued wat disappointment. Then I felt ashamed\\u0026rdquo; (N10).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePhysical injuries from the attempt also served as constant reminders, compounding emotional distress:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;The pain in my stomach went away, but the emptiness inside me grew bigger\\u0026rdquo; (N9).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eCombating stigmatization\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFollowing their attempts, participants encountered social stigmatization and exclusion. Societal narratives that frame suicide as a sign of weakness or moral failure intensified their psychological burden. Many felt further alienated by dismissive or moralizing responses from their families and communities:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;Everyone was looking at me as if I was not a normal person\\u0026rdquo;(N1).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;Even my own family tried to close the subject by telling me, \\u0026lsquo;You are weak, you should endure, you should pray\\u0026rsquo;\\u0026rdquo; (N3).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;My relatives said others have gone through worse things than you, but they still endured. There was no one who understood my pain... I kept silent\\u0026rdquo;\\u0026nbsp;\\u003c/em\\u003e\\u003cem\\u003e(N4).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003ePsychosocial reconstruction\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eDespite the initial despair, several participants described processes of recovery, renewed meaning-making, and post-traumatic growth. Psychosocial support and therapeutic interventions facilitated emotional healing and a re-evaluation of life:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;I did not die, so maybe I can change something\\u0026rdquo; (N1).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;First I questioned why I was alive, but then I searched for the meaning of living\\u0026rdquo; (N3).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;I used to feel only exhaustion, but now I rewrote my destiny and learned to live\\u0026rdquo; (N7).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eImproved interpersonal relationships, rediscovery of support systems, and transformed identities were common outcomes during this stage.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eProfessional reconstruction\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eParticipants reflected deeply on their professional roles after surviving their attempts. This led to redefinitions of career purpose, decisions to continue or leave nursing, and the setting of new goals:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;Nursing had exhausted me, but I started again... I continued and tried to improve\\u0026rdquo; (N8).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;When I came back, my perspective on nursing changed- I restructured everything\\u0026rdquo; (N4).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eTheme 4: Metaphors Describing the Suicide Experience\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis theme captures the metaphors used by nurses to articulate their internal states and experiences throughout the suicide process. These are categorized into two sub-themes: Self-alienation and Internal Conflict and Professional, Social, and Cultural Stagnation.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eSelf-Alienation and internal conflict\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eParticipants often described a sense of losing their identity and emotional connection to themselves. Metaphors such as \\u0026ldquo;robot,\\u0026rdquo; \\u0026ldquo;masked face,\\u0026rdquo; \\u0026ldquo;empty shell,\\u0026rdquo; \\u0026ldquo;sinking ship,\\u0026rdquo; and \\u0026ldquo;spectator of my own life\\u0026rdquo; illustrated a fragmented sense of self:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;I was just an empty shell; I had lost my feelings\\u0026rdquo; (N2).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;I was smiling, but it was just my mask\\u0026rdquo; (N4).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;Sometimes it was as if I was watching my own life from the outside. I was doing something, but nothing belonged to me\\u0026rdquo; (N6).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eProfessional, social, and cultural stagnation\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eParticipants also expressed a sense of entrapment and invisibility in their professional and societal roles. They used metaphors such as \\u0026ldquo;never-ending bleeding,\\u0026rdquo; \\u0026ldquo;invisible handcuffs,\\u0026rdquo; \\u0026ldquo;shadow people,\\u0026rdquo; \\u0026ldquo;cage,\\u0026rdquo; and \\u0026ldquo;a boat in the middle of the sea without a paddle\\u0026rdquo;:\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;No matter how much I worked at home and at work, it was never-ending. People at work, outside, and at home were constantly demanding something.