Working effectively with clients who self-injure using a solution focused approach

Do educational interventions improve the attitudes of emergency nurses towards patients who self-harm? A systematic review

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.

Interventions to change clinicians' behavior related to suicide-prevention care in the emergency department: a scoping review

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.

Examining the relationship between solution-focused thinking skills and self-efficacy levels of nursing students in Turkey

BACKGROUND

Learning and developing communication skills fundamental to solution-focused thinking increases the confidence of nursing students towards individuals and improves their self-efficacy, thereby enabling these students to plan appropriate care.

PURPOSE

To evaluate solution-focused thinking skills and self-efficacy levels of nursing students and to determine the factors affecting these variables as well as the relationship among them.

METHOD

This was a descriptive and correlational study. The study was conducted between March and June 2019 with 337 nursing students from two universities with different curricula. Data were collected using a "personal information form," the "solution-focused inventory," and the "self-efficacy scale."

RESULTS

A statistically significant positive relationship was observed in the total scores on the solution-focused inventory and self-efficacy scale and the mean scores on the completing behavior and dealing with obstacles on the self-efficacy scale. In addition, a moderate relationship (r = 0.447, p < 0.01) was observed between the total solution-focused inventory scores and mean scores of completing behavior on the self-efficacy scale.

CONCLUSIONS

The nursing students had above-average mean scores on the solution-focused inventory and self-efficacy scales. However the students can further enhance their problem-solving ability by improving their solution-focused skills and self-efficacy.

The Validity and Reliability of Professional Self-Concept in Nursing in Accelerated Bachelor's and Master's Nursing Students

BACKGROUND AND PURPOSE

Accelerated bachelor's and master's nursing students supported through the New Careers in Nursing program were surveyed (n = 3,506) using subscales from Arthur's Professional Self-Concept in Nursing Instrument (PSCNI). Reliability and validity of the instrument was assessed.

METHODS

Factor analysis using a random split-half design were conducted and differences investigated based on characteristics.

RESULTS

Four factors were revealed: leadership (α = .85), skill (α = .89), career positivity (α = .72), and career negativity (α = .72), with acceptable confirmatory fit. Gender and race/ethnicity differences were found in self-perceived leadership and skill and in career positivity by race/ethnicity. Accelerated bachelor's and master's students were different on skill and career positivity.

CONCLUSIONS

Self-perceived leadership, skill, career positivity, and career negativity are distinct PSCNI concepts.

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.

Attitudes of General Hospital Staff Toward Patients Who Self-harm in South India: A Cross-Sectional Study

BACKGROUND

There is growing global interest into the attitudes and clinical management of persons who deliberately self-harm. People who self-harm experience many problems and typically have many needs related to management of their psychological wellbeing. A positive attitude amongst general hospital staff should prevail with people who self-harm. The principal purpose was to determine student staff attitudes towards patients who self-harmed from a professional and cultural perspective, which might influence patient treatment following hospital admission. The focus concentrated upon staff knowledge, attitudes and beliefs regarding self-harm.

METHODS

A cross sectional survey of the hospital staff using a validated questionnaire was carried out. This paper reports on interdisciplinary staff from two large general hospitals in Mysuru, South India (n=773).

RESULTS

Findings suggest that within a general hospital setting there is wide variation in staff attitudes and knowledge levels related to self-harm. Whilst there is attitudinal evidence for staff attitudes, this study investigates interprofessional differences in an attempt to progress treatment approaches to a vulnerable societal group. Very few staff had any training in assessment of self harm survivors.

CONCLUSION

There is an urgent need for training general hospital staff in self harm assessment and prevention in south India. The results allow a series of recommendations for educational and skills initiatives before progressing to patient assessment and treatment projects and opens potential for cross cultural comparison studies. In addition, interventions must focus on current resources and contexts to move the evidence base and approaches to patient care forward.

