The home care team approach to self-neglecting elders

Elderly patients who neglect their own health present special challenges. This article describes techniques for establishing rapport, understanding the patient's world, using a team approach to care, and achieving closure. At each step the clinician must find a balance between respecting the elder's rights and meeting his or her healthcare needs.

Self-neglect: a proposed new NANDA diagnosis

PURPOSE

To propose a new NANDA diagnosis, self-neglect.

DATA SOURCES

Research studies and literature published from a variety of disciplines including nursing as well as primary research.

DATA SYNTHESES

This diagnosis can be used to describe a constellation of self-care problems of varying severity and impact on the health and well-being of people who self-neglect. Included are two subtypes of self-neglect based on the degree of intentionality. Clarification of self-neglect is long overdue because self-neglect presents conceptual, identification, and intervention problems for nurses, healthcare workers, and for medicolegal systems across settings and in many countries.

CONCLUSION

The proposed diagnosis, self-neglect, fills a gap in current standardized terminology. This diagnosis will contribute significantly to nurses leading the way in the explication of an interdisciplinary and international health concern. PRACTICE AND POLICY IMPLICATIONS: Developing self-neglect as a recognized nursing label is vital to clinicians and policy makers within and across countries. Appreciating less serious/non-life-threatening presentations will give nurses a care perspective to improve the health and well-being of those in earlier stages of self-neglect. Definitions for this phenomenon will contribute to care planning and interventions, leading to consistency in practice and research.

Staff views of a deliberate self-harm protocol for children and young people

An audit to evaluate a protocol for the management of children and young people presenting with self-harm was undertaken at Calderdale and Huddersfield NHS Trust. The objectives were to review current practice and to identify strengths and challenges. The audit showed that most staff were aware of the written procedure for obtaining a specialist assessment by the child and adolescent mental health services (CAMHS), but that feedback was inconsistent and there was a need for improved communication between health professionals.

Accident and emergency nurses’ attitudes towards patients who self-harm

The study aimed to assess if accident and emergency (A&E) nurses have positive or negative attitudes towards patients with deliberate self-harm, and to assess if nurses' age, length of A&E experience, or in-service education influence their attitudes towards these patients. An adapted version of the Suicide Opinion Questionnaire was used to assess attitudes towards patients with deliberate self-harm. Data were collected from 43 Registered Nurses in the A&E department of a major city hospital in Australia. Data were analysed using SPSS. Most nurses had received no educational preparation to care for patients with self-harm. Over 20% claimed the department either had no practice guidelines for DSH or they did not know of their existence; one-third who knew about them had not read them. There were significant differences between respondents on several variables. Older and more experienced nurses had more supportive attitudes than younger and less experienced nurses. Nurses who had attended in-service education on DSH had more positive attitudes than non-attendees. Overall, the findings have implications for improving the educational preparation of A&E nurses, improving awareness and adoption of practice guidelines, mentoring nurses, and improving attitudes towards patients who self-harm.

Parasuicide, self-harm and suicide in Aboriginal people in rural Australia: a review of the literature with implications for mental health nursing practice

With reports of increased rates of suicide and parasuicide among Aboriginal people worldwide, the dual purpose of this background paper is to examine the literature on underlying mental health issues, as well as primary and secondary actions to try to minimize the risk related to this area among Aboriginal people nationally and internationally. The literature review contained in this paper has been developed upon the fundamental belief that prevention of mental health problems, mental illness and suicide should incorporate understanding of the factors that heighten the risk of these occurring and the factors that are protective against them, while simultaneously developing, disseminating and implementing effective interventions that are culturally and linguistically appropriate. To this end, continuity and integration of mental health care for rural Aboriginal people is attendant upon a whole-of-community and a whole-of-government response that respects the metaphor of cultural and linguistic experiences, as well as the mental health scope of practice.

Emergency mental health nursing for self-harming refugees and asylum seekers

This article describes the structure and function of emergency mental health nursing practice for self-harming refugees and asylum seekers on Temporary Protection Visas. Emergency nurses working in accident and emergency departments or as part of crisis intervention teams will see self-harming refugees and asylum seekers at the very point of their distress. This clinical paper is intended to support nurses in their practice should they encounter an adult asylum seeker needing emergency mental health care. Practical strategies are highlighted to help mental health nurses assess, care, and comfort refugees and asylum seekers in this predicament. Mental health nurses should, where possible, work closely with asylum seekers, their support workers, and accredited interpreters and translators to ensure the appropriate use of language when dealing with mental and emotional health issues without further isolating the asylum seeker from appropriate services. To help strengthen continuity and integration of mental health supports for refugees and asylum seekers, well-resourced care must be experienced as coherent and connected. A coherent, interdisciplinary and team-orientated approach will synthesize different viewpoints to shape clinical practice and create workable solutions in local situations.

Countertransference and self-injury: a cognitive behavioural cycle

AIM

This paper discusses the emotional, cognitive and behavioural effects of self-injury on nurses as helpers, and shows the usefulness of a cycle that can affect care provision for this group of people.

BACKGROUND

People self-injure for many different reasons, such as feeling angry, sad, guilty or frightened, and these emotions are often linked to feeling helpless, powerless or out of control. Self-injury has often been reported as a coping strategy to gain control. Psychoanalytic and cognitive behavioural concepts have been used to understand why people self-injure and also inform intervention strategies. Unfortunately, negative emotional responses in professionals may interfere with the effectiveness of any therapeutic relationship.

DISCUSSION

Negative emotional responses from nurses can affect the way they think about and behave towards clients who self-injure. During clinical supervision or education, nurses' thoughts can be challenged to become less negative, so that their resulting behaviour can also become less punitive. Non-punitive or more positive behaviour can in turn challenge some of the negative self-beliefs of clients.