\\u0026nbsp;\\u003c/em\\u003e\\u003cem\\u003eI was stuck\\u0026mdash;life was a cage\\u0026rdquo; (N9).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;No one could see what I was going through. I was a shadow\\u0026rdquo; (N11).\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026ldquo;At that time, it was as if I was bleeding non-stop. I was bleeding everywhere\\u0026mdash;at home, at work\\u0026rdquo; (N11).\\u003c/em\\u003e\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThis study explored the suicide-related perspectives and lived experiences of nurses in Türkiye who had survived a suicide attempt. It is among the first qualitative studies to comprehensively examine the factors leading to, accompanying, and following a suicide attempt within this professional group. By foregrounding nurses’ personal narratives, this study offers critical insights that can inform the design of realistic and effective suicide prevention strategies in healthcare settings.\\u003c/p\\u003e\\n\\u003cp\\u003eThe findings demonstrate that suicide among nurses is not the result of a single cause, but rather a convergence of psychological, physical, occupational, social, political, and financial stressors. This aligns with previous studies [5, 19, 20], which have shown that psychological distress and emotional fatigue significantly contribute to nurses’ detachment from life over time. Burnout, high emotional labor, and empathy fatigue—long recognized in the literature as occupational hazards—were confirmed here as critical precursors to suicidal ideation. Depression and anxiety have been found to increase suicide risk by 3.8 and 7.6 times, respectively, among nurses [19].\\u003c/p\\u003e\\n\\u003cp\\u003eThe current study also emphasizes the role of physical exhaustion, long working hours, and unhealthy lifestyle habits in the development of suicidal behavior. These findings support earlier studies, which indicate that physical strain and neglect of self-care significantly heighten suicide risk [5, 21].\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eFurthermore, this research confirms that occupational and systemic issues—such as low wages, insufficient administrative support, workplace bullying, and exclusion from decision-making—are major contributors to psychological distress among nurses [4, 22]. Inadequate health policies, lack of union representation, and political neglect further intensify the burden. Violence against healthcare professionals, negative societal perceptions of nursing, and religious and cultural taboos about suicide exacerbate feelings of isolation and prevent nurses from seeking help [14, 23].\\u003c/p\\u003e\\n\\u003cp\\u003eIn contrast to earlier assumptions that suicide is often an impulsive act [24], this study found that the path from ideation to action is gradual, involving cognitive and emotional phases. Persistent negative thoughts, internalized distress, and a growing sense of entrapment were found to precede a suicide attempt. For many participants, death was perceived as an escape from unbearable psychological pain [14]. In some cases, a last-minute internal conflict or survival instinct interrupted the attempt—underscoring the complex, non-linear nature of suicidal behavior [25].\\u003c/p\\u003e\\n\\u003cp\\u003eAmbivalence and emotional fluctuation were common across participant accounts. In fact, 85.4% of 888 individuals who attempted suicide reported uncertainty about whether they truly wanted to die [26]. This echoes the findings of other studies that emphasize the dynamic and conflicted emotional state that often characterizes suicidal crises\\u0026nbsp;[14, 27].\\u003c/p\\u003e\\n\\u003cp\\u003eImportantly, nurses who survived their suicide attempts described undergoing profound psychological, social, and professional transformation. While some experienced lasting shame, regret, and social exclusion—known obstacles to recovery attempt [28, 29]—others found the experience to be a catalyst for meaning-making and growth. This dichotomy is consistent with prior findings that suicide survival does not automatically equate with recovery. Without adequate support, individuals are at high risk of relapse into hopelessness and isolation [29].\\u003c/p\\u003e\\n\\u003cp\\u003eTherefore, it is essential to establish comprehensive support systems for nurses at both the individual and institutional levels [30]. Improving working conditions, enhancing job satisfaction, and offering confidential, accessible mental health services are crucial for suicide prevention and recovery [7].