Nurses' attitudes towards self-harm: a literature review

Pathways and transitions for patients admitted to an emergency department after self-harming events

The frequency of people presented in emergency departments (EDs) after self-harming events is increasing. Previous studies have shown that the complexity of the disorders of patients admitted to the ED after self-harming events can be overwhelming for ED healthcare professionals (HCPs) to handle. The objective of this study was to observe and investigate the pathways for patients admitted to the ED after self-harming events to either transition or discharge. Participant observation and interviews were selected as the methods to generate insight into the pathways of patients admitted to the ED after self-harming events. The data were analysed using interpretative phenomenological analysis. A sample size of 20 patients was analysed, and a total of 213 h of observation took place during the data collection. Three main themes appeared: (1) patients' mental stress versus high expectations, (2) uncertainty about how to address the self-harming event and (3) a system of chaos. Patients admitted to the ED after self-harming events struggle with difficult mental stress. Despite this, they face high expectations that they will fit in and cooperate in the ED. The healthcare system is organised with unclear responsibilities and without systematic ways to care for self-harm patients and so provides chaotic patient pathways. There is a need for improved cross-sectional competencies, mutual agreements and systematic communication for discharge, transitions and follow-up care between those involved in the patient's pathway and care.

Psychiatry Nurses' Experiences of Patient-Initiated Brief Admission from Inpatient and Outpatient Perspectives: A Qualitative Exploratory Study

Patient-initiated brief admission (PIBA) allows patients to decide when admission to psychiatric care is necessary. This may prevent long-term hospitalisation and promote patient participation. Research on psychiatric nurses' experiences with PIBA is lacking, therefore 11 nurses were interviewed and data analysed using content analysis. Prominent categories were: improved personal development for the patient, more equal nurse-patient relationship, rapid access to a safe environment and strengthened professional collaboration. PIBA is a helpful intervention for patients in crisis, giving both patients and nurses a sense of security. Future studies should explore how this impacts nurses' work environment and job satisfaction.

Adolescents' Experience of Pain: A Focus Group Study in Sweden

The purpose of this study was to describe experiences of pain among students at upper secondary schools (adolescents aged 16-19 years) in Sweden. Focus group (n = 9) interviews with 41 adolescents were conducted in southern Sweden in 2021. The interviews were analyzed by qualitative content analysis, which identified four categories encompassing the theme how pain expressed itself: (1) a warning bell-the body's way of saying that something is wrong; (2) school- and work-related pain; (3) interpersonal physical and emotional pain; and (4) heartache-a sign of humanity; and four categories describing the theme ways of dealing with pain: (1) turn your attention elsewhere; (2) "bite the bullet" and endure the pain; and (3) use painkillers or complementary treatments; and (4) ask for help from others. Findings are linked to the crucial role of school nurses in supporting students who experience pain.

Emergency department nurses’ perceptions of caring for patients with intentional self-poisoning: a qualitative study

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.

An Integrative Model of In-Hospital and Out-of-Hospital Nursing Care for Non-Suicidal Self-Injury: A Narrative Review

Background: Non-suicidal self-injury (NSSI) refers to the intentional and repeated physical trauma of an individual without explicit suicidal intent, which has negative effects on the physical and mental well-being of an individual, especially for adolescents. Timely and accessible nursing care may play an important role in the survival and rehabilitation process of NSSI. Methods: In this review, we systematically discuss the nursing care of NSSI behavior and provide recommendations based on an integrated nursing model for NSSI management. Results: As reported in previous studies, a variety of factors can contribute to NSSI behavior, such as personality traits, current psychological status, history of mental illnesses, as well as family and social factors. In-hospital care is the most necessary and effective care during acute episodes of NSSI behavior. To effectively manage inpatients with NSSI behaviors, nurses should first understand the motivation of NSSI, and provide comprehensive and multi-level care through nurse-patient communication, individualized psychological care, and multidisciplinary cooperation with other professionals. While the purpose of out-of-hospital nursing is to reduce the frequency of NSSI behaviors by screening high-risk individuals, providing psychological support, promoting health education, and improving self-awareness. Conclusions: An integrative model of in-hospital and out-of-hospital nursing care can help improve the clinical management and long-term prognosis of patients with NSSI and minimize the risk of suicidal ideation or suicidal behavior.

Development and Validation of the 'Self-Efficacy in Dealing with Self-Harm Questionnaire' (SEDSHQ)

Clinicians find it challenging to engage with patients who engage in self-harm. Improving the self-efficacy of professionals who treat self-harm patients may be an important step toward accomplishing better treatment of self-harm. However, there is no instrument available that assesses the self-efficacy of clinicians dealing with self-harm. The aim of this study is to describe the development and validation of the Self-Efficacy in Dealing with Self-Harm Questionnaire (SEDSHQ). This study tests the questionnaire's feasibility, test-retest reliability, internal consistency, content validity, construct validity (factor analysis and convergent validity) and sensitivity to change. The Self-Efficacy in Dealing with Self-Harm Questionnaire is a 27-item instrument which has a 3-factor structure, as found in confirmatory factor analysis. Testing revealed high content validity, significant correlation with a subscale of the Attitude Towards Deliberate Self-Harm Questionnaire (ADSHQ), satisfactory test-retest correlation and a Cronbach's alpha of 0.95. Additionally, the questionnaire was able to measure significant changes after an intervention took place, indicating sensitivity to change. We conclude that the present study indicates that the Self-Efficacy in Dealing with Self-Harm Questionnaire is a valid and reliable instrument for assessing the level of self-efficacy in response to self-harm.

Preparing children's nurses for working with children and adolescents who self-harm: Evaluating the 'our care through our eyes' e-learning training package

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.

Professionals' attitudes towards people with intellectual disabilities who self-harm: A literature review

BACKGROUND

National Institute for Health and Care Excellence (NICE, 2013) Guidance on Self-Harm states that professionals supporting people who self-harm should demonstrate compassion, respect and dignity. This literature review examines the evidence for professionals' attitudes towards people with intellectual disabilities who self-harm.

METHOD

Four databases (PsychInfo, IBSS, CINAHL and Medline) were systematically searched to find relevant research since 2000.

