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Perceptions of Australian emergency staff toward patients presenting with deliberate self-poisoning: A qualitative perspective
Abstract
Introduction/background
Attitude of staff toward patients who present to the emergency department following deliberate self-poisoning may be integral to the outcome of these events. There is little in-depth understanding of emergency staff perceptions about this vulnerable group.
Aim
Explore staff perceptions about caring for patients who present to the emergency department following deliberate self-poisoning
Design
Qualitative descriptive study
Methods
Two open-ended questions enabled 186 clinicians to describe their perceptions about caring for people who present to the emergency department following deliberate self-poisoning. Data were analysed using qualitative data analysis procedures
Results
Three themes emerged from the data representing staff perceptions about caring for patients who deliberately self-poisoned and included depends on the patient, treat everyone the same, and skilled and confident to manage these patients.
Conclusion
Staff reported mixed reactions to patients presenting with deliberate self-poisoning. These included feelings of empathy or frustration and many lacked the skills and confidence to effectively manage these patients.
Relevance to practice
health networks are required to ensure that emergency staff have specialist support, knowledge, skills, and guidelines to provide effective care for this vulnerable population
... 30 Various studies revealed that nurses did not consider the emergency department as a suitable place to provide care for patients with intentional self-poisoning. [30][31][32][33] Overcrowding in the emergency department can adversely affect the quality of care provided to patients with intentional self-poisoning. 34 Most nurses attributed overcrowding in the emergency department, lack of adequate time to care, and the increased workload caused by self-poisoned patients to feel angry with patients with intentional self-poisoning. ...
... Therefore, the emergency department and the balance between nurses and patients need proper management to reduce nursing workload so that nurses can provide quality care with calm and patience to patients with intentional self-poisoning. The results of a study by Chapman and Martin (2014) showed that emergency department nurses provided equal care to patients with intentional self-poisoning and they had a sense of empathy and compassion for these patients, although many of them did not have the necessary skills and confidence to care for these patients. 33 Emergency department nurses in Beaver's study in South Carolina stated that they were indifferent to patients with intentional self-poisoning and were reluctant to communicate with them. ...
... The results of a study by Chapman and Martin (2014) showed that emergency department nurses provided equal care to patients with intentional self-poisoning and they had a sense of empathy and compassion for these patients, although many of them did not have the necessary skills and confidence to care for these patients. 33 Emergency department nurses in Beaver's study in South Carolina stated that they were indifferent to patients with intentional self-poisoning and were reluctant to communicate with them. In the study mentioned before, the training of emergency department nurses in relation to intentional self-poisoning patients led to an improvement in the quality of care provided to these patients. ...
Nurses have an important role in caring for patients with intentional self-poisoning. This study was attempted to explore the emergency department nurses' perception of caring for patients with intentional self-poisoning. The present qualitative study was performed using phenomenological method. This study was done on 14 emergency department nurses with experience in caring for patients with intentional self-poisoning. Data were collected through semi-structured interviews and transcribed verbatim. Data were analyzed using Colaizzi's method. Following data analysis, two themes and five sub-themes were extracted, which included being reluctant to provide care for patients with intentional self-poisoning (discomfort in providing care, and lack of desire to care for these patients) and comprehensive patient support (providing complete care and emotional support). Given that emergency department nurses are the first medical staff who face with intentional self-poisoning patients and play an important role in the care and treatment of these patients, it is necessary to improve their understanding of caring for these patients. In addition, their comprehensive support for these patients should be strengthened. Psychological support for nurses and training them on how to communicate with intentional self-poisoning patients and their families are also recommended.
... From a healthcare perspective, some staff have previously reported negative views about those in suicidal crisis. Recent studies identified that ED nurses and doctors who report negative attitudes toward patients presenting in a suicide crisis or with intentional self-harm experience low empathy and some degree of antipathy toward mental health patients in general (12)(13)(14). Australian emergency nurses indicated that negative attitudes toward help seekers impacted the quality of care they delivered (13). ED staff also report not having time to build rapport necessary for a psychological assessment (15), or to appropriately assess the risk of future suicide (12,15,16). ...
... Australian emergency nurses indicated that negative attitudes toward help seekers impacted the quality of care they delivered (13). ED staff also report not having time to build rapport necessary for a psychological assessment (15), or to appropriately assess the risk of future suicide (12,15,16). Moreover, research has suggested that ED staff are inadequately trained in mental health (17,18) and suicide presentations, such as causes, crisis intervention, assessment, and appropriate referral options (12,14,19,20). ...
... ED staff also report not having time to build rapport necessary for a psychological assessment (15), or to appropriately assess the risk of future suicide (12,15,16). Moreover, research has suggested that ED staff are inadequately trained in mental health (17,18) and suicide presentations, such as causes, crisis intervention, assessment, and appropriate referral options (12,14,19,20). ...
Help seekers regularly present to Emergency Departments (EDs) when in suicidal crisis for intervention to ensure their immediate safety, which may assist in reducing future attempts. The emergency health workforce have unique insights that can inform suicide prevention efforts during this critical junction in an individual's experience with suicide. This paper explores the treatment and care delivery experiences of 54 health professionals working in EDs within one of the LifeSpan suicide prevention trial sites in Australia. Data was collected via six focus groups and six interviews. Thematic analysis resulted in three themes: (1) physicality of the emergency department, (2) juggling it all–the bureaucracy, practicalities, and human approach to care, and (3) impact of care delivery on ED staff. Findings highlight the need for workplace training that incorporates responding to the uncertainty of suicidal crisis, to compliment the solution-focused medical model of care. Broader policy changes to the ED system are also considered to ensure better outcomes for health professionals and help-seekers alike.
... Positive attitudes and therapeutic interactions are vital to improving the physical and psychological outcomes of people who self-injure (Rayner et al., 2019). While there is evidence reporting the attitudes of MHNs (McAllister, Creedy, Moyle, & Farrugia, 2002;Vine, Shawwhan-Akl, Maude, Jones, & Kimpton, 2017) and ED nurses (Artis & Smith, 2013;Chapman & Martin, 2014) towards those who self-injure, there is limited evidence in Australia examining these two groups together, despite these nurses working alongside each other in EDs in Australia. Examining the two groups together is important as nurses in both settings frequently interact with people who self-injure and nursing knowledge, positive attitudes and confidence are essential for their clinical practice. ...
... Positive empathy and confidence to provide therapeutic care to people who self-injure may directly affect the development of a therapeutic relationship, which is vital in providing appropriate care (Chapman & Martin, 2014). Further exploration of the association of these two constructs and experience of ED and MHNs is needed. ...
Non‐suicidal self‐injury (NSSI) is a major public health concern and is also associated with increased risk of suicide. The type of care people with NSSI receive at the hospital impacts their health outcomes. This study explored emergency department (ED) and mental health nurses’ (MHNs) understanding, attitudes, empathy and confidence to work with people presenting with NSSI. ED and MHNs who belonged to either the College of Emergency Nursing Australasia (CENA) or the Australian College of Mental Health Nurses (ACMHN) were invited to complete an online survey through a group email from their college. One hundred and one nurses (56 ED and 45 MHNs) completed the survey. The results revealed that nurses from both groups had an accurate understanding of NSSI and had positive attitudes about patients who self‐injure. However, confidence was higher among MHNs. Greater knowledge of NSSI was correlated with increased confidence, positive attitudes and empathy. For mental health nurses, but not ED nurses, years of clinical practice was associated with nurses’ confidence. In contrast, ED nurses with more than 10 years’ experience were less confident in addressing NSSI than ED nurses with less experience. Issues that affect both ED and MHNs’ knowledge, attitude, empathy and confidence to care for patients who self‐injure are multifactorial. Future education and training should focus on therapeutic interactions with people at risk of repeat NSSI. Further, more research is recommended to explore patients’ perspectives of nurses’ attitudes in care for people who self‐injure.
... Вопреки рекомендациям Национального института здравоохранения и медицинской помощи (NICE) по лечению самоповреждений в общих больницах [80], недовольство пациентов распространено: профессионалы не понимают, относятся небрежно и неуважительно, плохо обращаются и неловко привлекают к лечению. Соответственно, работники отделений неотложной помощи сообщают о негативном отношении к СХ, проявляемом раздражением, гневом и разочарованием [81,82]. Попытки контроля, усиленного мониторинга и дисциплинарных мер воспринимаются подростками и молодыми бесполезными и ведут к хронификации цикла СХ [64,83]. ...
... Contrary to the recommendations of the National Institute of Health and Medical Care (NICE) on the treatment of self-harm in general hospitals [80], patient dissatisfaction is widespread: professionals do not understand, are careless and disrespectful, mistreat, and embarrassingly attract to treatment. Accordingly, emergency department employees report a negative attitude towards SH, manifested by irritation, anger, and frustration [81,82]. Attempts to control, strengthen monitoring and disciplinary measures are perceived by adolescents and young people as useless and lead to a chronicization of the SH cycle [64,83]. ...
... A pool of 199 papers were then appraised in full, and 51 papers were sub-divided into a main sample (26 papers) and a secondary sample (25 papers). The main sample consisted of 26 papers of relevance published between 1996 and 2016 (Malone, 1996(Malone, , 1998Hopkins, 2002;Decoux, 2005;Liggins and Hatcher, 2005;Kerrison and Chapman, 2007;Clarke et al., 2007;Hume and Platt, 2007;Henderson et al., 2008;Hadfield et al., 2009;Hall et al., 2011;Marynowski-Traczyk et al., 2011;Muzaffer et al., 2011;Gerdtz et al., 2012;MacNeela et al., 2012;Doran et al., 2013Doran et al., , 2014Paterson et al., 2013;Van Nieuwenhuizen et al., 2013;Chapman and Martin, 2014;Jackson et al., 2014;Morgan, 2014;Shefer et al., 2014;Ackerman et al., 2015;Giandinoto and Edward, 2015;Renker et al., 2015). These contributed the data for the framework development. ...