\\u003c/p\\u003e\\n\\u003cp\\u003eThe findings reveal that nurses experienced profound psychological and emotional oppression during the suicide process, stemming from identity erosion, professional pressures, and rigid social expectations. This study differs from previous research by highlighting how nurses used metaphors—rather than direct language—to express their emotional and existential breakdown. Metaphors such as \\u003cem\\u003e“robotization,” “sinking ship,”\\u003c/em\\u003e and \\u003cem\\u003e“living with masks”\\u003c/em\\u003e reflect the emotional numbness and mental exhaustion experienced by nurses who continued to function physically but felt internally depleted.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eMetaphors like \\u003cem\\u003e“invisible handcuffs,” “a boat without oars in the middle of the sea,”\\u003c/em\\u003e and \\u003cem\\u003e“repressed identity”\\u003c/em\\u003e emphasize that suicide is not merely an individual act, but one shaped and intensified by systemic professional, social, and cultural constraints. These layered stressors deepen the sense of hopelessness and entrapment.\\u003c/p\\u003e\\n\\u003cp\\u003eParticipants reported being assigned duties beyond their specialization, transferred between departments without consultation, and treated as invisible extensions of the healthcare system—often seen as mere assistants to physicians. While previous studies have addressed these issues from a psychological or occupational stress lens [31, 32], the present study underscores how professional devaluation and social disregard can lead nurses toward existential collapse. These findings reinforce the necessity of not only providing emotional support to nurses but also re-evaluating their roles and working conditions within the healthcare system [7].\\u003c/p\\u003e\"},{\"header\":\"Conclusion and Recommendations\",\"content\":\"\\u003cp\\u003eThis study explored the experiences of nurses in Türkiye who had attempted suicide and found that these attempts were shaped by a confluence of psychological, physical, occupational, social, political, and financial factors. It further revealed that nurses often expressed their emotional suffering through metaphoric language, which conveyed feelings of professional, social, and cultural entrapment.\\u003c/p\\u003e\\n\\u003cp\\u003eFollowing a suicide attempt, participants experienced psychological and physical shock, stigmatization, social isolation, and a challenging process of psychosocial and professional reconstruction. These findings underscore the urgent need for comprehensive interventions targeting the mental health and working conditions of nurses.\\u003c/p\\u003e\\n\\u003cp\\u003eHealthcare institutions must take proactive steps to strengthen psychological support systems, regulate workloads, and prevent workplace bullying and burnout. Policies should aim to enhance the professional recognition, autonomy, and job satisfaction of nurses. Psychiatric and mental health nurses should play a central role in designing and implementing suicide prevention and post-crisis support programs tailored specifically to the needs of high-risk nurses.\\u003c/p\\u003e\\n\\u003cp\\u003eIntegrating these professionals into peer support networks and workplace mental health initiatives can aid in the early detection of distress and facilitate timely intervention. In parallel, broader societal efforts must focus on eliminating stigma, addressing violence against healthcare workers, and promoting public awareness to foster a more open dialogue around mental health. Future research should aim to develop nurse-specific suicide prevention frameworks and evaluate their effectiveness across different healthcare systems.\\u003c/p\\u003e\\n\\u003ch1\\u003eLimitations\\u003c/h1\\u003e\\n\\u003cp\\u003eThis study has several limitations. Due to the sensitive nature of the topic, some participants may have withheld parts of their experiences, influenced by cultural and social stigma associated with suicide. Additionally, the study was conducted exclusively in Türkiye, which may limit the transferability of findings to other countries or healthcare systems with differing cultural, institutional, and social dynamics.\\u003c/p\\u003e\\n\\u003cp\\u003eTo address these limitations, future studies should involve larger and more diverse samples and employ mixed methods approaches across various cultural and clinical settings to broaden the understanding of suicide among nurses globally.