RESULTS

Four studies met the criteria. Attitudes of professionals supporting people with intellectual disabilities are contrasted with those of professionals in settings focused on supporting people without intellectual disabilities. Professionals supporting people with intellectual disabilities tended to display attitudes and attributions reflective of biobehavioural and psychosocial theories of self-harm, with a greater emphasis on relationships.

CONCLUSION

Much more research is needed which examines the attitudes of professionals supporting people with intellectual disabilities who self-harm.

The Meaning of Suicidal Behaviour for Portuguese Nursing Students

BACKGROUND

The nursing perspectives on suicidal behaviors may influence the quality of assistance and suicidal prevention. This phenomenon is scarcely investigated among nursing students.

AIMS

The aim of this study is to understand the meanings of suicidal behavior for Portuguese undergraduate students.

METHODS

This qualitative study utilized Grounded Theory and Symbolic Interactionism. We collected data in Portugal in 2017-2018 with 13 undergraduate students.

RESULTS

Students compared suicidal behavior to "A complex and close haze" and considered it "A neglected phenomenon". Suicidal behavior was predominantly perceived as an emotional distress that requires assistance. The students compared the person and society as "The car and the road: behavior influenced by communication and interaction" and valorized social dimensions and repercussions of suicidal behavior.

LIMITATIONS

Lack of triangulation in the data and the sampling restricted to nursing students of a single institution are considered limitations of this study.

CONCLUSIONS

This study can contribute to the development of academic education strategies and psychosocial support for nursing students.

Evaluation of the effectiveness of the Australian Mental Health Triage Scale in the emergency department: The case of Turkey

PURPOSE

To examine the effectiveness of the Australian Mental Health Triage Scale(AMHTS) in Turkey.

DESIGN AND METHODS

The study is a methodological and semiexperimental study. It was carried out with 30 emergency service nurses and 378 psychiatric patients at a university hospital. The validity and reliability of the AMHTS were examined.

FINDINGS

The reliability of the AMHTS is good level (Cohen's κ = 0.631, p < 0.05). It is valid for making the patients' waiting time in triage more efficient(p < 0.05), and increases the nurses' ability to determine the treatment acuity.

PRACTICE IMPLICATIONS

It is an important tool that affects the quality of emergency psychiatric care for nurses working in the emergency departments of general hospitals.

Nurses' experiences of working in the community with adolescents who self-harm: A qualitative exploration

WHAT IS KNOWN ON THE SUBJECT?: Nurses' experience challenges of managing risk, boundaries and emotional responses when working with people who self-harm. Adolescent self-harm is a growing problem, with rates increasing in the UK. Existing research has failed to differentiate and specifically explore nurses' experiences of working with adolescents who self-harm. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides an understanding of the impact of working with adolescents who self-harm in the community on nurses, and highlights recommendations to improve staff and patient experiences and care. Community CAMHS nurses experience personal and professional conflicts when working with adolescents who self-harm. They experience interpersonal conflicts balancing the needs of adolescents with the needs of the systems around them, and intrapersonal conflicts regarding experiencing mixed emotions, and balancing the care they want to provide with service pressures. Community CAMHS nurses experience feelings of self-doubt and shame due to their emotional responses, self-care behaviours, personal and professional boundaries. They use their feelings of pride, honour and enjoyment to manage these experiences. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses working in CAMHS should be provided with more opportunities for reflective practice and self-care, to enable reflection and learning regarding the emotional impacts and working with systems. Managerial investment is required to facilitate this. Nurses working with adolescents who self-harm in CAMHS could benefit from training regarding understanding and managing self-harm (such as dialectical behavioural therapy), and effectively working with families and people who support these adolescents (such as attachment-based family therapy). ABSTRACT: 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 were 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.

Coercive containment measures for the management of self-cutting versus general disturbed behaviour: Differences in use and attitudes among mental health nursing staff

Self-harm is common in mental health facilities, and coercive containment measures are sometimes used to manage it. Nurses' attitudes towards these measures have been investigated in relation to disturbed behaviour in general, but rarely to self-harm specifically. We therefore investigated mental health nurses' use of and attitudes towards coercive measures (seclusion, restraint, intermittent and constant observations, forced intramuscular medication, and PRN medication) for self-cutting management compared with for disturbed behaviours in general using a cross-sectional, repeated measures survey design. Participants were N = 164 mental health nursing staff. Data collection was via a questionnaire comprising validated attitudinal measures. The study is reported in line with STROBE guidelines. Physical restraint (36.6%), forced intramuscular medication (32.3%) and seclusion (48.2%) had reportedly been used by individuals for self-cutting management. Respondents disapproved of using each coercive measure for self-cutting more than they did for disturbed behaviour in general with the exception of PRN medication. Attitudes to coercive measures differed across target behaviours. Hence, nurses who had used each measure for managing self-cutting disapproved of it less for that purpose than those who had not. Nurses who had used coercive techniques for self-cutting management had less desirable attitudes to their use. We cannot say whether prior use of these techniques led to increased approval or whether greater approval led to an increased willingness to use them. Reducing the use of coercive techniques for self-harm will require attitudes that support its use to be challenged. Less coercive techniques should be encouraged. Harm reduction techniques offer one such alternative.

Patient-Initiated Brief Admission for Individuals with Emotional Instability and Self-Harm: An Evaluation of Psychiatric Symptoms and Health-Related Quality of Life

Patient-initiated brief admission (PIBA) was developed for patients with emotional instability and self-harm, to cope with crises. The hypothesis was that psychiatric symptoms would decrease, and health-related quality of life (HRQoL) increase, after 1-3 days at hospital. One hundred and thirteen patients were recruited from a psychiatric clinic in Stockholm during 2016-2020. At admission and discharge, the patients completed the Hospital Anxiety and Depression Scale (HADS) and the EuroQoL-5 Dimension Questionnaire (EQ-5D). The patients also evaluated PIBA as a crisis intervention. A significant decrease in symptoms of anxiety and depression was found. HRQoL increased significantly assessed with EQ-5D and 95.2% of the participants found PIBA to be a constructive intervention.

