The Concept of Self-Harm - Dissertation Example

?Self harm: Discussion of research papers The review of literature on the attitudes of nurses towards patients of self-harm, conducted as a part of this study helped me in understanding the scope and extent of the problem and its likely impact on the patient's health outcomes. I found that patients of self-harm are, at times, perceived negatively by the nurses particularly those in the A&E (Accidents and Emergency) departments. The nurses believed that the patients of self-harm are attention-seekers and do not need any immediate care. This attitude towards such patients was largely influenced by the fact that most of these nurses lacked the required training and education needed to assess the patients' care needs and generate appropriate and timely responses. They were found to be largely ignorant regarding the gravity of the issue which resulted in a negative attitude towards the patients of self-harm. Furthermore it was also observed during the part of the study that the attitudes of other health care professionals such as doctors were relatively more positive as compared to that of the nurses working in the A&E department. This could be attributed to the fact that the doctors had extensive experience and knowledge regarding the matter and were highly aware of the care and treatment needs of such patients. This paper includes a comprehensive discussion of the literature reviewed particularly with regard to the three key factors i.e., attitudes of nurses working in A&E department towards the patient of self-harm; attitude of emergency staff and healthcare professionals; and the development of measurement tools and effective management policies; to address the key concerns highlighted during the study. The key objective of this study was to understand, assess and examine the attitudes of nurses, and healthcare professionals towards the patients of self-harm and determine the various development and measurement tools as well as management policies that can be implemented to enhance service delivery and effectiveness of the nurses as well as to improve health outcomes for the patients. The literature also assesses the various reasons behind patients indulging in self-harm and highlights the need to provide mental health care to such patients. It also stresses the significance of providing education intervention to nurses in the A&E department in order to ensure better service delivery and prompt response on the part of the nurses as well as the healthcare professionals. The key aim of this study was to understand the attitudes of nurses in the A&E department and other healthcare professionals towards patients of self-harm. In order to achieve this objective it is important to understand the fundamental factors that drive the patients towards self-harm as well as the basic definition and meaning of the term. The literature reviewed as a part of this course described the concept of self-harm in fairly uniform manner. The terms self-harm / injury are used interchangeably throughout the literature, to describe the various ways in which individuals deliberately harm themselves. Such individuals are described as having para-suicidal tendencies and are at the most risk of causing serious injury to them. The concept of self-harm was coined by Kreitman et al. (1969: 746) and was used to describe situations wherein an individual simulates or mimics suicide through acts which can prove to be potentially fatal and cause serious harm or injury to themselves in the process. According to Brophy (2006 qtd. in McAllister 2838) the term is used to refer to people who have suicidal tendencies and indulge in self-harming behaviour such as consuming poison, cutting or slashing of one's wrists, drug overdose, and at times hanging or banging their heads, or even pulling one's own hair. Hawton et al. (2002) states that a significant proportion of patients of self-harm choose self-poisoning as a method to harm themselves however various other widely observed methods used by such patients include laceration, burning as well as hanging. Significance of the problem: Deliberate self-harm has been widely recognized as one of the most common reasons for attendance at the accident and emergency departments. The number of patients of self-harm has far exceeded the total number of completed suicide cases as observed in a study conducted by DSH in the UK over a period of 10 years (Friedman et al. 273). Although the characteristics and background of the patients vary from case to case, it has been observed by researchers that most of such cases include single young women and men. Furthermore it has also been observed that the patients of self-harm are highly likely to attempt complete suicide thus endangering their lives (Suominen et al. (2004). Timely treatment and prompt action on the part of the healthcare professionals and the nurses in the emergency department is hence of crucial significance to ensure their health and well-being. Also the drastic rise in the number of such incidences places higher pressure on the staff at the emergency departments who are required to cope with the increased demand and offer effective health care services (Sherad et al. qtd. in Mackay & Barroclough 256). According to Berry & Harrison (2007 qtd. in McAllister 2838) deliberate self-harm is one of the most common healthcare issues faced by the hospital authorities and the ignorance regarding the gravity of the issue tends to impede recovery and reduce the opportunities for such