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eIPA\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eInterpretative Phenomenological Analysis\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eCOREQ\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eConsolidated Criteria for Reporting Qualitative Research\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics Approval and Consent to Participate:\\u0026nbsp;\\u003c/strong\\u003eEthical approval was obtained from the Harran University Non-Pharmaceutical Clinical Research Ethics Committee prior to the commencement of the study (Approval Number: HR\\u0026Uuml;/24.12.37). At the beginning of the interviews, the participants were informed in line with the provisions of the 1995 Declaration of Helsinki (as revised in Brazil, 2013). Written and verbal consent was obtained from each participant.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u0026nbsp;\\u003c/strong\\u003eNot Applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials:\\u0026nbsp;\\u003c/strong\\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request. Due to the sensitive nature of the data, access is restricted to protect participant anonymity.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting Interests:\\u0026nbsp;\\u003c/strong\\u003eThere is no between authors in this research.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eFunding:\\u0026nbsp;This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\\u003c/p\\u003e\\n\\u003cp\\u003eAuthors\\u0026apos; contributions: OK:\\u0026nbsp;Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Validation, Visualization,Writing \\u0026ndash; original draft, Writing \\u0026ndash; review \\u0026amp; editing. \\u0026nbsp;MKE:\\u0026nbsp;Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Supervision, Validation, Visualization,Writing \\u0026ndash; original draft, Writing \\u0026ndash; review \\u0026amp; editing\\u003c/p\\u003e\\n\\u003cp\\u003eAcknowledgments: We would like to express our sincere gratitude to the nurses who participated in this study, as well as to Mary Ellen TOFFLE, Emre \\u0026Ccedil;IYDEM, and Abdul HADI, who provided invaluable support throughout.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eWorld Health Organization. Suicide prevention. 2024. https://www.who.int/health-topics/suicide#tab=tab_1. Accessed 12 May 2025.\\u003c/li\\u003e\\n \\u003cli\\u003eWolf LA, Delao AM, Perhats C, Clark PR, Edwards C, Frankenberger WD. Traumatic stress in emergency nurses: Does your work environment feel like a war zone? International Emergency Nursing. 2020;52 July:100895. https://doi.org/10.1016/j.ienj.2020.100895.\\u003c/li\\u003e\\n \\u003cli\\u003eGuille C. Rate of suicide among women nurses compared with women in the general population before the COVID-19 global pandemic. JAMA Psychiatry. 2021;78:597. https://doi.org/10.1001/jamapsychiatry.2021.0141.\\u003c/li\\u003e\\n \\u003cli\\u003eCheung T, Lee PH, Yip PSF. Suicidality among Hong Kong nurses: Prevalence and correlates. Journal of Advanced Nursing. 2016;72:836\\u0026ndash;48. https://doi.org/10.1111/jan.12869.\\u003c/li\\u003e\\n \\u003cli\\u003eGroves S, Lascelles K, Hawton K. Suicide, self-harm, and suicide ideation in nurses and midwives: A systematic review of prevalence, contributory factors, and interventions. Journal of Affective Disorders. 2023;331 March:393\\u0026ndash;404. https://doi.org/10.1016/j.jad.2023.03.027.\\u003c/li\\u003e\\n \\u003cli\\u003eDavis MA, Cher BAY, Friese CR, Bynum JPW. Association of US nurse and physician occupation with risk of suicide. JAMA Psychiatry. 2021;78:651. https://doi.org/10.1001/jamapsychiatry.2021.0154.\\u003c/li\\u003e\\n \\u003cli\\u003eDavidson JE, Proudfoot J, Lee K, Terterian G, Zisook S. A longitudinal analysis of nurse suicide in the United States (2005\\u0026ndash;2016) with recommendations for action. Worldviews on Evidence-Based Nursing. 2020;17:6\\u0026ndash;15. https://doi.org/10.1111/wvn.12419.\\u003c/li\\u003e\\n \\u003cli\\u003eLee KA, Friese CR. Deaths by suicide among nurses: A rapid response call. Journal of Psychosocial Nursing and Mental Health Services. 2021;59:3\\u0026ndash;4. https://doi.org/10.3928/02793695-20210625-01.\\u003c/li\\u003e\\n \\u003cli\\u003eAmerican Psychiatric Nurses Association. APNA Position: Youth Suicide Prevention. 2024. https://www.apna.org/news/apna-position-youth-suicide-prevention/#:~:text=It is the position of,suicide screening%2C risk assessment%2C and.\\u003c/li\\u003e\\n \\u003cli\\u003eYıldırım MŞ, Ak\\u0026ccedil;an R, Alemdar MZ. Rising health problem of T\\u0026uuml;rkiye, healthcare professionals\\u0026rsquo; suicides in media. Health Sciences Quarterly. 2023;3:27\\u0026ndash;33. https://doi.org/10.26900/hsq.1868.\\u003c/li\\u003e\\n \\u003cli\\u003ePirkis J, Dandona R, Silverman M, Khan M, Hawton K. Preventing suicide: a public health approach to a global problem. The Lancet Public Health. 