Valued attributes of professional support for people who repeatedly self-harm: A systematic review and meta-synthesis of first-hand accounts

Therapeutic interventions are an important adjunct to self-help strategies for people who self-harm. There is little guidance for those offering therapy on the effective components of interventions for people who self-harm. This was a systematic review aiming to identify the factors that contribute to positive experiences of therapy as described by people who have reduced or stopped self-harm. The review followed PRISMA guidelines to locate and synthesize peer-reviewed qualitative studies describing experiences of therapy among people who had reduced or stopped self-harm. Study selection, data extraction, and quality assessment were peer reviewed and conducted for at least two researchers independently. Relevant first-hand quotations were extracted from eligible studies and synthesized using a thematic analysis in collaboration with experts with personal and professional experience of self-harm. Twenty-three studies met eligibility criteria. Themes identified in the reported accounts were arranged under two meta-themes. 'Positive aspects of seeing a professional' identified aspects of professional care that were common to all encounters: the value of sharing, space to talk and reflect, and the boundaries inherent in contact with a professional. 'Positive attributes of individual professionals' depended upon individual characteristics: the ability to build reciprocal trust by being non-judgemental, showing genuine empathic concern, and being confident to talk about and respond directly to self-harm. Our review indicates that therapeutic alliance is perceived as key to effective professional help for self-harm, irrespective of underlying principles of therapy. All forms of therapy should be timely and reliable and centred around the needs of the individual and their experience of self-harm.

Experiences of nursing care for patients who self-harm and suggestions for future practices: The perspectives of emergency care nurses

Self-harm is a major challenge in healthcare systems. Emergency department nurses provide care to numerous patients with self-harm injuries. Accordingly, nurse-patient interactions are vital to improve the physical and psychological outcomes of this complex patient group. Previous studies have proposed the establishment of improved teaching programs to increase the competence of emergency department nurses within mental health care; however, few studies have comprehensively investigated the experiences and suggestions for future nursing practices. Therefore, we gathered in-depth knowledge of Danish emergency department nurses' experiences caring for patients who self-harm and obtained their suggestions on future nursing practices. Ten semi-structured interviews were conducted to capture the nurses' individual perspectives. The scientific theory is based on phenomenology and hermeneutics. Interpretative phenomenological analysis was used, and three themes were identified: (i) importance of having the competences to establish a relationship in the acute phase; (ii) acute care from a biomedical perspective; and (iii) highlighting ideas for improved future practices. The emergency department nurses were aware of the importance of mental health care but found their competence and motivation situated in medical care. The nurses felt that they lacked skills to undertake in-depth mental care for patients who self-harm and that the healthcare system failed to help this group of patients. Based on these findings, rather than aiming at improving nursing skills, we suggest a close collaboration between the emergency and psychiatric departments to improve the quality of care for patients who self-harm. We also recommend organizational changes within the emergency department, such as the introduction of a so-called 'social track'.

Attitudes of under graduate nursing students to suicide and their role in caring of persons with suicidal behaviors

This cross-sectional survey was carried out among nursing students (n = 223) to examine their attitudes towards suicide and their role in suicide prevention. The data were collected by administering a Suicide Attitude questionnaire. The majority (68.7%) of nursing students had positive attitudes towards suicide with more favorable attitudes in the "Professional role, work, and care" (33.08 ± 4.21) domain, followed by 'Morality and mental illness' (20.80 ± 3.61) and 'Communication and attention' (13.60 ± 2.81). In addition, age and education were significantly different in participants' attitudes towards suicide (p < 0.05). The results suggest that nursing students need culturally relevant suicide education programs to provide optimal care to suicide victims.

Somatic health care professionals' stigmatization of patients with mental disorder: a scoping review

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.

Adolescents with suicidal behaviours: A qualitative study about the assessment of Inpatient Service and Transition to Community

WHAT IS KNOWN ON THE SUBJECT?: Only a small number of adolescents with suicidal behaviour receives any follow-up treatment. The implementation of recurrent behaviour prevention strategies is crucial in the period following suicide attempts and should take into account adolescents' opinions to be effective and congruent. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This paper shows that the 33 adolescent participants in the study identified the following protective factors of recurrent suicidal behaviour: family, friends and other trusted persons, as well as the self and newly learned strategies. The adolescents described their family as a constant presence and reported wishing that their parents maintain their current family support. Psychological support, health professionals and occupational activities are what the adolescents value most about hospitalization, and some criticisms are related to the environment, activities and health professionals. The adolescents also emphasize the need to maintain contact with the nurses after hospital discharge and make suggestions for service improvement related to the environment and the interventions implemented. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Knowing the protective factors of recurrent suicidal behaviours, perception of the impact of the intervention, the expectation of future support and healthcare follow-up is crucial for adapting suicide prevention strategies to be put in place by health services for better quality care delivery. The results obtained allow us to define as specific implications the implementation of psychoeducational intervention directed at the adolescent's family with suicidal behaviour during hospitalization and the definition of strategies for maintaining contact and follow-up with the adolescent after discharge. This study emphasizes the need to reinforce training in suicidology for all health professionals for the improvement of clinical practice.

ABSTRACT

INTRODUCTION: The prevention of recurrent suicidal behaviours in adolescents should consider their perceptions, needs and expectations.

AIM/QUESTION

To identify the protective factors of recurrent suicidal behaviours in adolescents; To describe the family and the expectations for future involvement; To know the most important aspects of hospitalization and discuss expectations of nursing care follow-up after hospital discharge.

METHOD

A descriptive, qualitative and exploratory study was carried out in a sample of 33 adolescents with suicidal behaviours. Data were collected through semi-structured interviews, and the data processing used the content analysis technique.

RESULTS

Findings arising from data allowed identifying the protective factors: family, friends and other trusted persons. During the hospitalization, the adolescents reinforce the knowledge about themselves and the newly learnt coping strategies. Psychological support and health professionals are what they value most about hospitalization and emphasize the need to maintain contact with the nurses after discharge.

DISCUSSION

Knowing the needs and expectations of adolescents with suicidal behaviour will make nursing psychotherapeutic interventions more effective and congruent in this vulnerable group.