patients to receive effective care. McCann et al. (2005) states that the emergency department is at the frontline in terms of providing treatment and caring for patients of self-harm. The attitude of nurses and healthcare professionals is of utmost significance in such cases since it directly affects the health outcomes for the patients. Happell et al. (2003) also highlighted the significance of emergency departments by describing them as the first point of contact for patients of self-harm. The literature also stressed on the importance of nurses who play a key role in treatment of such patients. They are the key staff responsible for diagnosing, detecting and providing appropriate care services to such patients. It has also been observed that increased incidences of deliberate self-harm tends to have a greater impact on the emergency department. The background of the patients is of particular significance while considering and providing care services. Studies have indicated that despite the growing number of patients of self-harm only seek healthcare services. This poses a critical problem to the healthcare professionals since such patients are known to have high suicidal tendencies (Dower et al. 2000 qtd. in McCann et al. 1705). Considering the composition and background of the individuals who tend to indulge in deliberate self-harm and the serious negative consequences of lack of availability of proper healthcare services to such patients it is quite apparent that there is a high need to offer improved services to such patients. Also there is a need to include strategies and develop effective care models to ensure better health outcomes for such patients. Attitudes of nurses in the A&E department: It has been observed through research that the staff in the emergency care unit often displays prejudicial attitudes towards patients who self harm. Such patients are judged, stigmatised and even ignored thus delaying and denying them the opportunity to receive effective and appropriate treatment. In the study conducted by McAlister et al. (2008) it was observed that the nurses in the emergency departments had little or no knowledge regarding the complexity and gravity of the issue on hand. Furthermore they were found to be largely unaware regarding the appropriate measures, attitudes and approach that can be taken to resolve the issue in the most effective manner. They also lacked proper training regarding provision of care to such patients. Also, due to lack of adequate resources the nurses in the emergency department were ill-equipped to deal with such patients, thus further adding to the problem. On account of these reasons the nurses displayed negative attitudes towards the patient. This hypothesis was substantiated by the research initiated by the authors whereby it was successfully proved that the attitudes of nurses in the A&E department can be transformed by providing training intervention. According to a similar study conducted by McCann et al. (2005) it was observed that the nurses in the emergency department believed that they did not have proper knowledge regarding treating patients of self harm. Such lack of awareness and information on their part is known to affect their confidence levels ultimately resulting in display of negative attitudes towards their patients (McCann 1705). With regard to their attitudes towards the patients of self harm, it was observed that most of the participants displayed a favourable attitude towards their patients and acknowledged their need for a professional therapy. However most of the respondents displayed a lack of awareness regarding the gravity of the issue. This was evident from the majority of responses which indicated their general negative disposition towards patients of self-harm who were largely described by the participants as ‘attention seeking behaviour’ along with other generalizations and misinterpretations regarding their mental health status (McCann 1706). In a study conducted by Friedman (2005) it was observed that the nursing staff was highly aware of the significance of professional training in dealing with patients of self-harm. They admitted that specialist opinion was of crucial significance in providing effective care to the patients and displayed positive and helpful attitudes towards such patients. The key similarity between all the studies evaluated so far was that the participants unanimously acknowledged the need for professional training and responded positively to education intervention measures. There was a marked improvement in their opinions and perceptions towards patients of self-harm post such training. According to Mackay and Barrowclough (2005) the attitudes of the nursing staff towards patients of self-harm were largely influenced by their gender i.e. the male staff were found to be relatively less attentive to the patients of self harm as compared to the female staff. The male staff displayed higher levels of irritability and frustration while dealing with such patients as compared to their female counterparts. Huband and Tantam (2000) observed that an overwhelming majority of nursing staff perceived patients of self-harm as attention seekers. They displayed negative attitudes towards such patient since they believed that the patients of self-harm were highly unlikely to indulge in such behaviour again. Although there were concerns among the nursing staff regarding the severity of the issue and they did acknowledge the need for establishing an empathic relationship with her as a part of