2024;9:e787\\u0026ndash;95. https://doi.org/10.1016/s2468-2667(24)00149-x.\\u003c/li\\u003e\\n \\u003cli\\u003eAriapooran S, Ahadi B, Khezeli M. Depression, anxiety, and suicidal ideation in nurses with and without symptoms of secondary traumatic stress during the COVID-19 outbreak. Archives of Psychiatric Nursing. 2022;37 January 2021:76\\u0026ndash;81. https://doi.org/10.1016/j.apnu.2021.05.005.\\u003c/li\\u003e\\n \\u003cli\\u003eCreswell J. Qualitative inquiry and research design: Choosing among five approaches. Ankara: Siyasal Publisher; 2020.\\u003c/li\\u003e\\n \\u003cli\\u003eMarzetti H, McDaid L, O\\u0026rsquo;Connor R. A qualitative study of young people\\u0026rsquo;s lived experiences of suicide and self-harm: intentionality, rationality and authenticity. Child and Adolescent Mental Health. 2023;28:504\\u0026ndash;11. https://doi.org/10.1111/camh.12641.\\u003c/li\\u003e\\n \\u003cli\\u003eDavidson J, Mendis J, Stuck AR, DeMichele G, Zisook S. Nurse Suicide: Breaking the Silence. NAM Perspectives. 2018;8. https://doi.org/10.31478/201801a.\\u003c/li\\u003e\\n \\u003cli\\u003eSmith JA, Larkin M, Flowers P. Interpretative phenomenological analysis: Theory, method and research. 2nd edition. Sage Publication; 2021.\\u003c/li\\u003e\\n \\u003cli\\u003eLincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills: CA: Sage Publication; 1985.\\u003c/li\\u003e\\n \\u003cli\\u003eTong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007;19:349\\u0026ndash;57. https://doi.org/10.1093/intqhc/mzm042.\\u003c/li\\u003e\\n \\u003cli\\u003eKavaliauskas P, Kazlauskas E, Smailyte G. Psychological distress, suicidality and resilience of Lithuanian nurses. BMC Nursing. 2024;23. https://doi.org/10.1186/s12912-024-02632-2.\\u003c/li\\u003e\\n \\u003cli\\u003eBasu N, Barinas J, Williams K, Clanton C, Smith PN. Understanding nurse suicide using an ideation-to-action framework: An integrative review. Journal of Advanced Nursing. 2023;79:4472\\u0026ndash;88. https://doi.org/10.1111/jan.15681.\\u003c/li\\u003e\\n \\u003cli\\u003eChoflet A, Davidson J, Lee KC, Ye G, Barnes A, Zisook S. A comparative analysis of the substance use and mental health characteristics of nurses who complete suicide. Journal of Clinical Nursing. 2021;30:1963\\u0026ndash;72. https://doi.org/10.1111/jocn.15749.\\u003c/li\\u003e\\n \\u003cli\\u003eChin WS, Chen YC, Ho JJ, Cheng NY, Wu HC, Shiao JSC. Psychological work environment and suicidal ideation among nurses in Taiwan. Journal of Nursing Scholarship. 2019;51:106\\u0026ndash;13. https://doi.org/10.1111/jnu.12441.\\u003c/li\\u003e\\n \\u003cli\\u003eHajiyousouf II, Bulut S. Mental health, religion and suicide. Open Journal of Medical Psychology. 2022;11:12\\u0026ndash;27. https://doi.org/10.4236/ojmp.2022.111002.\\u003c/li\\u003e\\n \\u003cli\\u003eLim M, Lee S, Park JI. Differences between impulsive and non-impulsive suicide attempts among individuals treated in emergency rooms of South Korea. Psychiatry Investigation. 2016;13:389\\u0026ndash;96. https://doi.org/10.4306/pi.2016.13.4.389.\\u003c/li\\u003e\\n \\u003cli\\u003eMacintyre VG, Mansell W, Pratt D, Tai SJ. The psychological pathway to suicide attempts: A strategy of control without awareness. Frontiers in Psychology. 2021;12 March. https://doi.org/10.3389/fpsyg.2021.588683.\\u003c/li\\u003e\\n \\u003cli\\u003eKim H, Kim B, Kim SH, Park CHK, Kim EY, Ahn YM. Classification of attempted suicide by cluster analysis: A study of 888 suicide attempters presenting to the emergency department. Journal of Affective Disorders. 2018;235 April:184\\u0026ndash;90. https://doi.org/10.1016/j.jad.2018.04.001.\\u003c/li\\u003e\\n \\u003cli\\u003eAbdollahpour Ranjbar H, Parhoon H, Mohammadkhani S, Munawar K, Moradi AR, Jobson L. Investigating cognitive control and cognitive emotion regulation in Iranian depressed women with suicidal ideation or suicide attempts. Suicide and Life-Threatening Behavior. 2021;51:586\\u0026ndash;95. https://doi.org/10.1111/sltb.12735.\\u003c/li\\u003e\\n \\u003cli\\u003eWiklander M, Samuelsson M, \\u0026Aring;sberg M. Shame reactions after suicide attempt. Scandinavian Journal of Caring Sciences. 2003;17:293\\u0026ndash;300. https://doi.org/10.1046/j.1471-6712.2003.00227.x.\\u003c/li\\u003e\\n \\u003cli\\u003eBotha K-J, Guilfoyle A, Botha D. Beyond normal grief: A critical reflection on immediate post-death experiences of survivors of suicide. Australian e-Journal for the Advancement of Mental Health. 2009;8:37\\u0026ndash;47. https://doi.org/10.5172/jamh.8.1.37.\\u003c/li\\u003e\\n \\u003cli\\u003eFayaz I. Posttraumatic growth experiences in suicide survivors: a qualitative inquiry in conflict zone. Psychology, Health and Medicine. 2024;29:442\\u0026ndash;7. https://doi.org/10.1080/13548506.2022.2124524.