... 'If they have taken a small amount of a drug that is harmless, I see it as attention-seeking and such behaviour should not be rewarded by giving more attention.' (Healthcare Professional, Chapman and Martin, 2014). ...
Rationale
Patients with long-term mental health conditions often have complex physical, mental, and social needs. They are frequent users of the acute general healthcare system, but can experience stigmatising attitudes and behaviours, and structural discrimination. We wished to improve understanding of stigmatisation in the acute healthcare setting, to target areas for future intervention.
Objective
A synthesis of qualitative literature was undertaken in order to understand how patients with long-term mental health conditions are stigmatised, or otherwise treated, within the acute healthcare system.
Method
A theory-driven framework approach was implemented. Existing stigma theory was used to outline a framework for categorizing stigmatising and non-stigmatising phenomena within the acute healthcare system.
Results
A systematic literature search of qualitative studies identified a sample of 51 studies that would inform the framework. Using data in these studies, a final theoretical ‘best fit’ framework was developed. In this framework there is an overarching pattern of labelling and stereotyping, plus five ways in which patients with mental health conditions are stigmatised in the acute healthcare system: devaluation, social control, avoidance, rejection, and failure to act. In addition, the framework outlines positive attitudes and behaviours – valuing, adjustment, responding, legitimising, and positive action – which contrast with the stigmatisation patterns.
Conclusions
The study offers a framework for identifying stigmatisation and positive treatment of those with mental health conditions in an acute health setting. This framework is of potential value in targeting areas for improved quality of care and may have utility beyond this setting and stigmatised group.
... Correspondingly, staff working in A&E report negative attitudes towards people who self-harm, including feelings of irritation, anger and frustration. 6,7 Existing research relates to adults or mixed adult/adolescent populations. The views of young people who self-harm are very difficult to access and their fears about presenting to healthcare services, including A&E, are not well understood. ...
... Chapman & Martin report that A&E staff find those presenting with self-inflicted injuries 'harder work' than acutely ill patients, and 'very time consuming' . 7 Our findings may offer some comfort to A&E staff. Although they point to a need for clinicians to be alert to the hidden aspects of the encounter, it is clear that the young people in our study recognised the pressures on A&E staff and did not expect any special treatment. ...
... Correspondingly, staff working in A&E report negative attitudes towards people who self-harm, including feelings of irritation, anger and frustration. 6,7 Existing research relates to adults or mixed adult/adolescent populations. The views of young people who self-harm are very difficult to access and their fears about presenting to healthcare services, including A&E, are not well understood. ...
... Chapman & Martin report that A&E staff find those presenting with self-inflicted injuries 'harder work' than acutely ill patients, and 'very time consuming' . 7 Our findings may offer some comfort to A&E staff. Although they point to a need for clinicians to be alert to the hidden aspects of the encounter, it is clear that the young people in our study recognised the pressures on A&E staff and did not expect any special treatment. ...
Background
Presentation at an accident and emergency (A&E) department is a key opportunity to engage with a young person who self-harms. The needs of this vulnerable group and their fears about presenting to healthcare services, including A&E, are poorly understood.AimsTo examine young people's perceptions of A&E treatment following self-harm and their views on what constitutes a positive clinical encounter.Method
Secondary analysis of qualitative data from an experimental online discussion forum. Threads selected for secondary analysis represent the views of 31 young people aged 16-25 with experience of self-harm.ResultsParticipants reported avoiding A&E whenever possible, based on their own and others' previous poor experiences. When forced to seek emergency care, they did so with feelings of shame and unworthiness. These feelings were reinforced when they received what they perceived as punitive treatment from A&E staff, perpetuating a cycle of shame, avoidance and further self-harm. Positive encounters were those in which they received 'treatment as usual', i.e. non-discriminatory care, delivered with kindness, which had the potential to challenge negative self-evaluation and break the cycle.Conclusions
The clinical needs of young people who self-harm continue to demand urgent attention. Further hypothesis testing and trials of different models of care delivery for this vulnerable group are warranted.
... We recently reported that ED nursing and medical staff felt empathy towards DSP patients who presented once but frustration towards DSP patients who presented repeatedly [24,25]. The association of psychosocial history, unemployment and psychiatric illness, and more frequent absconding behaviour from the ED may result in staff feeling that they are dealing with patients who are difficult to manage, do not take responsibility for their actions, and do not want help. ...
... This finding is especially significant for those patients who re-present on numerous occasions. Many of the RPP patients were considered to be attention seeking, taking up resources and some staff queried whether the ED was the right place for these patients [24,25]. The sub-analysis of the most frequent DSP attenders suggested that the severity of poisoning was similar to the single presenters. ...
Background
A proportion of deliberate self-poisoning (DSP) patients present repeatedly to the emergency department (ED). Understanding the characteristics of frequent DSP patients and their presentation is a first step to implementing interventions that are designed to prevent repeated self-poisoning.
Methods
All DSP presentations to three networked Australian ED’s were retrospectively identified from the ED electronic medical record and hospital scanned medical records for 2011. Demographics, types of drugs ingested, emergency department length of stay and disposition for the repeat DSP presenters were extracted and compared to those who presented once with DSP in a one year period. Logistic regression was used to analyse repeat versus single DSP data.
Results
The study determined 755 single presenters and 93 repeat DSP presenters. The repeat presenters contributed to 321 DSP presentations. They were more likely to be unemployed (61.0% versus 39.9%, p = 0.008) and have a psychiatric illness compared to single presenters (36.6% versus 15.5%, p < 0.001). Repeat presenters were less likely to receive a toxicology consultation (11.5% versus 27.3%, p < 0.001) and were more likely to abscond from the ED (7.5% versus 3.4%, p = 0.004). Repeat presenters were more likely to ingest paracetamol and antipsychotics than single presenters. The defined daily dose for the most common antipsychotic ingested, quetiapine, was less in the repeat presenter group (median 1.9 [IQR: 1.3-3.5]) compared with the single presenter group (4 [1.4-9.5]), (OR 0.85, 95% CI 0.74-0.99).
Conclusion
Patients who present repeatedly to the ED with DSP have pre-existing disadvantages, with increased likelihood of being unemployed and having a mental illness. These patients are also more likely to have health service inequities given the greater likelihood to abscond from the ED and lower likelihood of receiving toxicology consultation for their DSP. Early recognition of repeat DSP patients in the ED may facilitate the development of individualised care plans with the aim to reduce repeat episodes of self-poisoning and subsequent risk of successful suicide.
... From a healthcare perspective, however, staff have often noted not having appropriate time and resources to build rapport with people presenting in suicidal crisis (Petrik et al., 2015). Some research has suggested ED nurses and doctors have negative views towards those presenting in suicidal crisis and that some staff are inadequately trained in mental health, specifically the causes, crisis intervention and appropriate referral options for suicidal crisis attendances (Chapman & Martin, 2014;Rayner et al., 2019). There is an absence of research, however, examining staff perspectives in a UK ED setting. ...
Introduction
Emergency departments (EDs) are often the first point of contact for people in suicidal crisis. Yet, previous work has tended to focus on only one type of staffing role, failing to account for different staff perspectives along the clinical pathway.
Aims
To explore and synthesise the perspectives of ED administrative (i.e. receptionists), medical (triage nurses) and mental health staff (liaison psychiatrists) working with people presenting in suicidal crisis.
Method
Qualitative study guided by thematic analysis of semi-structured interviews with 23 ED staff across six EDs in Cheshire and Merseyside, England.
Results
Findings demonstrate that staff experience a lack of confidence, training and burnout due to regularly supporting people in suicidal crisis. The main challenges reported are an increase in working pressures, unavailability of resources and staff retention.
Discussion
Staff felt unequipped to deal with suicide-related presentations. Organisational support is perceived to be lacking, with increased staffing pressures and poor service availability. This lack of support was linked to job dissatisfaction.
Implications for Practice
Findings are of particular relevance to individual EDs and NHS England. Addressing the challenges staff are reporting can have positive implications for staff wellbeing, as well as a patient's experience and journey throughout the ED.
... 15 Emergency health care providers often report that a lack of knowledge and training to deal with these situations is a barrier to providing adequate care for people with MHC. 4,16,17 This need, coupled with the stressful ED environment and brief interactions with patients due to time pressures, strains the ability of staff to meet patients' emotional needs. 18,19 In contrast, people with MHC perceive that the attention they receive from health professionals needs to be improved. ...
Introduction:
After coronavirus disease 2019, there has been an increase in patients in the emergency department with mental health conditions. They are usually received by professionals who are not specialized in mental health. This study aimed to describe nursing staff's experiences in the emergency department, in the care they provide to people with mental health problems who often feel stigmatized by society and also in health care settings.
Methods:
This is a descriptive qualitative study with a phenomenological approach. The participants were nurses from the Spanish Health Service from the emergency department of the Community of Madrid hospitals. Recruitment was performed by convenience sampling snowball sampling until data satruation was met. Data were collected through semistructured interviews conducted during January and February 2022.
Results:
The exhaustive and detailed analysis of the nurses' interviews made it possible to extract 3 main categories-health care, psychiatric patient, and work environment-with 10 subcategories.
Discussion:
The main study findings were the need to train emergency nurses to be prepared to care for people who experience mental health concerns including bias education and the need for implementation of standardized protocols. Emergency nurses never doubted their ability to care for people experiencing mental health disorders. Still, they recognized that they needed specialized professionals' support at certain critical moments.