IMPLICATIONS FOR PRACTICE

Ensuring psychoeducational intervention to the families of adolescents with suicidal behaviour and continuity of care after discharge, and reinforcing the training in suicidology for all health professionals.

Knowledge, attitudes and experiences of self-harm and suicide in low-income and middle-income countries: protocol for a systematic review

INTRODUCTION

Over 800 000 people die due to suicide each year and suicide presents a huge psychological, economic and social burden for individuals, communities and countries as a whole. Low-income and middle-income countries (LMICs) are disproportionately affected by suicide. The strongest risk factor for suicide is a previous suicide attempt, and other types of self-harm have been found to be robust predictors of suicidal behaviour. An approach that brings together multiple sectors, including education, labour, business, law, politics and the media is crucial to tackling suicide and self-harm. The WHO highlights that evaluations of the knowledge and attitudes that priority groups, not only healthcare staff, have of mental health and suicidal behaviour are key to suicide prevention strategies. The aim of this systematic review is to examine the knowledge, attitudes and experiences different stakeholders in LMICs have of self-harm and suicide.

METHODS AND ANALYSIS

MEDLINE, Embase, PsycINFO, CINAHL, BNI, Social Sciences and Cochrane Library will be searched. Reviewers working independently of each other will screen search results, select studies for inclusion, extract and check extracted data, and rate the quality of the studies using the Strengthening the Reporting of Observational studies in Epidemiology and Critical Appraisals Skills Programme checklists. In anticipation of heterogeneity, a narrative synthesis of quantitative studies will be provided and metaethnography will be used to synthesise qualitative studies.

ETHICS AND DISSEMINATION

Ethical approval is not required. A report will be provided for the funding body, and the systematic review will be submitted for publication in a high-impact, peer-reviewed, open access journal. Results will also be disseminated at conferences, seminars, congresses and symposia, and to relevant stakeholders.

PROSPERO REGISTRATION NUMBER

CRD42019135323.

Perceptions of knowledge, attitude and skills about non-suicidal self-injury: A survey of emergency and mental health nurses

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.

Balancing between a Person-Centred and a Common Staff Approach: Nursing Staff's Experiences of Good Nursing Practice for Patients Who Self-Harm

The aim of this study was to describe nursing staff's experiences of good nursing practice in psychiatric in-patient care for patients with self-harming behavior. The participants were nine nurses and eight nursing assistants working in two in-patient wards in general psychiatry. Four focus group discussions were held and subjected to qualitative content analysis. The findings showed that good nursing practice balanced a person-centred approach with a common staff approach, allowing people who self-harm and staff to share responsibility for structuring everyday life, keeping to the plan, communicating decisions, and finding individual opportunities for relief. Reflective discussions among the staff concerning prejudice, emotional stress, lack of resources, and shortcomings in care planning could also prevent a stigmatizing culture and organizational deficiencies, which would be beneficial for both the people who self-harm and the staff.

'Relieved to be seen'-patient and carer experiences of psychosocial assessment in the emergency department following self-harm: qualitative analysis of 102 free-text survey responses

OBJECTIVES

We sought to explore patient and carer experiences of psychosocial assessments following presentations to hospital after self-harm.

DESIGN

Thematic analysis of free-text responses to an open-ended online survey.

SETTING

Between March and November 2019, we recruited 88 patients (82% women) and 14 carers aged ≥18 years from 16 English mental health trusts, community organisations, and via social media.

RESULTS

Psychosocial assessments were experienced as helpful on some occasions but harmful on others. Participants felt better, less suicidal and less likely to repeat self-harm after good-quality compassionate and supportive assessments. However, negative experiences during the assessment pathway were common and, in some cases, contributed to greater distress, less engagement and further self-harm. Participants reported receiving negative and stigmatising comments about their injuries. Others reported that they were refused medical care or an anaesthetic. Stigmatising attitudes among some mental health staff centred on preconceived ideas over self-harm as a 'behavioural issue', inappropriate use of services and psychiatric diagnosis.

CONCLUSION

Our findings highlight important patient experiences that can inform service provision and they demonstrate the value of involving patients/carers throughout the research process. Psychosocial assessments can be beneficial when empathetic and collaborative but less helpful when overly standardised, lacking in compassion and waiting times are unduly long. Patient views are essential to inform practice, particularly given the rapidly changing service context during and after the COVID-19 emergency.

Meanings of suicidal behavior from the perspective of primary care professionals

OBJECTIVE

To explore the meaning of suicidal behavior from the perspective of family health professionals.

METHOD

A qualitative study developed during 2017-2018 with 18 primary care professionals from a Brazilian municipality. Grounded theory was used as the methodological framework. Semi-oriented interviews were conducted, transcribed, and analyzed by open, axial, and selective coding.

FINDINGS

The professionals perceived themselves as unprepared, emotionally affected, and fearful to work in suicide prevention, prioritizing the referral of people to specialized services regardless of the severity of the situation. Suicide was represented as both a choice and a condition of vulnerability, being more reprehensible when associated with individual choice.

CONCLUSION

We identified beliefs related to suicidal behavior that could affect the care of people at risk. Our findings reinforce the need for education and training in the prevention of suicidal behavior in primary care.

Mental health nurses' perspectives of people who self-harm

Self-harm is a significant health issue, a leading cause of serious injury and is an indicator of psychological distress. Nurses play an important role in providing therapeutic care to people who self-harm. The aim of this study was to explore mental health nurses' (MHNs) experience of working with people who self-harm. Data were collected using semi-structured interviews and transcribed verbatim from 14 MHNs across Australia. Elo and Kyngäs' inductive content analysis was used to extract meaning from the data which is reported in accordance with the consolidated criteria for qualitative research guidelines (COREQ). Two categories were identified which captured the MHNs' experiences of working with people who self-harm: (i) Nurses' level of preparedness to work with people who self-harm; and (ii) The healthcare system. Several sub-categories were identified. Attitudes, knowledge, skills, and support from others influenced their experience of working with people who self-harm. Clinical and life experience, undergraduate programme preparation and ongoing education all contributed towards developing therapeutic care with this group of patients. Nurses are vital in the care of people who self-harm and an accurate understanding of the functions of self-harm focuses therapeutic interactions to manage psychological distress and reduce further self-harm and lessen the risk of suicide.