\\u003c/li\\u003e\\n \\u003cli\\u003eDall\\u0026rsquo;Ora C, Ball J, Reinius M, Griffiths P. Burnout in nursing: A theoretical review. Human Resources for Health. 2020;18:1\\u0026ndash;17. https://doi.org/10.1186/s12960-020-00469-9.\\u003c/li\\u003e\\n \\u003cli\\u003eDespotović MM, Ignjatović Ristić D, Banković D, Milovanović D, Stepanović Ž, Despotović M, et al. Suicidality, resilience and burnout in a population of oncology nurses. Scientific Reports. 2025;15:3251. https://doi.org/10.1038/s41598-025-87677-2.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-psychology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"psyo\",\"sideBox\":\"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"\",\"title\":\"BMC Psychology\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"lived experiences, mental health, nurses, phenomenological study, suicide\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8491955/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8491955/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground:\\u003c/strong\\u003e In recent years, suicide rates among nurses have risen to an alarming level, underscoring the urgent need to understand the underlying causes within this professional group.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAim:\\u003c/strong\\u003e This study aimed to explore the perspectives and lived experiences related to suicide among nurses in Türkiye who have attempted suicide.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods:\\u003c/strong\\u003e The research was conducted between September 2, 2024, and January 6, 2025, using a hermeneutic phenomenological approach. The study sample consisted of 11 nurses who had previously attempted suicide and voluntarily participated in the research. Data was collected through a structured questionnaire and semi-structured, in-depth interviews. The data was then analyzed using the interpretive phenomenological analysis method.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults:\\u003c/strong\\u003e The findings were organized into four main themes: (1) Reasons Leading to Suicide; (2) The Process of Deciding and Attempting Suicide; (3) The Reconstruction Process Following a Suicide Attempt; (4) Metaphors Describing the Suicide Experience. This study underscores the complex interplay of psychological, professional, social, and cultural factors influencing the suicide experiences of nurses in Türkiye.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions: \\u003c/strong\\u003eParticipants’ narratives revealed not only personal struggles but also systemic challenges within the healthcare system that exacerbate these difficulties. Recovery following a suicide attempt necessitates strong emotional, social, and institutional support. Consequently, comprehensive prevention strategies should be implemented, including the promotion of a supportive work environment and the improvement of working conditions within the nursing profession. Interventions must prioritize mental health awareness, early identification of psychological distress, and the provision of accessible psychosocial services tailored to the specific needs of nurses.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Suicide-related perspectives and life experiences of nurses in Türkiye who attempted suicide: A phenomenological study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-02-03 15:41:21\",\"doi\":\"10.21203/rs.3.rs-8491955/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-02-22T21:37:54+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"316672243370430611032042694379328562404\",\"date\":\"2026-01-31T11:40:07+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"253003527900729971961650946681111112857\",\"date\":\"2026-01-30T08:29:38+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-01-29T09:35:23+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2026-01-07T11:39:28+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-01-05T12:48:55+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-01-05T12:48:32+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Psychology\",\"date\":\"2025-12-31T19:27:49+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-psychology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"psyo\",\"sideBox\":\"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"\",\"title\":\"BMC Psychology\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"f59e2d3d-6b85-4a7d-8c1c-eb0cba54c3f5\",\"owner\":[],\"postedDate\":\"February 3rd, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-02-03T15:41:24+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-02-03 15:41:21\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8491955\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8491955\",\"identity\":\"rs-8491955\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}