... No other study has yet measured empathy in this particular setting and as such no comparison can be made. However, a small number of studies (Carter et al. 2018;Chapman & Martin 2014;Dickinson & Hurley 2012;Leddie et al. 2021) highlighted how children nurses may benefit from some empathy and attitudes-based training to assimilate concepts, promote communication, and may increase the delivery of compassionate and effective care to CYP self-harm. These studies (Pryjmachuk et al. 2012;Thomas 2017;Wissow et al. 2011) illustrated the importance of empathy training for children's nurses when dealing with CYP who self-harm or a suicide attempt and found that nurses who complete attitudes training adopt a more patient-centred and empathetic response to psychosocial distress. ...
Rates of self‐harm among children and adolescents have risen significantly over the past decade and clinical guidelines place children's nurses at the heart of their care. This article reports on the evaluation of ‘Our Care Through Our Eyes’, an online self‐harm learning programme for children's nurses. A self‐selected, convenience sample of registered children's nurses (n = 42) completed scales pre‐ and postlearning programme that captured their attitudes, beliefs, empathy, anxiety, and confidence. Mean change scores were assessed, and qualitative comments captured postintervention were thematically summarized. There were small improvements in participants' attitudes, empathy and confidence were reported. Anxiety scores increased in a small number of items. Qualitative comments confirmed the value of the online learning programme for improving children's nurses' knowledge and understanding of self‐harm among CYP. Our findings demonstrate that children's nurses agree on the importance of mental health training in self harm, and this could be a catalyst for renewal of both pre‐ and postregistration education including support structures within the National Health Service. This study is the first to explore the feasibility of evaluating ‘Our Care Through Our Eyes’ delivered using e‐leaning and could be used to inform further investigations.
... Research on GEC staffs' experiences of caring for people with mental ill health is limited (Koning et al. 2018;Ryan et al. 2021). However, GEC staff often report their lack of knowledge and training as a major barrier to providing appropriate care for people with mental ill health (Chapman & Martin 2014;Holmberg et al. 2020;Jelinek et al. 2013;Marynowski-Traczyk & Broadbent 2011;Plant & White 2013;Weiland et al. 2011). The physical environment of the ED and short interactions due to time pressures further challenge the ability of GEC staff to meet patients' emotional needs (Broadbent et al. 2014;Marynowski-Traczyk & Broadbent 2011;Weiland et al. 2011). ...
People with mental ill health attend general emergency care more often than others for physical and psychiatric care needs. Staff in general emergency care report they lack knowledge and strategies to meet with and care for people with mental ill health. This study aimed to describe how people with mental ill health experience encounters with staff in general emergency care. We conducted individual semi-structured interviews with 11 people with mental ill health about their experiences in general emergency care and subjected the interview data to qualitative content analysis. Our results show the importance to people with mental ill health of being acknowledged as capable persons, and how this relates to their experiences of being recognized, ignored, or dismissed by staff in general emergency care. Even small, ordinary aspects of staff/patient interactions can have major impacts on a person’s recovery and well-being. The study is reported according to the consolidated criteria for reporting qualitative research (COREQ) guidelines.
... In a recent qualitative examination of ED providers' perspectives regarding suicide risk assessment, elements of the practice environment (e.g., limited time and privacy, tendency to collaborate and consult with other health care professionals), providers' communication style, and patient engagement in assessment were found to be important implementation considerations [57]. Previous work has additionally found that ED providers may experience frustration and a desire to focus on patients' medical concerns rather than on psychosocial needs when working with patients who present with suicide-related concerns [58,59] and may be skeptical about the ability to prevent suicide deaths [9]. Continuing to identify the factors that can be modified to enhance ED providers' ability to deliver evidence-based care for suicide risk is needed and will be the key in designing effective policies and procedures for ED suicide prevention efforts. ...
Purpose of Review
It is estimated that emergency departments (EDs) could prevent 5% of all suicide attempts and 8% of suicide deaths, making EDs a critical setting in which to identify individuals at risk for suicide and to intervene to mitigate the risk. The goal of this review was to detail recent advances in the identification, assessment, and management of suicide risk in emergency medicine and to provide best practice recommendations for these processes.
Recent Findings
Advances in caring for patients who present to EDs with suicide risk include improved workflows and tools for ED providers to identify, assess, and manage suicide risk, increased patient-centeredness and quality of ED care for patients at risk of suicide, and shifting beliefs of ED providers regarding the feasibility of integrating the assessment and management of suicide risk into emergency care.
Summary
ED suicide prevention efforts have notably changed in recent years. Strategies for universal screening, secondary screening tools, and evidence-based workflows for the management of suicide risk all show potential for feasibly addressing suicide risk in EDs. Effective implementation of evidence-based practices is necessary as integrating these new practices requires significant change in the clinical practice and culture of many EDs.
... The papers included in the review varied in methods and in quality. Chapman and Martin (2014), O'Donovan and Gijbels (2006), and Mattson and Binder (2012) scored low in quality due to ambiguity around methodology, analysis, epistemology, and reflexivity. The research by Artis, Smith, and Scarff (2012) was a doctoral thesis which provided context around the research and methods and as a result was rated higher, along with Tofthagen, Talseth, and Fagerstr€ om (2014). ...
Purpose:
This review aimed to synthesize qualitative literature exploring inpatient hospital staff experiences of their relationships with people who self-harm.
Methods:
Nine studies were identified from a systematic search of five research databases. Papers included the experiences of physical health and mental health staff working in inpatient settings. The studies employed various qualitative research methods and were appraised using an adapted quality assessment tool (Tong, Sainsbury, & Craig, 2007). A meta-synthesis was conducted using traditional qualitative analysis methods including coding and categorizing data into themes.
Results:
Three main themes derived from the data. 'The impact of the system' influenced the extent to which staff were 'Fearing the harm from self-harm', or were 'Working alongside the whole person'. A fear-based relationship occurred across mental health and physical health settings despite differences in training; however, 'Working alongside the whole person' primarily emerged from mental health staff experiences. Systemic factors provided either an inhibitory or facilitative influence on the relational process.
Conclusions:
Staff experiences of their relationship with people who self-harm were highlighted to have an important impact on the delivery and outcome of care. Increasing support for staff with a focus on distress tolerance, managing relational issues, and developing self-awareness within the relationship may lead to a more mutually beneficial experience of care. Equally, structure, clarity, and support within inpatient systems may empower staff to feel more confident in utilizing their existing skills.
Practitioner points:
Working with people who self-harm can be emotionally challenging and how staff cope with this can significantly impact on the engagement of staff and patients. Increasing the skills of staff in managing relational issues and tolerating distress, as well as providing support and reflective practice groups may be useful in managing emotional responses to working with people who self-harm. Refining the supportive, procedural, and environmental structures surrounding the caregiving relationship may help enable better integration of physical and mental health care.
... Previous studies from Oslo have found significant elevated risk for suicide and early death after intoxication [43] but insufficient possibilities for treatment and a longer follow-up [44], also is observed in other countries [3,4,45,46]. Neglect of the patients' problems might lead to insufficient referral to mental health care, where professionals are more positive towards providing help. ...
Background
Attitudes toward suicidal behaviour can be essential regarding whether patients seek or are offered help. Patients with suicidal behaviour are increasingly treated by mental health outpatient clinics. Our aim was to study attitudes among professionals at outpatient clinics in Stavropol, Russia and Oslo, Norway.
Methods
Three hundred and forty-eight (82 %) professionals anonymously completed a questionnaire about attitudes. Professionals at outpatient clinics in Stavropol (n = 119; 94 %) and Oslo (n = 229; 77 %) were enrolled in the study. The Understanding Suicidal Patients (USP) scale (11 = positive to 55 = negative) and the Attitudes Towards Suicide Scale (ATTS) (1 = totally disagree, 5 = totally agree) were used. Questions about religious background, perceived competence and experiences of and views on suicidal behaviour and treatment (0 = totally disagree, 4 = totally agree) were examined.
Results
All groups reported positive attitudes, with significant differences between Stavropol and Oslo (USP score, 21.8 vs 18.7; p < 0.001). Professionals from Stavropol vs. Oslo reported significantly less experience with suicidal patients, courses in suicide prevention (15 % vs 79 %) guidelines in suicidal prevention (23 % vs 90 %), interest for suicide prevention (2.0 vs 2.7; p < 0.001), and agreed more with the ATTS factors: avoidance of communication on suicide (3.1 vs 2.3; p < 0.001), suicide is acceptable (2.9 vs 2.6; p = 002), suicide is understandable (2.9 vs 2.7; p = 0.012) and (to a lesser extent) suicide can be prevented (4.2 vs 4.5; p < 0.001). In both cities, psychiatric disorders (3.4) were considered as the most important cause of suicide. Use of alcohol (2.2 vs 2.8; p < 0.001) was considered less important in Stavropol. Psychotherapy was considered significant more important in Stavropol than Oslo (3.6 vs 3.4; p = 0.001).
Conclusions
Professionals reported positive attitudes towards helping suicidal patients, with significant differences between cities. A need for further education was reported in both cities, but education was less integrated in mental health care in Stavropol than it was in Oslo. In both cities, psychiatric disorders were considered the major reasons for suicide, and psychotherapy was the most important treatment measure.
Purpose
To determine the attitudes of emergency department (ED) staff toward people who have attempted suicide and the factors associated with these attitudes.
Method
This study was conducted between January and February 2023 and included 147 participants working in an ED in a city in Türkiye. Data were collected using a personal information form and the Attitude Scale Towards Attempted Suicide Cases for Evaluating Emergency Medical Teams (ASETSA).
Results
Participants' mean years of experience in emergency services was 4.63 years ( SD = 3.97 years) and mean perceived level of competence in intervening in suicidal behavior was 6.08 ( SD = 2.16). Total mean ASETSA score of participants was 114.68 ( SD = 12.31). Factors such as marital status, educational level, profession, working unit, working shift, having received training on how to approach a person who has attempted suicide, existence of a written procedure in the department, years of ED experience, and perceived level of competence in intervening in suicidal behavior were associated with positive attitudes toward people who have attempted suicide.