emergency care while very few of them admitted to feel annoyed or irritated by such behaviour. The overall popular opinion based on the study was that the patient deserved to be offered psychotherapy treatment or an in-depth counselling. According to Costigan et al. (1987 qtd. in McElroy p. 67) the attitudes of nurses towards the patients of self-harm may be unconscious and covert but the patients are highly likely to sense rejection through their demeanour and manner. Such experiences of hostile behaviour by the nurses towards the patients tend to add to their initial reluctance to seek professional help. The gravity of the issue has been highlighted in various literature reviews and studies conducted over the years. The negative attitudes of the nurses may drive the patients away and prevent them from seeking professional guidance and ultimately endanger their lives. Since they are highly likely to harbour suicidal tendencies the rejection and hostility by the nurses and the healthcare staff may ignite such behaviour and worsen their situation even further. Attitudes of emergency staff and healthcare professionals towards patients of self-harm: The healthcare professionals have ambivalent attitudes towards patients who self-harm (McCann 1705). According to studies conducted over the years it has been observed that healthcare professionals are divided on the issue of most appropriate treatment for such patients. It is on account of such indecisiveness and lack of adequate knowledge that the patients of self-harm are exposed to discriminatory attitudes of the healthcare professionals. Furthermore has also been observed that most of the times the healthcare professionals perceive self-harm patients as troublesome as well as attention seekers and hence deny them the required treatment. Also their knowledge and awareness regarding the critical psychological state of such patients is found to be extremely limited, thus leading to neglect. The study conducted by McElroy and Sheppard (1999) displayed similar results. The findings of this study revealed that there was significant difference between the approaches and care methods used by the staff and the key factors responsible for such differences included time, personal bias, intuition etc among others. The study stressed the need for inclusion of social services, primary care as well as inclusion of representative members from the voluntary sector in order to facilitate better service provision to patients of self-harm. This is mainly because most of the A&E departments are understaffed thus resulting in poorly managed care for patients suffering from serious harm and in dire need of mental health as well as other support services. Furthermore, similar to other studies conducted in this behalf; this study too highlighted the need for education intervention and training programs for the nursing staff in order to help them to cope with patients of self-harm. The findings of this study revealed that there was significant difference between the approaches and care methods used by the staff and the key factors responsible for such differences included time, personal bias, intuition etc among others. The study stressed the need for inclusion of social services, primary care as well as inclusion of representative members from the voluntary sector in order to facilitate better service provision to patients of self-harm. This is mainly because most of the A&E departments are understaffed thus resulting in poorly managed care for patients suffering from serious harm and in dire need of mental health as well as other support services. Furthermore, similar to other studies conducted in this behalf; this study too highlighted the need for education intervention and training programs for the nursing staff in order to help them to cope with patients of self-harm. Patients who self-harm are widely perceived negatively by the staff at the A&E department thus leading them to act in an hostile manner towards them. Their perception towards such patients tends to largely influence their decision making with regard to provision of required care services and affects their cognitive processes. Alston & Robinson (1992 qtd. in McLeroy 1999 p. 67) states that the deliberate self-harming behaviour of the patients tends to evoke negative attitudes among the nurses such as anger, anxiety as well as absence of empathy. The repetitive behaviour on the part of such patients tends to further aggravate the situation with the result that the A&E staff develops a cold attitude towards such patients and are often observed to feel frustrated due to their inability to cure the patients. The reason behind the negative attitudes of nurses in the A&E department can be attributed to the fact that they are often busy working in a highly stressful and emotionally charged environment. Also the studies have shown that most of the hospitals experience a serious shortage of staff and the A&E department is often overburdened with patients in need of emergency care. The nurses are made to deal and interact with critical patients experiencing serious life threatening situations. Hence the patients who tend to display repetitive self-harming behaviour invoke indifferent responses from them. Impact of negative attitudes of nurses and healthcare professionals on patients of self-harm: Through the literature review it has been established that the patients of self-harm are at a critical risk of attempting complete suicide if not given proper and prompt care. They are highly likely to