Impact of the COVID-19 pandemic on students at elevated risk of self-injury: The importance of virtual and online resources

Non-suicidal self-injury (NSSI), which involves deliberate damage to body tissue without suicidal intent, has long been a concern for schools and school staff. Secondary schools are an ideal setting in which to identify, and appropriately refer, students who self-injure as well as implement evidence-based prevention and early intervention programs. However, in the context of the global COVID-19 pandemic, schools have been closed and students sent home to learn online. This may result in the exacerbation of existing anxieties and pose several new stressors that cumulatively may increase risk of NSSI. In this article, we draw on recent research and our collective experience working with schools, as well as digital mental health, to outline some of these potential stressors and offer resources for school staff to help students who are engaging in or at risk of NSSI.

The attitudes and feelings of mental health nurses towards adolescents and young adults with nonsuicidal self-injuring behaviors

BACKGROUND

Attitudes towards patients with self-harm behaviors are decisive for the quality of the relationship of healthcare professionals towards them, which is further linked to successful treatment. In mental health settings, nurses are the ones spending the longest time caring for these patients. Nurses often experience negative emotions while delivering care which may lead to professional burnout and suboptimal patient care. The purpose of this study was to explore the feelings and attitudes of nurses working in different psychiatric hospital settings toward adolescents and young adults with non-suicidal self-injury (NSSI).

SUBJECTS AND METHODS

The subjects were nurses from the tertiary psychiatric hospital who deliver mental health care to patients with NSSI on a daily basis (n = 76; 20 males, 56 females; average age 42 ± 8 years; average working experience 20 ± 9 years). Data were collected via a self-report questionnaire consisting of three parts (sociodemographic data, Emotional Burden, Adapted Self-Harm Antipathy-Scale). In the latter two parts of the questionnaire, the subjects rated their level of agreement with the emotions and statements on a five-point Likert scale. Nonparametric tests were used for statistical analysis. The statistical significance was set to p < 0.05.

RESULTS

The emotions of nurses towards patients with NSSI were not very negative and the attitudes were positive. Powerlessness was the most prevalent (3.55 ± 1.038) of the studied emotions, followed by uncertainty (3.21 ± 1.225). The subjects disagreed with feeling anger (2.34 ± 1.17) and despair (2.07 ± 1.09) and were undecided about being afraid (3.07 ± 1.2). The nurses with higher education felt more negative emotions than those with medium education. Education did not affect nurses' attitudes. The nurses from non-psychotherapeutic units felt more negative emotions and less positive attitudes than those from psychotherapeutic units. Gender did not affect the emotions felt towards patients, but the female nurses held more positive and less negative attitudes.

CONCLUSIONS

The respondents expressed low levels of negative emotions and positive and caring attitudes towards patients with NSSI, indicating a good predisposition for empathetic work and long-term burnout prevention. However, the differences observed with regards to education, gender and especially working environment indicate the different needs for environmental, educational and supervisory support.

Frequency of suicide attempts and attitudes toward suicidal behaviour among doctors and nurses in Lagos, Nigeria

Background

Competence and attitudes toward suicidal behaviour affect practice. These attitudes may influence the consideration of suicide during personal crisis among doctors and nurses.

Aim

The attitudes of doctors and nurses towards suicidal behaviour was assessed using the Attitudes Toward Suicide Scale (ATTS), which was validated in another study by the authors, evaluated for the possible factors affecting this relationship and estimated the frequency of suicide attempts among doctors and nurses.

Setting

Lagos State University Teaching Hospital Lagos, Nigeria.

Methods

The cross-sectional survey about attitudes toward suicide was done among 226 doctors and nurses working at a tertiary institute hospital in Lagos, Nigeria, using the ATTS. Sociodemographic profile and self-rated competence, commitment, empathy and irritation toward suicide were obtained. Stratified random sampling was used, data were analysed using Statistical Package for Sociological Sciences. Data was summarised, reliability of the ATTS was assured and variables compared by t-test and ANOVA. Independent predictors were identified via multiple regression (p ≤ 0.05).

Results

Frequency of suicide attempts of 7.50% was found among respondents with a mean age of 35.84 ± 6.76 years. Attitudes toward suicidal behaviour were slightly positive (77.92 ± 9.90) and the independent predictors of less positive attitudes were nursing profession (β = 0.025, p < 0.001) and high self-rated irritation toward suicide (β = 0.18, p < 0.01).

Conclusion

The frequency of suicide attempts is higher among doctors and nurses when compared to the general population. Doctors and nurses reported slightly positive attitudes toward suicidal behaviour with significant differences in the type of profession and levels of self-rated irritation toward suicide.

Revising the Self-Harm Antipathy Scale: validation among staff in psychiatric healthcare in Sweden

Background: The Self-Harm Antipathy Scale (SHAS) is a questionnaire designed to measure nurses' attitudes towards self-harm. This can be useful to improve the quality of care provided to individuals who self-harm.Aim: The purpose of this study was to revise and adapt the SHAS for use in Sweden and evaluate the psychometric properties of this Swedish version (Self-Harm Antipathy Scale - Swedish Revised; SHAS-SR).Methods: A sample of 596 employees within psychiatric healthcare was recruited (from a total of 3507, response rate 17.0%), the majority encountering self-harming individuals regularly at work. Participants completed the SHAS-SR questionnaire along with a scale assessing community attitudes towards individuals with mental illness (New CAMI-S). The sample was randomly split in half (n = 298 each). Exploratory factor analysis was performed on one subsample and confirmatory on the other. Confirmatory factor analysis on the original SHAS model, and convergent validity testing against New CAMI-S, used the whole sample.Results: The final version of the SHAS-SR included 17 items forming three factors. Convergent validity was established (r = -0.57, ρ = -0.48, p < 0.001). The SHAS-SR and all its subscales demonstrated acceptable internal consistency (α = 0.73-0.79, ω = 0.78-0.79).Conclusion: This study indicates that the SHAS-SR is reliable and valid when assessing attitudes towards self-harm among a sample of Swedish psychiatric healthcare staff. The scale could be useful for assessing the impact of attitude interventions to improve healthcare services. It may, however, have limited applicability for staff not working in caring roles.