Conclusion
It is recommended that formal education curricula address how to approach people who have attempted suicide, that randomized controlled trials regarding the impact of in-service training be performed, and that studies evaluating the contribution of trainings to improvements in patient outcomes be conducted. [ Journal of Psychosocial Nursing and Mental Health Services, xx (xx), xx–xx.]
Background
Patients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals’ stigmatization toward patients with mental disorders.
Methods
We conducted a scoping review using Arksey and O’Malley’s framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May-June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008–2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo.
Results
A total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies (n = 73) and intervention studies (n = 64). A majority of studies (N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia (n = 13), self-harm (n = 13), and eating disorders (n = 9). Half of the studies focused on health students (n = 64), primarily nursing students (n = 26) and medical students (n = 25), while (n = 66) focused on health care professionals, primarily emergency staff (n = 16) and general practitioners (n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions.
Conclusions
The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.
Negative nurse attitudes towards emergency department patients who self-harm may increase the risk of repeated self-harm and suicide. This article details a systematic review that aimed to examine the evidence on the efficacy of educational interventions to improve the attitudes of emergency nurses towards patients who self-harm. Eight articles describing six intervention studies, published between 2001 and 2018, met the criteria for inclusion. The review found that educational interventions for emergency nurses improved their attitudes to patients who self-harm, but there was a lack of consistency in the approaches used and a reliance on self-report measures. Further training for emergency nurses is needed because of their crucial role in self-harm and suicide prevention.
Objective:
The objective of this scoping review was to explore, characterize, and map the literature on interventions and intervention components implemented to change emergency department clinicians' behavior related to suicide prevention using the Behaviour Change Wheel as a guiding theoretical framework.
Introduction:
An emergency department is a critical place for suicide prevention, yet patients are often discharged without proper suicide risk assessments and/or referrals. In response, we must support emergency department clinicians' behavior change to follow evidence-based suicide prevention strategies. However, reviews to date have yet to systematically and theoretically examine interventions' functional characteristics and how they can influence emergency department clinicians' behaviors related to suicide-prevention care.
Inclusion criteria:
This review considered interventions that targeted emergency department clinicians' behavior change related to suicide prevention. Behavior change referred to observable practice changes as well as proxy measures of behavior change, including changes in knowledge and attitude.
Methods:
This review followed JBI methodology for scoping reviews. Searches included PubMed, PsycINFO, CINAHL, Embase, and gray literature, including targeted Google searches for relevant organizations/websites, ProQuest Dissertations and Theses Global, and Scopus conference papers (using a specific filter). This review did not apply any date limits, but our search was limited to the English language. Data extraction was undertaken using a charting table developed specifically for the review objective. Narrative descriptions of interventions were coded using the Behavior Change Wheel's intervention functions. Reported outcome measures were categorized. Findings are tabulated and synthesized narratively.
Results:
Forty-one studies were included from the database searches, representing a mixture of experimental (n = 2), quasi-experimental (n = 24), non-experimental (n = 12), qualitative (n = 1), and mixed methods (n = 2) approaches. An additional 29 citations were included from gray literature searches. One was a pilot mixed methods study, and the rest were interventions. In summary, this review included a total of 70 citations, describing 66 different interventions. Identified interventions comprised a wide range of Behaviour Change Wheel intervention functions to change clinicians' behavior: education (n = 48), training (n = 40), enablement (n = 36), persuasion (n = 21), environmental restructuring (n = 18), modeling (n = 7), and incentivisation (n = 2). Based on the Behaviour Change Wheel analysis, many interventions targeted more than one determinant of behavior change, often employing education and training to improve clinicians' knowledge and skills simultaneously. Among the 42 studies that reported outcome measures, effectiveness was measured at clinician (n = 38), patient (n = 4), and/or organization levels (n = 6). Few studies reported implementation outcomes, such as measures of reach (n = 4), adoption (n = 5), or fidelity (n = 1). There were no evaluation data reported on the interventions identified through Google searches.
Conclusions:
Interventions included in this review were diverse and leveraged a range of mechanisms to change emergency department clinicians' behavior. However, most interventions relied solely on education and/or training to improve clinicians' knowledge and/or skills. Future research should consider diverse intervention functions to target both individual- and/or organization-level barriers for a given context. Secondly, the ultimate goal for changing emergency department clinicians' behavior is to improve patient health outcomes related to suicide-related thoughts and behaviors, but current research has most commonly evaluated clinicians' behavior in isolation of patient outcomes. Future studies should consider reporting patient-level outcomes alongside clinician-level outcomes.
Introduction
Nurses often work in the community with adolescents who self-harm. There is a lack of qualitative research exploring nurses’ experiences of working with adolescents who self-harm.
Aim
This study aimed to gain an understanding of community nurses’ experiences of working with adolescents who self-harm.
Method
Ten semi-structured interviews were conducted with registered nurses working in Child and Adolescent Mental Health Services (CAMHS) in the United Kingdom (UK).
Results
Data was analysed using Interpretative Phenomenological Analysis (IPA). Two superordinate themes were identified, each consisting of two subordinate themes: personal and professional conflicts, describing interpersonal and intrapersonal conflicts the nurses experienced working with adolescents who self-harm and the systems around them, and personal and professional development, outlining processes of management of conflicts and development.
Discussion
Nurses feel conflicted about working with adolescents who self-harm within the context of working with systems surrounding the adolescent. They report positive experiences, which they use to reframe their experiences and feelings of shame as a result of their emotional responses, self-care behaviours and personal and professional boundaries.
Implications for Practice
Nurses working with adolescents who self-harm would benefit from training, reflective practice and self-care. CAMHS managers should encourage and invest in these areas.
Background
There are a substantial number of self-harm presentations to emergency departments (EDs) yearly throughout Ireland. Nurses often struggle with the psychosocial nursing interventions required when caring for patients who present following self-harm.
Aim
To explore the experiences of registered general nurses (RGN) who care for patients presenting with self-harm to the ED in Ireland.
Method
A qualitative descriptive study design was used to explore experiences of RGNs in caring for patients with self-harm in the emergency department. Data was collected using one to one interviews with a purposive sample of nine RGNs working in ED. Transcripts were analysed using Burnard’s thematic content analysis framework.
Results
Three themes emerged: 1) waiting for assessment/treatment in an unsuitable environment 2) caring for self-harming patients from a nursing perspective and 3) nurses’ perceptions of self-harming patients.
Conclusion
Overall ED nurses hold a positive attitude towards patients who self-harm but acknowledge that barriers and challenges do exist when caring for this patient group. This study highlights the need for specific training on caring for patients who present to ED following self-harm.
Background
Patients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals’ stigmatization toward patients with mental disorders.
Methods
We conducted a scoping review using Arksey and O’Malley’s framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May–June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008–2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo.
Results
A total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies ( n = 73) and intervention studies ( n = 64). A majority of studies ( N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia ( n = 13), self-harm (n = 13), and eating disorders ( n = 9). Half of the studies focused on health students ( n = 64), primarily nursing students ( n = 26) and medical students ( n = 25), while ( n = 66) focused on health care professionals, primarily emergency staff ( n = 16) and general practitioners ( n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions.
Conclusions
The large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.
Aims and objectives:
The objective of this philosophical analysis is to use a poststructuralist framework to critique historical, social and institutional constructions of emergency nursing and examine conflicting discourses surrounding suicide prevention. The aim is to also demonstrate practical guidance for enhancing emergency nursing practice and research with regard to suicide prevention.
Background:
Emergency departments have been historically constructed as places for treating life-threatening physical crises, thereby constructing other 'non-urgent' health needs as less of a priority. Physical needs take priority over psychological needs, such as suicide-related thoughts and behaviors, negatively impacting the quality of care that certain groups of patients receive DESIGN: A theoretical analysis of the published literature on the topic of emergency nursing and suicide prevention was conducted and analyzed using a poststructuralist framework.
Methods:
Relevant literature on the topic of emergency nursing related to suicide prevention was analyzed for a poststructuralist construct of power, language, subjectivity and discourse. Implications to practice and research were identified, as well as expanding emergency nursing using a poststructuralist framework. SQUIRE guidelines were used (See Supplementary File1).
Discussion:
The emergency department is a critical point of intervention for patients with urgent and life-threatening needs. However, the biomedical model and historical, social, and institutional expectations that influence emergency nurses' beliefs and values do not effectively respond to the needs of suicidal patients. One step to address this issue is to deconstruct the current understanding of emergency nursing as a treatment for only life-threatening physical crises in order to become inclusive of psychological crises such as suicide-related thoughts and behaviors.
Relevance to clinical practice:
How a poststructural framework can be used to expand emergency care is discussed. Examples include empowering nurses to challenge the 'taken-for-granted' emergency nursing and recognizing the health needs that fall outside of the dominant discourse of emergency care.
To understand emergency department (ED) providers' perspectives regarding the barriers and facilitators of suicide risk assessment and to use these perspectives to inform recommendations for best practices in ED suicide risk assessment.
Ninety-two ED providers from two hospital systems in a Midwestern state responded to open-ended questions via an online survey that assessed their perspectives on the barriers and facilitators to assess suicide risk as well as their preferred assessment methods. Responses were analyzed using an inductive thematic analysis approach.
Qualitative analysis yielded six themes that impact suicide risk assessment. Time, privacy, collaboration and consultation with other professionals and integration of a standard screening protocol in routine care exemplified environmental and systemic themes. Patient engagement/participation in assessment and providers' approach to communicating with patients and other providers also impacted the effectiveness of suicide risk assessment efforts.