cause repeated harm to themselves and the in the absence of proper health care services made available to them the situation is likely to worsen further and may lead to fatal consequences. Armson (1994 p. 97) states that the patients of self-harm are likely to seek support from a range of care providers instead of seeking services from the trained professionals. Thus they are often denied the services which are specifically designed to treat them. Most of the researchers observed that a significant proportion of patients of self-harm are not in contact with service departments offering psychiatric health care services thus denying them the opportunity to receive special care designed for them. Also it was observed that there is hardly any co-ordination between different health care departments and agencies (Barraclough et al. qtd in McLeroy 1999 p. 67). Such lack of co-ordination among various healthcare departments and service providers leads to lack of effective treatment and care for patients of self-harm. According to McLeroy et al. (1999 p.67) the mere provision of adequate healthcare services to patients of self-harm is not sufficient enough to ensure their long-term health and well-being. It is of utmost significance to ensure that the attitudes of nurses and healthcare professionals towards such patients are changed for the better since it tends to have therapeutic benefits. Positive and welcoming behaviour of the nurses in the emergency departments towards the patients help them to be at ease and share their feelings thus enabling them to receive optimum treatment and prevent such actions in the future. In a study conducted on patients who self-harm to assess their level of satisfaction regarding the care services received as a part of treatment, it was observed that a large majority of those interviewed showed high levels of dissatisfaction. The patients rated the support provided by the medical personnel as highly unsatisfactory (qtd. in Mackay p. 256). In another study it was observed that a large number of patients of self-harm rarely seek psychiatric services. Also the study revealed that most of the cases attended by the staff working at the A&E department were psychiatric cases and the staff was not qualified enough to attend to such patients. Thus their reaction and attitudes towards such patients was found to be highly hostile and unwelcoming since they lacked proper awareness and knowledge regarding the gravity of the problem on hand. Factors such as these results in denying of appropriate services to the patients of self-harm thus exposing them to high risks of attempting complete suicide. The negative attitudes of the nurses and healthcare professionals are unanimously cited by such patients as one of the key causes of not seeking healthcare services. The patients of self-harm suffer from mental distress and need professional psychiatric treatment and care. They must be provided personalized care services that help them to circumvent their feelings and help them overcome their grief in order to avoid repetitive self-harm behaviour in the long-run. This can be achieved by changing the perception of the emergency staff towards such patients which can only be achieved through training and education intervention. Development of measurement tools and effective management policies: Various developmental measures and management strategies have been suggested by researchers to enhance the provision of healthcare services to patients of self-harm. One of the most prominent and widely recommended strategies is to provide education intervention to nurses in the A&E department as well as to healthcare professionals in order to ensure effective treatment and care to such patients. There is overwhelming evidence which indicate the impact and influence of such intervention measures on treatment outcomes. The nursing staffs interviewed during the course of research has unanimously acknowledged the positive impact of such training methods in terms of increase in their awareness on the issue as well as provision of improved care to the patients of self-harm. They also reported that the newly gained knowledge helped them to be more focused and enhanced their communication skills thus ultimately resulting in better care for their patients. Some of the widely reported positive outcomes of this study include- a marked improvement in the ability to provide early support; significant improvement in proactive response skills and strategic assessment skills; the ability of the nursing staff to help assuage guilt and offer positive encouragement to the patients. According to McAllister (2001) the attitudes of the nurses and healthcare professionals were found to vary in accordance with their working experience and professional qualification. The results indicated that the attitudes and behaviour of the nursing staff towards such patients were largely dependent on several key factors such as their perceived confidence; their ability to deal with and communicate with such patients effectively; the level of empathic approach displayed by them; as well as their own interpersonal characteristics such as their ability to cope with legal and professional regulations. As observed in the previous studies this study also indicated that the participants with higher qualifications and wider work experience were generally known to display positive attitudes towards patients of self harm as compared to those who lacked such traits. Those participants who lacked professional qualification and