To Identify and Support Youths Who Struggle with Living-Nurses' Suicide Prevention in Psychiatric Outpatient Care

Nurses working in psychiatric care daily encounter youths who are struggling with living. Despite this, nurses' suicide-prevention work is seldom addressed in research or in recommendations for care. The overall aim of this paper is to discuss how nurses, with their caring science perspective, may contribute to suicide prevention. The paper presents how nurses in psychiatric outpatient care may identify and support suicidal youths, according to experts in suicide prevention. The interviews with six experts in suicide prevention resulted in three themes: Engagement necessary but demanding, Acknowledgement of warnings signs and Supportive relationship. The respondents elaborated on how suicide-risk can be assessed. A good rapport with the youths was stressed and the recommended act of care included: to listen openheartedly without interrupting as well as to listen after risk- and protective factors to emphasize or to penetrate. To ask about suicidality as well as to let the person elaborate on what's important for him or her. To endure in the patients' suffering as well as steering the conversations toward hope. The paper also presents warning signs that need to be noticed according to the experts and the literature consensus. Our findings suggest that communication in suicide-prevention is an "art and act" that cannot be reduced to a method or simple guidelines. We argue that the recommended acts of care demand sensitivity and skills and that nurses as well as the domain of caring science may contribute to this competence.

Oncologists, oncology nurses and oncology social workers experiences with suicide: impact on patient care

OBJECTIVE

To explore how oncology healthcare workers' (HCPs) personal experiences with suicide impacts their practice with cancer patients.

DESIGN

The study was designed using Grounded Theory strategies in data collection and analysis.

PARTICIPANTS

Eighteen social workers, 23 oncologists, and 20 nurses, participated in the research.

METHODS

Themes emerged from systematic line-by-line coding of the interview transcripts.

FINDINGS

HCPs reported that personal experiences with suicide: impacted the way they communicated with patients about suicide; made them vigilant about signs of suicidality; and made them aware of specific indicators of this distress.

CONCLUSIONS

HCPs drew a direct line between their experiences with suicide to the ways in which they care for their patients.

IMPLICATIONS

Increasing HCP awareness of these issues alongside training using evidence-based guidelines for identifying and responding to suicide risk in patients will ensure providing the best quality of care for patients.

The significance of site of cut in self-harm in young people

BACKGROUND

Self-cutting in young people is associated with high risk of repetition and suicide. It is important, therefore, to identify characteristics of self-cutting that might impact on repetition and aspects of care by staff. This study aimed to explore differences in clinical (e.g., previous self-harm) and psychological characteristics (intent, mental state, precipitants) of self-cutting in young people based on whether site of cut was visible or concealed.

METHODS

Data were from a large prospective self-harm monitoring database that collected data on hospital emergency department presentations for self-harm in the City of Manchester, UK, between 2005 and 2011. Clinical and psychological characteristics, as well as onward referral/clinical management from the emergency department, of 799 young people (totalling 1,196 episodes) age 15-24 who self-cut in visible or concealed areas were compared using logistic regression.

RESULTS

During the study period 500 (40%) episodes were in a concealed location. Concealed self-cutting was more likely to be precipitated by specific self-reported precipitants such as abuse and characterised by the following: previous self-harm, current psychiatric treatment, premeditation, and greater risk of repetition within the study period. Receiving a psychosocial assessment and referral to psychiatric services from the emergency department were less likely, however. Repetition and referral to psychiatric treatment were not significantly associated with site of injury when adjusting for other factors.

CONCLUSIONS

There are meaningful differences in characteristics associated with location of cut. We recommend that all young people who present to hospital following self-harm receive a psychosocial assessment, in line with NICE guidance.

Brief admission (BA) for patients with emotional instability and self-harm: nurses' perspectives - person-centred care in clinical practice

Purpose: Emotional instability and self-harm pose major problems for society and health care. There are effective interventions in outpatient care, but when patients need inpatient care, nurses often struggle meeting their patient’s needs. Brief admission (BA) is a newly implemented crisis intervention and novel form of inpatient care. The aim of this study is to describe nurses’ experiences working with BA related to patients with emotional instability and self-harm.

Methods: Eight nurses were interviewed according to a semi-structured interview guide. The data was analysed using qualitative content analysis.

Results: Four main categories emerged regarding nurses’ experiences with BA: provides security and continuity, fosters caring relationships, shifts focus towards patient’s health and empowers the patient. The nurse’s role shifted from “handling problems” to establishing caring relationships with a focus on the person’s health and possibilities for recovering instead of psychiatric symptoms.

Conclusions: Previous studies on patients’ perspective of BA describe positive experiences such as increased autonomy and participation in the healthcare process. This study supports those findings, albeit from the perspective of nurses. Our findings suggest that BA may reduce work-related stress experienced by nurses while caring for persons with emotional instability and self-harm. BA may also support nurses in their ability to provide more meaningful and constructive psychiatric inpatient care.

Mortalidade por suicídio no Espírito Santo, Brasil: uma análise do período de 2012 a 2016

Objetivo: descrever a mortalidade dos óbitos por lesões autoprovocadas intencionalmente no Espírito Santo, Brasil.Materiais e métodos: estudo epidemiológico, baseado em dados secundários sobre a tendência dos suicídios ocorridos no Espírito Santo no período de 2012 a 2016.Resultados: a análise de tendência indicou crescimento da taxa de mortalidade por suicídio ao longo do período de 2012 a 2016 (R2 = 0,9307; p < 0,001). A maioria das vítimas foram homens (73,5 %), pardos (47,9 %), adultos (81,4 %)que morreram por enforcamento, seguido de envenenamento e arma de fogo. O enforcamento foi mais prevalente entre os homens (P = 63; p < 0,001); entre as mulheres, o envenenamento (P = 20,8 %; p < 0,001) e a precipitação de lugar elevado (P = 14 %; p < 0,001).Conclusão: o aumento na mortalidade por suicídio entre a população estudada vem acompanhando a tendência de crescimento no Brasil e no mundo. Acredita-se que este estudo se constitui como mais um recurso de acesso à informação sobre o suicídio de modo a facilitar a tomada de decisão por parte dos órgãos competentes no enfrentamento dessa problemática bem como estimular e ampliar a discussão sobre o tema. 