The findings inform feasible suicide risk assessment practices in EDs. Appropriately utilizing a collaborative, multidisciplinary approach to assess suicide-related concerns appears to be a promising approach to ameliorate the burden placed on ED providers and facilitate optimal patient care. Recommendations for clinical care, education, quality improvement and research are offered.
Copyright © 2015. Published by Elsevier Inc.
Background
Self-harm entails high costs to individuals and society in terms of suicide risk, morbidity and healthcare expenditure. Repetition of self-harm confers yet higher risk of suicide and risk assessment of self-harm patients forms a key component of the health care management of self-harm patients. To date, there has been no systematic review published which synthesises the extensive evidence on risk factors for repetition.Objective
This review is intended to identify risk factors for prospective repetition of self-harm after an index self-harm presentation, irrespective of suicidal intent.Data sourcesPubMed, PsychInfo and Scirus were used to search for relevant publications. We included cohort studies which examining factors associated with prospective repetition among those presenting with self-harm to emergency departments. Journal articles, abstracts, letters and theses in any language published up to June 2012 were considered. Studies were quality-assessed and synthesised in narrative form.ResultsA total of 129 studies, including 329,001 participants, met our inclusion criteria. Some factors were studied extensively and were found to have a consistent association with repetition. These included previous self-harm, personality disorder, hopelessness, history of psychiatric treatment, schizophrenia, alcohol abuse/dependence, drug abuse/dependence, and living alone. However, the sensitivity values of these measures varied greatly across studies. Psychological risk factors and protective factors have been relatively under-researched but show emerging associations with repetition. Composite risk scales tended to have high sensitivity but poor specificity.Conclusions
Many risk factors for repetition of self-harm match risk factors for initiation of self-harm, but the most consistent evidence for increased risk of repetition comes from long-standing psychosocial vulnerabilities, rather than characteristics of an index episode. The current review will enhance prediction of self-harm and assist in the efficient allocation of intervention resources.
[This corrects the article on p. e84282 in vol. 9.].
Correction: An affiliation for the last author is incorrectly omitted. In addition to institution number 1, Ella Arensman is also affiliated with the following institution: Department of Epidemiology & Public Health, University College Cork, Ireland.
Background: Repeated episode(s) of deliberate self-harm (RDSH) is a major risk factor for suicide. Aims: To identify specific risk factors for RDSH among patients admitted following an episode of deliberate self-harm (DSH) through acute intoxication. Methods: A prospective 6-month study was conducted with 184 patients (71% female) admitted to the emergency room (ER) as a result of self-poisoning (SP). Results: Rate of RDSH stood at 18% after 6 months. The sociodemographic variables associated with repeated deliberate self-harm were to have no principal activity, consultation with a medical professional during the 6 months preceding the self-poisoning, and referral to psychiatric services upon release from the ER. The clinical variable associated with RDSH was alcohol addiction (OR = 2.7; IC 95% = 1.2-6.1, p < .05) as assessed at the time of the initial ER admission. Conclusions: When patients are initially admitted to the ER as a result of self-poisoning, it is important to evaluate specific factors, particularly alcohol use, that could subsequently lead to repeated deliberate self-harm. The goal is to improve the targeting and referral of patients toward structures that can best respond to their needs.
Marked differences have been found in the characteristics of people dying by suicide in Western and Asian countries. However, there is less information available on possible differences for deliberate self-harm (DSH).
To compare the characteristics of people presenting to hospital in Hong Kong and Oxford (UK) with DSH, and to assess the outcome of those persons in Hong Kong.
A sample of DSH patients admitted to the accident and emergency (A&E) department of a regional hospital in Hong Kong was assessed and followed up 6 months later to assess the risk of repetition of DSH, and was then compared with such patients in Oxford.
The majority of patients in Hong Kong were female (male:female ratio of 1:2.4), young (59% were under 35), and had used self-poisoning (78%). Over one-third were single (37%) and one-fourth unemployed (26%). About half (49%) scored in the high or very high categories of the Beck's Suicide Intent Scale, considerably more so than in Oxford; 44.6% of patients defaulted psychiatric outpatient service during the 6-month follow-up period. The repetition rate within the following 6 months was 16.7%. The number of self-reported adverse life problems, history of childhood sexual and physical abuse, and repetitive self-mutilation were shown to be the factors most strongly correlated with the risk of re-attempt. Alcohol problems were much lower than in Oxford.
The findings show that DSH patients in Hong Kong show some marked differences compared to those in Oxford. Implications for the prevention of repeated DSH in Hong Kong are discussed.
Behavioural disturbance and aggression in the ED is an increasing problem. The present study describes the characteristics of patients with acute behavioural disturbance and their emergent treatment in an ED with a structured team approach.
This was a retrospective review of acute behavioural emergencies that required response from the Code Black (CB) Team (duress response team) in the ED during 2006. The hospital security log and hospital incident-reporting system identified all documented CB, and the patients' medical records were reviewed. Information extracted included patient demographics and presenting complaint, details of the CB, the use of pharmacological sedation, physical restraint and patient disposition. Injuries to hospital staff were also extracted.
There were 122 patients, median age 32 years (interquartile range: 24-43 years, range: 14-81 with 71 male patients (58%) who accounted for 143 CB activations. The primary problems were deliberate self-poisoning or self-harm (38%), alcohol and illicit drug intoxication (33%) and psychiatric, organic illness and drug withdrawal (29%). One hundred and eight (89%) patients had a past history of alcohol/illicit drug abuse or psychiatric illness. Indications for CB activation were threatening harm to others or behaving violently in 67% of cases. Combined pharmacological sedation and physical restraint were required on 66 (46%) occasions, pharmacological sedation alone on 20 (14%), physical restraint alone on 14 (10%) and neither on 43 (30%) occasions. Benzodiazepines were most commonly used for initial sedation, including i.m. (29%), i.v. midazolam (20%), diazepam (42%) and antipsychotics (9%), most commonly droperidol. More diazepam and droperidol were used for subsequent pharmacological sedation. A staff member was injured on only one occasion (0.7%).
Acute behavioural disturbance was common in the present study, and underlying causes were predominantly organic in nature. A team approach appears to be valuable in managing these incidents.
Self-harm is a prevalent phenomenon regularly faced by doctors and nurses working in accident and emergency (A&E) departments. We argue that the treatment decisions A&E doctors make are fundamental to decreasing the high risk of suicide among this group. In this article we present a qualitative study exploring how doctors working in A&E respond to treating people who self-harm. In total, five A&E doctors were interviewed and the data were analyzed using interpretative phenomenological analysis. Three main themes were extracted: treating the body, silencing the self, and mirroring cultural and societal responses to self-harm. Within these themes, we identified both facilitative and unhelpful aspects of the relationships between people who self-harm and A&E doctors. We consider the clinical implications of these findings within the context of A&E doctors having limited opportunities to address the relational nature of the care they offer to this group.
This Australian study evaluated the effectiveness of a solution-focused education intervention in extending and improving emergency nursing responses to patients who present because of self-injury.
Emergency nurses commonly report lack of training and feeling unskilled in managing people who present because of self-harm. Most educational interventions have provided content knowledge, yet rarely have they focused on conveying the value of health promotion strategies such as proactive skills and coping strategies.
A mixed method pretest-posttest group design was used.
Nurses (n = 36) were interviewed to examine differences in professional identity, awareness of self-injury and clinical reasoning.
The qualitative results are presented in this paper and these showed improvements in knowledge and understanding of self-harm, self-belief in nurses' capacity to positively influence clients and the value of health promotion skills. The intervention produced a positive attitudinal shift towards clients and an expressed intention to act in ways that were more person-centred and change oriented.
The solution-focused education intervention appears to show promise as an intervention for enabling nurses to value their unique contribution to providing a health service that is more proactive and health-promoting.
Interactive education bringing psychosocial skills to technical nursing staff builds confidence, competence and more person-focused care.
Self-harm is increasingly common in many countries, is often repeated and may have other negative outcomes.
To systematically review people's attitudes towards clinical services following self-harm in order to inform service design and improvement.
A search of electronic databases was conducted and experts in the field were contacted in order to identify relevant worldwide qualitative or quantitative studies. Data were extracted independently by two reviewers with more weight given to studies of greater quality and relevance.
Thirty-one studies met the inclusion criteria. Despite variations in healthcare systems and setting, participants' experiences were remarkably similar. Poor communication between patients and staff and a perceived lack of staff knowledge with regard to self-harm were common themes. Many participants suggested that psychosocial assessments and access to after-care needed to be improved.
Specific aspects of care that might increase service user satisfaction and treatment adherence include staff knowledge, communication and better after-care arrangements. A standard protocol could aid regular audits of users' experiences of services.
The repetition of acute poisoning occurs frequently. The intention may change between episodes and many poisonings are treated outside the hospital setting. Few studies have taken this into account.
To quantify the repetition frequency regardless of the level of health care or the intention behind the poisoning, and to identify possible risk factors for repetition.
A prospective multicentre study of all acute poisonings in Oslo treated in hospital, at an out-patient clinic or by the ambulance service. Repetition was estimated using Kaplan-Meier calculations, and predictive factors were identified using Cox regression analysis.
The estimated 1-year repetition rate was 30% (95% CI 24-35). Independent predictors of repetition were middle age (30-49 years), poisoning with opiates or sedatives, unemployment or living on social welfare, a previous suicide attempt, and a history of psychiatric treatment. Intention was not a significant predictor.
Repetition of acute poisoning is high, irrespective of the level of healthcare and the intention behind the poisoning.
Deliberate self-poisoning is one of the frequent presentation types to emergency departments. It has been reported that attitudes of emergency staff may have negative consequences for the wellbeing of the self-poisoning patient.
Determine the attitude of nursing and medical staff towards patients who present with deliberate self-poisoning and to identify if differences exist between the two groups.
Mixed-method.