CONCLUSIONS

Knowledge about countertransference when working with people who self-injure may reduce nurses' negative thoughts and behaviours, which may result in improved client care.

Reasons for admission and their implications for the nature of acute inpatient psychiatric nursing

The purpose of acute inpatient psychiatric care, and nurses' role within that, are in need of clarification and restatement in order to provide a framework for practice, education, research and development. Inpatient psychiatry has suffered from a paucity of research in recent years. In addition, being a complex system, involving multiple professions with differing ideologies, means that widely accepted succinct descriptions of its purpose are hard to achieve. Yet such a framework is essential to support positive attitudes to patients and for good staff-management relationships. Using an oblique strategy, this paper defines the function of acute inpatient psychiatry, and the role of psychiatric nurses, via a structured examination of the literature on reasons for admission to acute inpatient psychiatric wards. Seven such reasons were discovered and are described: dangerousness, assessment, medical treatment, severe mental disorder, self-care deficits, respite for carers, and respite for the patient. Acute inpatient psychiatric nurses are therefore: providing safety for the patient and others; collecting and communicating information about patients, giving and monitoring treatment; tolerating and managing disturbed behaviour; providing personal care; and managing an environment where patients can comfortably stay. The implications for psychiatric nursing are discussed.

Psychosocial assessment of patients who attend an accident and emergency department with self-harm

It has been recommended that all patients attending hospital accident and emergency departments in the United Kingdom (UK) with self-harm should be offered adequate psychosocial assessment to identify those at risk of completed suicide or repeated self-harm. This paper focuses on the extent to which this recommendation has been implemented in a large district general hospital in Wales, and compares the characteristics and hospital management of patients who received no specialist assessment with those who were assessed by a psychiatric liaison nurse or a psychiatrist. Data were routinely collected as part of the hospital annual audit procedure and confirm previous findings that guidelines for the general hospital management of self-harm patients have not been well implemented. Whilst we found some evidence that certain high risk patient groups were more likely to receive specialist assessment, this was far from universal. We conclude that if there is to be a reduction in the rate of suicide in Wales and the UK as a whole, it is crucial that services for people who self-harm are more appropriately targeted on patients who are at greatest risk.

Emergency mental health nursing for refugees and asylum seekers

Emergency nurses see refugees and asylum seekers at the very point of their distress. This clinical update is intended to support nurses in their practice should they encounter an adult asylum seeker needing emergency mental health care. Practical strategies are highlighted to help nurses assess, care and comfort refugees and asylum seekers in this predicament.

Self-harm in young people: a perspective for mental health nursing care

AIMS

This paper addresses the assessment and management of self-harm in young people by a nurse consultant-led self-harm service in the UK. The purpose of the paper is to present some of the theoretical perspectives of the service and how these have influenced current practice with this group of young people.

BACKGROUND

Self-harm in young people continues to be a serious concern for health services globally. Rates of self-harm in teenagers in the UK are among the highest in Europe. The current literature offers information on the nature of self-harm and some evidence of specific interventions mainly from a 'psychiatric perspective'. This paper examines the development of a locally based nurse-led self-harm team involved in the care of this group of young people. A sociological view of children and young people is applied in examining the way society construes self-harm and the formation of the behaviour as a deviant act. Self-harm is considered in the context of transition through adolescence and the growth of self-identity.

CONCLUSION

The locally based child and adolescent mental health service has drawn together the evolving nurse consultant role, mental health nursing and medical sociology. This integration of people and theory will enhance the services understanding of self-harm in young people. At an international level, there is a need to consider the sociological dimensions of self-harm in young people as a way forward for mental health nurses who are involved in working with this group of people.

Self-harm and suicide: care, interventions and policy

This article aims to raise awareness about self-harming behaviours and suicide. It explores their complex nature, social context, why they have become a central issue in public health and the challenges they present. The assessment of patients who self-harm is discussed, together with psychological and social policy interventions that may be used.

Struggling for hopefulness: a qualitative study of Swedish women who self-harm

There has been an increase in the number of Swedish psychiatric patients who self-harm, yet self-harm is seldom described in published research. The aim of this study was to describe how people who self-harm experience received care and their desired care. Nine participants, all Swedish women who had been treated for inpatient or outpatient psychiatric care, narrated their experiences of care for self-harm. Using qualitative content analysis, two themes were formulated: 'Expecting to be confirmed while being confirmed fosters hopefulness'; and, 'Expecting to be confirmed while not being confirmed stifles hopefulness'. Each of these themes emerged from five subthemes that clustered around positive and negative aspects of being seen-not being seen, being valued-being stigmatized, being connected-disconnected, being believed-doubted, and being understood-not being understood. Of significance is for nurses to view persons who self-harm as human beings and to grasp the importance of being confirmed by staff that can foster hopefulness in persons who self-harm, yet realize the possibility of the paradoxical nature of hopefulness and being confirmed.

Introducing a nurse-led clinic for patients who self-harm

A fortnightly self-harm clinic was set up for patients from a secure psychiatric unit. This prize-winning paper describes how it both reduced admissions to A&E and won the support of patients, who became involved in their wound care.

Self-harm: understanding the causes and treatment options

Deliberate self-harm rates in the UK are the highest in Europe, and at present, this problem is poorly understood, as there has been little research available to shed light on why such a considerable number of young people are compelled to hurt themselves. The Mental Health Foundation and The Camelot Foundation recently launched a UK-wide inquiry into self-harm among 11-25-year-olds, which aims to produce a practical and thoughtful approach to the prevention and treatment of self-harm in young people, inform future education and training, and provide strategies for service providers.