How Do Families Represent the Functions of Deliberate Self-Harm? A Comparison between the Social Representations from Adolescents and Their Parents

Research has recognized the importance of understanding the social representations about the functions of deliberate self-harm, particularly in the context of clinical intervention. In addition, parents can play a relevant role in the rehabilitation of adolescents with these behaviors. However, there are few studies that focused on the description and comparison of the social representations about these functions, particularly in families. This article aimed to analyze the social representations about the functions of deliberate self-harm from adolescents and their parents. We developed two sets of analyses: first we compared the social representations from adolescents without a history of deliberate self-harm and their parents, and secondly we compared the social representations about the functions of deliberate self-harm from adolescents with a history of these behaviors and their parents' social representations. Results revealed significant differences between both groups of families, implying that the groups of participants represent the functions of deliberate self-harm differently. Overall, parents emphasized interpersonal functions and devalued intrapersonal functions. These differences were heightened in the families of adolescents with deliberate self-harm. The present article provides important insights regarding the social representations about the functions of deliberate self-harm and the differences between parents' social representations and their children experiences and social representations.

Suicidal Ideation, Suicidal Attempts, and Self-Harm in the UK Armed Forces

INTRODUCTION

In the UK military, suicide is infrequent and studies of self-harm behavior in this population are rare.

OBJECTIVES

To compare lifetime self-harm rates estimated on three occasions between 2004 and 2016 and to explore the associates of lifetime self-harm.

METHOD

Three phases of a UK AF cohort study (n = 10,272, 9,990, and 8,581, respectively) provided data. Telephone interviews assessed associates of self-harm among cohort members who reported subjective mental health problems in the past 3 years (n = 1,448). Validated measures of mental health and related stigmatization, social support, and help-seeking were obtained.

RESULTS

Lifetime self-harm increased significantly (p < .001) from 1.8% among serving personnel and 3.8% among veterans in 2004/06 to 1.9% and 4.5% in 2007/09 and to 4.2% and 6.6% in 2014/16 in the two groups, respectively. Veterans were consistently significantly more likely to report lifetime self-harm than serving personnel. Significant determinants of lifetime self-harm included current mental disorder symptoms, stigmatization, poor social support, suicidal ideation, and seeking help from formal medical sources.

CONCLUSION

Self-harm has increased over time in the UK serving and veteran community. Suicide prevention should focus on ameliorating mental disorder by encouraging engagement with health care, reducing negative views of mental illness, and fostering social support.

Addressing Self-Injury in Schools, Part 1: Understanding Nonsuicidal Self-Injury and the Importance of Respectful Curiosity in Supporting Youth Who Engage in Self-Injury

Nonsuicidal self-injury (NSSI) is defined as the deliberate, self-inflicted damage of body tissue without suicidal intent and for purposes not socially or culturally sanctioned. School nurses are often a first point of contact for young people experiencing mental health challenges, and yet they often report they lack knowledge and training to provide care for persons who engage in NSSI. In the first of two parts, this article provides school nurses with a better understanding of NSSI and the distinctions between NSSI and suicidal behaviors, discusses the role of nurses' knowledge and attitudes on their ability to care for their patients' mental health needs, and discusses approaches for developing a respectful, empathic manner for working with and supporting youth who engage in self-injury. Part 2 will offer a strategy for brief assessment of NSSI and reflect on two case studies and their implications for school nursing practice.

Stigma towards non-suicidal self-harm: evaluating a brief educational intervention

BACKGROUND:

health professionals' attitudes towards self-harming behaviour are predominantly negative. Research examining educational interventions to change negative attitudes is limited.

AIMS:

this study aimed to provide an educational intervention for student nurses to change negative attitudes around self-harm.

METHODS:

attitudes around self-harm and mental health in general were assessed through the Self-Harm Antipathy Scale and the Mental Health Attitude Scale. Fifty-five adult nursing students took part in the 45-minute intervention. This included facts and figures, celebrity stories and personal stories regarding self-harm, all intended to increase understanding.

FINDINGS:

after the intervention, attitudes measured by the Self-Harm Antipathy Scale had improved significantly.

CONCLUSION:

patients who self-harm will without doubt continue to experience negative attitudes from health professionals. This study shows an educational intervention can change attitudes towards those who self-harm.

Predictable, Collaborative and Safe: Healthcare Provider Experiences of Introducing Brief Admissions by Self-referral for Self-harming and Suicidal Persons with a History of Extensive Psychiatric Inpatient Care

People with severe self-harming behavior and histories of lengthy psychiatric inpatient admissions can represent a challenge to care providers. This interview-based study illuminates healthcare provider experiences (n = 12) of Brief Admission (BA) among self-harming individuals, with >180 days of psychiatric admission the previous year. Qualitative content analysis revealed that providers experienced benefits of increased predictability, and a shift from trigger and conflict to collaboration with individuals admitted to BA. Staff participants expressed an increased sense of safety and a strengthened link between inpatient and outpatient caregiving. Results indicated that BA is a promising intervention for self-harming individuals with extensive psychiatric histories.

Social representations about the functions of deliberate self-harm: Adolescents and parents

INTRODUCTION

The understanding of the social representations about the functions of deliberate self-harm can be an important factor for the comprehension of this phenomenon. Nonetheless, only a few studies focused on this topic and specifically on the social representations from adolescents with and without a history of deliberate self-harm and their parents.

METHODS

This article presents two studies that analysed these representations. Study 1 compared the social representations from 411 Portuguese adolescents (219 females and 192 males, aged 12-19 years), from which 109 reported having a history of deliberate self-harm. Study 2 focused on the comparison of the social representations from 471 parents (265 mothers and 206 fathers, aged 33-62 years) of Portuguese adolescents. Of the parents in Study 2, 120 had children with a history of deliberate self-harm.