The "Attitudes towards Deliberate Self-Harm Questionnaire" was distributed to all nursing and medical staff who had direct patient contact at three emergency departments (N=410). Total and factor scores were generated and analysed against variables age, gender, length of experience working in the emergency department, level of education and by profession. Two open ended questions asked staff to write their perceptions and stories about patients who deliberate self-poison and were analysed using qualitative data analysis.
Forty-five percent of staff returned the questionnaire. The attitude of emergency nurses and doctors was positive towards patients who deliberately self-poison. Doctors had significantly higher total and Factor 2 'dealing effectively with the deliberate self-poisoning patient' scores than nurses. After adjusting for length of time working in the emergency department only Factor 2 'dealing effectively with the deliberate self-poisoning patient' remained statistically significant. Staff reported high levels of frustration, in particular to patients who represent.
This information may be used to develop and implement educational strategies for staff to improve the experiences of and better support patients presenting to the emergency department who deliberately self-poison.
The emergency department of Aberdeen Royal Infirmary receives around 68,000 new adult admissions annually. All poisoning cases are admitted to a 14-bedded short-stay ward, except those admitted to intensive care or immediately discharged. This study aimed to analyse epidemiological trends and management of short-stay ward admissions for poisonings.
Adult (>13 years) poisoning presentations admitted to the emergency department short-stay ward of Aberdeen Royal Infirmary from 1 January-31 December 2009 were retrospectively reviewed using patient discharge summaries. During 2009, there were 1062 poisoning cases, of which repeat episodes were responsible for 15%. The mean age of presentation was 33.9 years (SD 14.4) and there was a female preponderance (62%). Almost half of poisonings were polypharmacy, alcohol was involved in 40% of cases and overdoses most commonly involved paracetamol (43%). Management involved basic observations only (66%), N-acetylcysteine (24%), naloxone (4%) and activated charcoal (1%). Liaison psychiatry reviewed 84% presentations and admitted 9% to the psychiatric unit.
The short-stay ward is important for acute management of poisonings and the data gained from this study should help to direct patient services appropriately.
The assessment and management of clients with mental illness is an important facet of providing emergency care. In Australian emergency departments, it is usually the generalist registered nurses† without adequate preparation in the assessment and care for clients with mental illness who conduct the initial assessment at triage. A search of the literature revealed a limited number of publications addressing the provision of triage and management guidelines to assist nurses to make objective clinical decisions to ensure appropriate care for clients with mental illness. This paper examines the need for such guidelines and reviews a number of mental health triage scales that have been evaluated for use in emergency departments. Findings show that these triage scales have led to improvements in staff confidence and attitudes when dealing with clients with mental health problems, resulting in improved outcomes for clients. Strengths and limitations of the evaluations have also been explored. Highlighted is the need for consideration of the inclusion of clients’ reactions to the impact of this change to service delivery in future evaluations.
Evidence is presented on doctors' and nurses' attitudes towards self-poisoning patients in general and psychiatric hospitals in Britain and Israel. The findings are firstly analysed in the light of the impact of professional roles in the context of an institutional setting. Secondly, the evidence is viewed on the background of the meanings attached to the motives and implications of attempted suicide vs. suicide in Western-oriented societies. The assumed total commitment to life as against death becomes questionable in the case of attitudes to self-poisoning patients.
Study objective The epidemiology, management and cost of emergency department (ED) visits for deliberate self-poisoning (DSP) are described.
Methods In a retrospective study, the medical records of all DSP patients older than 16 years, who presented to the ED from 1 January 2009 to 31 December 2009, were reviewed.
Results 312 episodes of DSP were included, accounting for 0.6% of all ED visits. 190 patients were women, with a female to male ratio of 1.56:1. Mean patient age was 37 years. More than 60% (n=190) of DSP patients were <40 years of age. Most patients presented to the ED between 18:00 and 23:00. A single drug was ingested in 39% (n=121) of patients. Alcohol was co-ingested by 36% of patients who were mostly middle-aged men. Of the overdoses, 50.8% were due to benzodiazepines, 23.2% were due to antidepressants and 16.4% were due to antipsychotics. Two-thirds of patients were treated with oral activated charcoal and 89% were seen by a psychiatrist. Nearly 90% of patients were admitted to the ED observation ward, with a mean length of stay of 16.7 h. The estimated total cost was €;266 134.89, with an average of €;872.57 per patient.
Conclusion Self-poisoning cases in Belgium are grossly similar to those in other Western countries. Supportive treatment alone should be considered in the majority of patients presenting with oral drug overdose. Overall, DSP leads to a significant financial burden on the community.
To assess whether emergency department (ED) overcrowding was reduced after the introduction of the 4-hour rule in Western Australia and whether any changes in overcrowding were associated with significant changes in patient mortality rates.
Quasi-experimental intervention study using dependent pretest and post-test samples. Hospital and patient data were obtained for three tertiary hospitals and three secondary hospitals in Perth, WA, for 2007-08 to 2010-11.
Mortality rates; overcrowding rates.
No change was shown in mortality from 2007-08 to 2010-11 for the secondary hospitals and from 2007-08 to 2009-10 for the tertiary hospitals. ED overcrowding (as measured by 8-hour access block) at the tertiary hospitals improved dramatically, falling from above 40% in July 2009 to around 10% by early 2011, and presentations increased by 10%, while the mortality rate fell significantly (by 13%; 95% CI, 7%-18%; P < 0.001) from 1.12% to 0.98% between 2009-10 and 2010-11. Monthly mortality rates decreased significantly in two of the three tertiary hospitals concurrently with decreased access block and an increased proportion of patients admitted in under 4 hours.
Introduction of the 4-hour rule in WA led to a reversal of overcrowding in three tertiary hospital EDs that coincided with a significant fall in the overall mortality rate in tertiary hospital data combined and in two of the three individual hospitals. No reduction in adjusted mortality rates was shown in three secondary hospitals where the improvement in overcrowding was minimal.
The emergency department is an important gateway for the treatment of self-harm patients. Nurses' attitudes towards patients who self-harm can be negative and often nurses experience frustration, helplessness, ambivalence and antipathy. Patients are often dissatisfied with the care provided, and meeting with positive or negative attitudes greatly influences whether they seek additional help. A quantitative design was utilised to measure emergency department nurses' attitudes towards deliberate self-harm. The 'Self-Harm Antipathy Scale', a validated questionnaire, was administered to a random sample of nurses in four emergency departments in the Republic of Ireland. A total of 87 questionnaires were returned (87% response rate). Results reveal that nurses show slightly negative antipathy overall, indicating positive attitudes towards self-harming patients. Attitudes were significantly different in accordance with a nurse's age. Education and social judgment also contribute to the way nurses view, interact and make moral decisions regarding self-harm patients. Evidence indicates there is need to improve the training, supervision and support of nurses caring for patients who self-harm, and that practical strategies should be implemented to manage the alienation process and inform practice.
To evaluate an emergency department (ED)-based mental health nurse practitioner (MHNP) outpatient service in Sydney, Australia.
Data collection incorporated waiting times for follow-up outpatient appointments, two brief self-report measures (the K-10 measure of psychological distress and the General Self-Efficacy Scale), a satisfaction tool, and interviews conducted with a random selection of outpatients and a stratified, purposive sample of ED staff.
Over 60% of outpatients were followed up within 5 days of their initial presentation. The mean K-10 score at baseline was 32 (very high psychological distress, n = 101) but this had decreased by two categories to 24 at follow-up (moderate psychological distress, n = 51). There was a modest association between decreased psychological distress and an increase in perceived self-efficacy. Participant satisfaction with aspects of the outpatient service was generally rated as high to very high. Interviewed outpatients (n = 23) were particularly positive about the accessibility, immediacy, and flexibility of the service and overall therapeutic benefits. Emergency staff (n = 20) considered the outpatient service enhanced service provision by facilitating access to a population of patients who were previously underserved.
The ED-based MHNP role enhances access to specialized mental health care and also supports emergency staff.
To address concerns about prolonged emergency department (ED) stays from crowding, England mandated that the maximum length of ED stay for 98% of patients be no greater than 4 hours. We evaluate the effect of the mandated ED care intervals in England.
This was a retrospective analysis of ED patient throughput before, during, and after implementation of the target. Fifteen acute hospital trusts' ED data were purposively sampled, including all patient visits during May and June of 2003 to 2006. We compared total time in ED and time to clinician across years, segregating for admitted versus discharged patients and young versus old patients, using a random-effects regression model and adjusting for hospital clustering.
We analyzed 735,588 ED visits. The proportion of patients seen and treated within 4 hours improved from 83.9% to 96.3%. Adjusted total length of ED stay from 2003 to 2006 increased by 8.6 minutes for all patients and 30 minutes for admissions; time to physician improved by 1 minute for all patients. The proportion of patients leaving the ED during the last 20 minutes before 4 hours increased from 4.7% of all patients in 2003 to 8.4% in 2006. Admitted patients were more likely than discharged ones to leave the ED in the last 20 minutes, and the relative likelihood increased each year after 2003, with incidence rate ratio 1.04 (95% confidence interval [CI] 0.78 to 1.39), 1.39 (95% CI 1.05 to 1.82), and 1.55 (95% CI 1.19 to 2.20) for 2004, 2005, and 2006, respectively. An increasing proportion of elderly patients were in the last 20-minute departure interval each year compared with younger patients (in 2003 7.4% versus 4.1%; in 2006 17.3% versus 6.3%).
The introduction of a time target reduced the proportion of patients staying greater than 4 hours. More patients departed within 20 minutes of the target 4-hour interval after the mandate, notably, the elderly.
To investigate potential risk factors associated with the repetition of deliberate self-poisoning (DSP).