Nurses' attitudes towards self-harm: a literature review

People who self-harm experience many problems and needs related to management of emotional and practical stress. A positive attitude among nurses is especially important given the close contact they have with people who self-harm. This article is based on a review of the literature. It includes articles that concern both general and mental health nurses who work in various healthcare settings (e.g. acute inpatients wards, community mental health, emergency departments and medical admission units). The literature shows that negative attitudes towards self-harm are common among nurses. It remains unclear how nurses' age, work experience and gender influence their attitudes. The setting in which nurses work appears to influence their attitude, as does their level of qualification. For example, mental health nurses appear to have more positive attitudes than general nurses. Nurses' attitudes can be improved with the help of education comprising reflective and interactive elements. Supervision and support from colleagues appear to be especially important for mental health nurses. Self-harm is a growing health problem. Nurses in a variety of healthcare settings play a central role in the care of people who self-harm. Their professional attitudes towards these people are essential for high-quality care. This review aims to develop insight into nurses' attitudes towards self-harm as they exist in contemporary nursing practice. A literature search was conducted in four databases, and a total of 15 relevant articles were found. This review indicates that negative attitudes towards self-harm are common among nurses. The influence of nurses' age, gender and work experience remains unclear. Healthcare setting and qualification level appear to be influencing factors. Education can have a positive influence on nurses' attitudes towards self-harm, especially when it includes reflective and interactive components. It is demonstrated in this review that a major change is needed regarding nurses' attitudes. To realize this change, nurses need to be trained and educated adequately concerning self-harm. They need time and resources to build a therapeutic relationship with people who harm themselves so they can offer high-quality care for this vulnerable group.

Perceptions of paramedic and emergency care workers of those who self harm: a systematic review of the quantitative literature

OBJECTIVE

The U.K. has one of the highest rates of self harm in Europe at 400 per 100,000 of population. Paramedics and emergency staff may be the first professionals encountered, therefore understanding their views and approaches to care is crucial. The aim of this study was to systematically review published quantitative literature relating to paramedic and emergency workers' perceptions and experiences of caring for people who self harm.

METHODS

CINAHL®, MEDLINE®, OVID ® and Psych INFO® databases were searched, PRISMA guidelines were followed, two researchers independently screened titles, abstracts and full papers against a priori eligibility criteria. Data synthesis was achieved by extracting and descriptively analysing study characteristics and findings.

RESULTS

16 studies met inclusion criteria; one included ambulance staff, all used questionnaires. Training, policies and guidelines improved staff knowledge and confidence in caring for people who self harm. Limited access to training was reported, ranging from 75% to 90% of staff lacking any. Limited departmental guidelines were also reported. Staff in acute settings exhibited increased feelings of negativity, becoming less positive closer to front line care. Recent studies report positive attitudes amongst emergency staff.

DISCUSSION

Despite guidelines indicating need for education and policies to guide staff in self harm care, there is limited evidence of this happening in practice. The lack of literature including paramedics suggests a gap in our understanding about care for self harm patients. This gap warrants greater attention in order to improve care for patients who self harm in their first point of contact.

Mental health nursing from a solution focused perspective

Solution focused therapy (SFT) is a relatively new and increasingly popular model of brief intervention in mental health care. The central assertion of SFT is that the individual's problem or difficulty (and its cause) need not determine the direction in which the discussion proceeds. Instead the role of the SFT practitioner is to identify what the individual wants to be different and then to explore and elaborate on that difference. This paper outlines the principles of SFT and highlights the compatibility of this approach with the core values of nursing practice. Specific strategies and techniques used in SFT are detailed with clinical examples to illustrate the application of SFT to mental health nursing practice. A summary of current research outcomes and future prospects for SFT in clinical practice and education is also presented.

A Strengths-Based Group Program on Self-Harm

Every day in Queensland, Australia, student services within schools are responding to children who have deliberately self-injured. Although school nurses are in a prime position to effectively intervene, mitigate risk, and promote healthy self-caring behaviors, no programs that focus specifically on self-harm currently exist. This feasibility study of a program to assist young people find safer alternatives to self-harm canvassed opinions of 12 school nurses in secondary schools on the Sunshine Coast in 2009. Participants showed strong support and reported that the program was much needed; had an innovative, strengths-oriented approach; incorporated an essential training component; would likely be engaging for young people; and was in appropriate format. Perceived challenges to implementation included garnering support from the school community and educational stakeholders and recruiting young people most likely to benefit. Suggested changes included providing a youth-friendly name for the program and formalizing inclusion criteria to select appropriate group members.