RESULTS

In Study 1, adolescents without a history of deliberate self-harm perceived most interpersonal functions as more relevant than adolescents with a history of these behaviours, while adolescents with a history of deliberate self-harm emphasized one intrapersonal function. In Study 2, no differences were found between parents of adolescents with and without a history of deliberate self-harm. However, results revealed differences between the representations of mothers and fathers in several intrapersonal functions.

CONCLUSIONS

This research provides important insight regarding the social representations about the functions of deliberate self-harm from adolescents with and without a reported history of these behaviours and their parents. The impact for clinical intervention and prevention programs is discussed.

Emergency department nurse's attitudes towards patients who self-harm: A meta-analysis

Self-harm is a major challenge to public health. Emergency department (ED) nurses treat significant proportions of patients with self-harm injuries, and positive therapeutic patient-nurse interactions are imperative to the physical and psychological outcome of this vulnerable patient group. Research, both nationally and internationally, suggests that treating those with self-harm injuries is emotionally challenging, and ambivalence, powerlessness, and ineffectiveness are commonly manifested in negative attitudes towards these patients. Following the PRISMA guidelines, this systematic review with meta-analyses examined the attitudes of ED nurses towards patients who self-harm, based on currently available evidence. The following databases were searched: CINAHL complete; Medline complete; PsycARTICLES; PsycINFO; The Allied and Complementary Medicine Database; Health Source: Nursing/Academic Edition; PsycEXTRA; and Psychology and Behavioural Sciences Collection. Clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant reports to identify additional studies, were also searched. Five studies were included in the meta-analysis. The Self-Harm Antipathy Scale (SHAS) was used as an outcome in two studies appropriate for meta-analysis. The Attitudes Towards Deliberate Self-Harm Questionnaire (ADSHQ) scale was used as an outcome in three studies appropriate for meta-analysis. Results demonstrated limited empathy and negativity towards patients who self-harm, indicating a requirement for education and supervision of ED staff, where the SHAS or the ADSHQ can be used to monitor attitude change. Self-harm educational content for ED staff should include areas of knowledge building including explanations and causes of self-harm; range, forms, and functions of self-harm; staff responses to self-harm; assessment, management, and interventions; professional practice issues.

Processes of Change and Nonsuicidal Self-Injury: A Qualitative Interview Study With Individuals at Various Stages of Change

Nonsuicidal self-injury (NSSI) is a pervasive and potentially lethal behavior that affects many youth and adolescents. Effective treatment and prevention efforts are critical but often lack a nuanced understanding of the behavior change process. To address this gap, this research employs a stage of change model to identify and understand the most salient and widespread processes that facilitate NSSI behavior change. Thirty-one semi-structured interviews were conducted with individuals with current or past self-injury. Individuals were recruited to represent all stages of change including those who have not thought about changing behavior to those who have been NSSI-free for years. We employ a directed content analysis to code for dimensions derived from the model and an inductive approach to surface more nuanced change levers. Four organizing dimensions emerged: relational, behavioral, self-knowledge, and barriers. Common change levers of value in clinical practice or in intervention modalities are discussed.

Attitudes of nursing students toward to the suicidal behavior

Objective:

to investigate attitudes related to suicidal behavior and associated factors, among students in the last year of an undergraduate nursing course.

Methods:

a cross-sectional study with 111 nursing students from a Brazilian educational institution. The data were collected in 2017, by self-administration of a questionnaire with sociodemographic characteristics, and the Suicide Behavior Attitude Questionnaire, which were analyzed by descriptive statistics, comparison of means, and correlation tests.

Results:

most of the nursing students had contact with someone with suicidal behavior, but did not have education related to the subject. The most negative attitudes were associated with the female sex, lack of materials on suicide prevention, and lower self-perception of professional competence. Suicidal thoughts throughout life were associated with the contact with someone with suicidal behavior, and less moralistic/condemnatory attitudes.

Conclusion:

investigations and interventions are necessary for academic qualification and prevention of suicidal behavior.

Social Representations About the Functions of Deliberate Self-Harm: Construction and Validation of a Questionnaire for Portuguese Adults

The present article focuses on the validation of the Questionnaire of Social Representations about the Functions of Deliberate Self-Harm for adults. The understanding of the social representations about deliberate self-harm can be relevant for clinical intervention and prevention. However, there is still a lack of instruments to assess these representations. The basis for this instrument was the translation of the Inventory of Statements About Self-Injury. To complement this instrument, we conducted semi-directive interviews with adults without deliberate self-harm and analysed the Portuguese written press. Results from these studies complemented the questionnaire with new items and functions. Study 1 consisted of an exploratory factor analysis with a sample of 462 adults. Results revealed a two-factor structure of interpersonal and intrapersonal dimensions. After item reduction, the factorial analysis of the independent functions was also acceptable. This structure was then corroborated in Study 2 by a confirmatory factor analysis with a new sample of 474 adults, revealing an acceptable model fit. This questionnaire presents a relatively solid structure and is based on acceptable psychometric properties, which allows its use in future research.

The meaning of suicidal behaviour from the perspective of senior nursing undergraduate students

The meaning ascribed to suicidal behaviours may influence the quality of the care provided to people at risk of suicide. Such a phenomenon has yet to be properly investigated amongst nursing undergraduate students, the aim of this study being to gain an understanding of the meanings of suicidal behaviour for a particular group of nurses. The study, which utilized grounded theory, was conducted in Brazil in 2016-2017 with 30 undergraduate students. The findings indicated that suicidal behaviour, classified according to the individual beliefs and judgements of the participants, presented a significant barrier to the delivery of care and was complex and multifaceted care phenomenon. Participants were often reluctant to discuss the topic, seemingly wanting to distance themselves from the care of persons exhibiting suicidal behaviour, and to avoid professional engagements relating to suicide prevention. Significant work is required in raising both an awareness and knowledge of suicidal behaviour befitting the promotion of tolerance, emotional competency, resilience, and empathy amongst nursing students.