Retrospective medical record review of all patients who presented to the emergency department of a tertiary teaching hospital after DSP between January 1, 2000, and December 31, 2009. Repetition of a suicide attempt was determined from reported episodes before the index episode or from 2 visits to the same hospital during the study period. Demographic information, clinical variables, and other variables at the first suicide attempt were investigated for factors associated with repetition of DSP.
Of the 967 patients, 203 (21%) presented with repeated suicide attempts. Patients with repeat suicide attempts differed in sex, occupation, living condition, method of DSP, history of psychiatric treatment, reversibility, and psychiatric diagnosis. In the multivariate regression analysis, the only reliable associated factors for repeat suicide attempt were sex (P = .001), living condition (P < .001), method of DSP (P < .036), and history of psychiatric treatment (P < .001).
Early psychological intervention and close observation is required for patients who are female, living without a family, use antidepressants, and have a history of psychiatric treatment.
Self-harm is a common reason for presentation to a general hospital, with a strong association with suicide. Trends in self-harm are an important indicator of community psychopathology, with resource implications for health services and relevance to suicide prevention policy. Previous reports in the UK have come largely from single centres.
To investigate trends in non-fatal self-harm in six general hospitals in three centres from the Multicentre Study of Self-harm in England, and to relate these to trends in suicide.
Data on self-harm presentations to general hospital emergency departments in Oxford (one), Manchester (three) and Derby (two) were analysed over the 8-year period 1 January 2000 to 31 December 2007.
Rates of self-harm declined significantly over 8 years for males in three centres (Oxford: -14%; Manchester: -25%; Derby: -18%) and females in two centres (Oxford: -2% (not significant); Manchester: -13%; Derby: -17%), in keeping with national trends in suicide. A decreasing proportion and number of episodes involved self-poisoning alone, and an increasing proportion and number involved other self-injury (e.g. hanging, jumping, traffic related). Episodes involving self-cutting alone showed a slight decrease in numbers over time. Trends in alcohol use at the time of self-harm and repetition within 1 year were stable.
There were decreasing rates of non-fatal self-harm over the study period that paralleled trends in suicide in England. This was reflected mainly in a decline in emergency department presentations for self-poisoning.
Emergency departments (EDs) face problems with crowding, delays, cost containment, and patient safety. To address these and other problems, EDs increasingly implement an approach called Lean thinking. This study critically reviewed 18 articles describing the implementation of Lean in 15 EDs in the United States, Australia, and Canada. An analytic framework based on human factors engineering and occupational research generated 6 core questions about the effects of Lean on ED work structures and processes, patient care, and employees, as well as the factors on which Lean's success is contingent. The review revealed numerous ED process changes, often involving separate patient streams, accompanied by structural changes such as new technologies, communication systems, staffing changes, and the reorganization of physical space. Patient care usually improved after implementation of Lean, with many EDs reporting decreases in length of stay, waiting times, and proportion of patients leaving the ED without being seen. Few null or negative patient care effects were reported, and studies typically did not report patient quality or safety outcomes beyond patient satisfaction. The effects of Lean on employees were rarely discussed or measured systematically, but there were some indications of positive effects on employees and organizational culture. Success factors included employee involvement, management support, and preparedness for change. Despite some methodological, practical, and theoretic concerns, Lean appears to offer significant improvement opportunities. Many questions remain about Lean's effects on patient health and employees and how Lean can be best implemented in health care.
Emergency department (ED) crowding and ambulance diversion has been an increasingly significant national problem for more than a decade. More than 90% of hospital ED directors reported overcrowding as a problem resulting in patients in hallways, full occupancy of ED beds, and long waits, occurring several times a week. Overcrowding has many other potential detrimental effects including diversion of ambulances, frustration for patients and ED personnel, lesser patient satisfaction, and most importantly, greater risk for poor outcomes. This article gives a basic blueprint for successfully making hospital-wide changes using principles of operational management. It briefly covers the causes, significance, and dangers of overcrowding, and then focuses primarily on specific solutions.
A questionnaire survey of the attitudes of ambulance personnel and of the casualty staff of 62 London hospitals towards patients who take drug overdoses was carried out in August 1975 (total N = 1248. It was found that patients who take an overdose accidentally are regarded more favourably than patients who do so deliberately in a suicidal attempt, who in turn are viewed more favourably than patients who take an overdose in the course of drug addiction. Differences between professional groups are reported, the determinants underlying their attitudes are considered and the implications are discussed.
Self-poisoning now constitutes one of the prime emergencies in hospital medical practice. This paper describes the results of the study of the attitudes of physicians and senior nurses towards several common illnesses in the medical wards. The junior doctors and the nurses who frequently have primary responsibility for the care of the self-poisoners tend to show unfavourable attitudes towards these patients.
Eighty-two house-physicians filled in a questionnaire concerning the care of self-poisoning patients with special emphasis on training and attitudes. These recently qualified doctors dealt with large numbers of such patients and expressed dissatisfaction with their training in this respect. Hostile attitudes towards these patients developed most clearly at those district hospitals where psychiatrists are rarely available. During their 6 months as a house-physician, doctors at the teaching hospital became more interested in making a full assessment of these patients whereas those at other hospitals became less so.
Better training at both undergraduate and pre-registration level is needed to make house-physicians more able and more willing to fully assess these patients.
This study investigated the number, timing and disposal (admission or discharge) of patients repeating an overdose who attended the accident and emergency department of a district general hospital during a 5-year period. There was a total of 1958 overdoses by 1597 individuals over the 5-year period. Overdoses were repeated by 12% (n = 191) of patients and accounted for 552 of the total overdoses (representing 361 repeats). First repeats were found to occur more frequently in the 3 months following the original overdose for 43% of patients, 70% of repetitions occurring within a year. The distribution of first repeats showed a similar pattern for males and females. During the 5-year period 49% of all repetitions occurred within 3 months. Almost one-fifth of repeaters were discharged, irrespective of whether it was the patient's 'index' (first overdose within the study period) or a repeat overdose. Within the repeater population, 31% of overdoses occurred on a Friday, Saturday and on, or immediately prior to, a Bank Holiday. Since there was no on-site psychiatric service available at such times, those patients had to wait until the next working day for assessment. The study recommends that all overdose patients should receive psychiatric assessment, and therefore on-site psychiatric services should be available for accident and emergency patients.
In the UK, someone dies by suicide every 2 hours. An increasing number are also harming themselves. Many of these people are admitted to Medical Admissions Units of General Hospitals. Department of Health guidelines now recommend that anyone who harms him or herself should have a psychosocial and risk assessment. This means that they have to stay in hospital until they are assessed and this renders them 'different' from other patients. This study uses an ethnographic approach to search for the meaning to nurses of having this group of patients on the ward, using participant observation and semistructured interviews with four nurses. Three themes were isolated through analysis of the data: the busy quality of such wards (busyness) how this group of clients impede the busy quality and the strategies which nurses use to cope with the difficulties. Analysis of the data revealed that the research participants found difficulty in understanding why people harm themselves and that they felt that they did not have the requisite skills to deal with this group of people. This appears to leave them with a sense of frustration and helplessness which perhaps mirrors that of this client group.
Deliberate self-harm is frequently encountered by emergency department (ED) nurses. However, clients are often dissatisfied with the care provided and clinicians feel ambivalent, helpless or frustrated when working with clients who self-harm.
The aim of the study was to develop and test a scale to identify relevant dimensions of ED nurses' attitudes to clients who present with self-injury.
Items on Attitudes Towards Deliberate Self-Harm Questionnaire (ADSHQ) were drawn from a literature review and focus group discussions with ED nurses. The tool was piloted with 20 ED nurses not working in the target agencies. A survey of nurses working within 23 major public and 14 major private EDs in Queensland, Australia (n = 1008) was then undertaken.
A total of 352 questionnaires were returned (35% response). Analysis revealed four factors that reflected nurses' attitudes toward these clients. The factors related to nurses' perceived confidence in their assessment and referral skills; ability to deal effectively with clients, empathic approach; and ability to cope effectively with legal and hospital regulations that guide practice. There was a generally negative attitude towards clients who self-harm. Correlations were found between years of ED experience and total score on the ADSHQ, and years of ED experience and an empathic approach towards clients who deliberately self-harm.
There is a need for continuing professional development activities to address negative attitudes and provide practical strategies to inform practice and clinical protocols.
This article presents the findings of a review of the first year of a night emergency department (ED) mental health triage and consultancy service. During the first 12 months of operation of the service, data on key performance indicators were entered into an emergency mental health triage and consultancy database. Data were also obtained from pre- and post-satisfaction surveys completed by ED staff and from self-appraisal statements generated by the five mental health nurses who undertook the position during the review period. The findings show the ED mental health triage and consultancy service positively impacted on the functioning of the emergency department. This was evidenced by staff' perceptions regarding the value of the service and through shorter "seen by times", a reduction in the number of patients with psychiatric/psychosocial problems who left the department without being seen, and the effective management of patients presenting with psychiatric/psychosocial problems, particularly those presenting with deliberate self-harm. The review provided evidence regarding the value of the emergency mental health triage and consultancy service and highlighted the advanced practice role undertaken by mental health nurses in this position.
This paper explores the nature of nurse-patient relationships in accident and emergency (A&E) drawing from nursing theory and research, and with reflection on three episodes of practice from the author's experience. First the case for nurse-patient relationships is presented with reference to nursing theory, statutory and professional literature. The benefits of positive nurse-patient relationships in A&E are then explored, followed by a discussion of the barriers to nurse-patient relationships forming in A&E. How relationships are formed is then considered, highlighting the short space of time available, and the importance of first impressions. The first practice episode analysed is a situation where the author felt she had not formed a relationship with the patient at all. In the second, the author questions whether the relationship had been over-involved and this is discussed in relation to the nature of involvement and what constitutes over-involvement. In the final practice episode the author felt that a positive relationship was formed with benefits to the patient concerned. The paper concludes by highlighting the importance of nurse-patient relationships in A&E, and how they can be formed in light of the barriers discussed previously.
Psychosocial assessment of self-harm patients by mental health service staff is an important aspect of their care. Nevertheless, in England around half of those attending a general hospital following a self-harm episode do not receive such an assessment. We have investigated the reasons for this and the characteristics of patients associated with self-discharge or planned discharge without a psychosocial assessment.
8-week audits of self-harm attendances were carried out in 32 Accident and Emergency Departments in England. Where a specialist psychosocial assessment by mental health services was not carried out, information on the reason for this was requested. Due to incomplete data 10 of the 32 hospitals were excluded from analysis.
There were 2780 self-harm attendances at the 22 hospitals. Psychosocial assessments were carried out on 59% of episodes. Among those not assessed, 57% discharged themselves and the remainder were discharged by hospital staff. In multivariable models, being male, taking illegal drugs/alcohol, attendance out of office hours and not being admitted to a hospital bed were associated with an increased risk of self-discharge. Younger subjects were more likely to self-discharge, but this association was explained by age-related admission patterns. Young age (<45 years), no previous self-harm and not being admitted were associated with an increased likelihood of discharge by hospital staff without a psychosocial assessment. The apparent increased risk of discharge without an assessment for those who self-lacerated was attenuated after allowing for their lower admissions rates.
Missing data from 10 hospitals led to their exclusion from analysis. Only the primary reason for discharge was reported on the audit forms.
Those at elevated risk of suicide--older patients and those with a history of self-harm--were the least likely to be discharged by hospital staff without a psychosocial assessment. However, males (at increased risk of suicide compared with females), those who had taken illegal drugs or/and alcohol and those attending 'out of hours' were more likely to self-discharge. Services need to be modified and evaluated, based on further information about why such individuals are not currently engaging in services.
The term self-harm is commonly used to describe a wide range of behaviours and intentions including attempted hanging, impulsive self-poisoning, and superficial cutting in response to intolerable tension. As with suicide, rates of self-harm vary greatly between countries. 5-9% of adolescents in western countries report having self-harmed within the previous year. Risk factors include socioeconomic disadvantage, and psychiatric illness--particularly depression, substance abuse, and anxiety disorders. Cultural aspects of some societies may protect against suicide and self-harm and explain some of the international variation in rates of these events. Risk of repetition of self-harm and of later suicide is high. More than 5% of people who have been seen at a hospital after self-harm will have committed suicide within 9 years. Assessment after self-harm includes careful consideration of the patient's intent and beliefs about the lethality of the method used. Strong suicidal intent, high lethality, precautions against being discovered, and psychiatric illness are indicators of high suicide risk. Management after self-harm includes forming a trusting relationship with the patient, jointly identifying problems, ensuring support is available in a crisis, and treating psychiatric illness vigorously. Family and friends may also provide support. Large-scale studies of treatments for specific subgroups of people who self-harm might help to identify more effective treatments than are currently available. Although risk factors for self-harm are well established, aspects that protect people from engaging in self-harm need to be further explored.
The aim of this study was to investigate the attitudes of accident and emergency (A&E) staff towards patients who self-harm through laceration.
We developed a questionnaire using focus group methodology. Questionnaires were distributed to 117 A&E staff members.
Of the staff, 53.8% responded. The staff believed that self-laceration was an important problem but felt unskilled in managing patients. The staff were unsure of the relationship between self-laceration and both mental illness and risk of suicide. They had previously received little training in managing this condition. In those staff without previous training, a longer period working in A&E was correlated with higher levels of anger towards patients and an inclination not to view patients as mentally ill. A&E staff were keen for further training and wanted a higher proportion of patients to be seen by specialist mental health services.
This study highlights the need for greater staff training in A&E. Despite considerable experience in the field, we found evidence for unhelpful attitudes amongst some staff. This is particularly true for more senior staff without previous DSH training, who, as a group, were less sympathetic to this group of patients. Unfavourable attitudes of health professionals are likely to adversely influence the quality of clinical care delivered to DSH patients who use self-laceration as well as those who use other methods of self-harm.
This commentary paper highlights the every day reality for nurses facing episodes of violence and aggression while working in the health care system in Western Australia and identifies future research necessary to address the problem. Nurses, in a range of work environments, face the terrifying possibility of being victims of aggressive and violent incidents while caring for patients. The consequences of these events are far reaching and include an increased cost to the health care system, loss of experienced nurses from the workforce and the inability to attract nurses back to the bedside. Although the West Australian government has attempted to address the problems with quick fixes, no current initiatives have been effective and nurses are still experiencing assault in ever increasing numbers. To ensure that nurses stop being the victims of these events it is essential that nurses, government and the community refuse to accept that violence and aggression are 'just part of the job'. Sound research is important in raising awareness and providing direction for hospital policy and practice. Furthermore, future research in the area has to investigate the phenomenon as a whole taking into consideration all aspects of these events. The results of this research must then form the framework for future education programs, policies and best-practice guidelines for safety of nurses and ultimately patient care.
Over the past 25 years, suicidal behaviour in young people has continued to be a major concern for health services around the world. Self-harm in individuals aged 13-18 is common and represents a significant reason for admission to accident and emergency departments, paediatric medical services and child and adolescent mental health services. Nurses' and doctors' working in these areas are the first point of contact for young people following an episode of self-harm. This paper presents a study exploring nurses and doctors perceptions of young people who engage in suicidal behaviour. The data presented form part of larger project conducted using both quantitative and qualitative methods, and a contemporary grounded theory approach to analysis. The findings revealed two main categories and associated subcategories: Experiences of frustration in practice (subcategories: non-therapeutic situations, insubstantiality of interventions and value of life) and strategies for relating to young people (sub-categories: specialist skills in care and reflections on own experience). The meanings of these categories highlight barriers in the relationship nurses and doctors have with young people who engage in suicidal behaviour. If suicide prevention policies around the world are to succeed the phenomena impacting on the communication between these professionals and young people needs to be addressed in research, education and in the development of practice.
This paper presents the findings of a qualitative project conducted to investigate the education and training requirements that non-mental health trained emergency nurses need to enable them to effectively care for psychiatric patients presenting to a West Australian emergency department. Non-mental health trained nurses are ill-equipped in their psychiatric knowledge, assessment and communication skills to provide best possible care to the one in ten patients presenting to the emergency department with a complex mental health issue. The area of assessment and management of mental health patients in the emergency department is a complex one and staff are required to assess, triage and manage these patients appropriately. Furthermore, with aggression and violence increasing, emergency department nurses are concerned about their safety in the workplace. Focus groups with emergency nurses and semi-structured interviews with subject matter experts were conducted at one West Australian teaching hospital. The findings of the project demonstrated that these nurses considered that customer focus, workplace aggression and violence, psychiatric theory, mental health assessment and chemical dependence as key learning areas. These findings will form a platform for further education and training for ED staff.
This exploratory study investigates emergency department nurses' attitudes towards patients who engage in deliberate self-harm. It examines their attitudes towards, and triage and care decisions with, patients who self-harm.
Emergency department nurses sometimes show unsympathetic attitudes towards patients who present with self-harm and these can contribute to difficulties in assessing and providing appropriate care.
A modified version of the Suicide Opinion Questionnaire was used. A non-probability sample of 43 emergency department nurses from a large Australian hospital participated in the study. Data were analysed using SPSS.
Most nurses had received no educational preparation to care for patients with self-harm; over 20% claimed that the department either had no practice guidelines for deliberate self-harm or they did not know of their existence and one-third who knew of them had not read them. Overall, nurses had sympathetic attitudes towards patients who self-harm, including both professional and lay conceptualizations of deliberate self-harm. They did not discriminate against this group of patients in their triage and care decisions.
The findings of this exploratory study are important because attitudes can affect care decisions. Recommendations are made for improving the educational preparation of emergency department nurses, for improving awareness and implementation of practice guidelines, and for improving attitudes towards patients with deliberate self-harm. Further research is needed to confirm these results.
Qualitatve Research Methods for the Social Sciences Epidemiology and trends in non-fatal self-harm in three centres in England
- B Berg
- Allyn
- Bacon
- Boston
- H Bergen
- K Hawton
- K Waters
- J Cooper
- N Kapur
Berg, B., 2009. Qualitatve Research Methods for the Social Sciences, Allyn & Bacon, Boston. Bergen, H., Hawton, K., Waters, K., Cooper, J., Kapur, N., 2010. Epidemiology and trends in non-fatal self-harm in three centres in England: 2000–2007. British Journal of Psychiatry. 197, 493–498.
Better Services for People who Self-Harm: Data Summary – Wave 2 Baseline Data
- L Palmer
- P Strevens
- H Blackwell
Palmer, L., Strevens, P., Blackwell, H., 2007. Better Services for People who Self-Harm: Data Summary – Wave 2 Baseline Data, Royal college of Psychiatrists, London.
Qualitative Research in Nursing Advancing the Humanistic Imperative Better Services for People who Self-Harm: Aggregated report – Wave 3 Baseline Data Attitudes towards clinical services among people who self-harm: systematic review
- H Speziale-Streubert
- D Carpenter
- P Strevens
- H Blackwell
- L Palmer
- E Hartwell
Speziale-Streubert, H., Carpenter, D., 2003. Qualitative Research in Nursing Advancing the Humanistic Imperative, Lippincott, Philadelphia. Strevens, P., Blackwell, H., Palmer, L., Hartwell, E., 2008. Better Services for People who Self-Harm: Aggregated report – Wave 3 Baseline Data, Royal College of Psychiatrists, London. Taylor, T.L., Hawton, K., Fortune, S., Kapur, N., 2009. Attitudes towards clinical services among people who self-harm: systematic review. British Journal of Psychiatry. 194, 104–110.