experience unanimously reacted negatively towards questions concerning patients of self-harm. Most of them believed dealing with such patients as tiring, irritating and as a ‘waste of time’. Also very few of them acknowledged the need for referring them to mental health professionals, thus indicating their lack of knowledge and awareness regarding the criticality of the issue. The findings of this study further reaffirm the belief that education intervention across all levels of health care is inevitable to ensure improvement in service delivery, particularly with regard to patients of self-harm. In another study conducted by Sivakumar et al. (2011) regarding the significance of mental health-related learning needs of clinicians in a nation-wide survey, it was observed that doctors unanimously acknowledged the positive impacts of education intervention strategies as a key measure to foster effective treatment of patients of self-harm. They displayed high amount of interest in training and learning new techniques about risk management for self-harm and/or suicidal patients in order to improve the health outcomes. According to McAllister (2003 p. 2839) a solution-focused nursing model of care can play a major role in improving the emergency care made available to patients of self-harm. Also solution oriented strategies which focus on the patients and offer them personalized services which include helping them overcome their feelings and provide them adequate care and support can help in improving the health outcomes of such patients. The literature further suggests that clinicians and healthcare professionals must include strategies which aim to reduce or eliminate the feeling of guilt or shame which are widely experienced by patients of self-harm and thus seek to reduce their tendencies to self-harm. The use of such strategies on the part of the healthcare professionals may help them in reducing the repetitive urge to self-harm and speed up the process of recovery thus offering long term benefits in the process. Furthermore according to Ouzouni and Nakaksis (2009: p. 2231) the patients of self-harm often encounter administrative setbacks with regard to admission and treatment mainly due to the negative perception and attitudes of nurses towards them and their failure to appropriately analyze the status of their mental and physical health condition. In order to prevent such negative attitudes of nurses from influencing the health outcomes of the patients of self-harm, the authors have put forward a measurement tool called the "ATAS-Q" - (Attitudes Towards Attempted Suicide-Questionnaire) which is likely to help the healthcare professionals in widening their present knowledge base regarding such cases and enhance their understanding and attitudes towards such patients. McElroy and Sheppard (1999: pp. 692) suggested the development and formation of a specially dedicated group i.e. a self-harm planning group which would focus on provision of social care services and primary care to the patients of self-harm. Furthemore this group may also include representatives from the voluntary sector. The staff of this group could be provided special training in order to ensure that they are well-equipped to treat, interact and offer appropriate healthcare services and guidance to patients of self-harm. Also effective monitoring of the patient's health condition can be made possible by way of such groups whereby the staff members can actively participate in observing the patients' health. Such activities on the part of the group could prove to be extremely helpful in avoiding and preventing the cases of repeated attempts to self-harm and reduce the burden on the staff of the A&E department. However the implementation of education intervention programs alone is not adequate to ensure positive health outcomes for the patients of self-harm. In order to provide improved services the healthcare departments must ensure effective allocation of resources, deal with staffing issues (since most of the hospitals were observed to be understaffed); and provide regular training courses for the nurses working in the A&E departments as well as doctors. The lack of availability of critical resources is one of the various reasons for poor treatment of patients of self-harm and the lacklustre attitudes of the nursing staff. Most of the staff is underpaid and overworked which further results in their neglect of such patients. Thus along with introduction of formal courses highlighting the significance and relevance of providing prompt and appropriate services to patients of self-harm, effective policies must be developed to ensure provision of required resources and enhancing the infrastructure across as hospitals. References: Friedman, T., Newton, C., Coggan, C., Hooley, S., Patel, R., ickard, M., Mitchell, A. J., (2005). Predictors of A&E staff attitudes to self-harm patients who use self-laceration: Influence of previous training and experience, Journal of Psychosomatic Research, 60: p. 273 – 277 Huband, N., Tantam, D., (2000). Attitudes to self-injury within a group of mental health staff. British Journal of Medical Psychology, 73: p. 495 - 504 Macay, N., Barrowclough, C., (2005). Accident and emergency staff’s perceptions of deliberate self-harm: Attributions, emotions and willingness to help, The British Journal of Clinical Psychology, 44: p. 255 - 267 McAllister, M., Moyle, W., Billet, S., Zimmer-Gembeck, M., (2008). I can actually talk to them now: Qualitative results of an educational intervention for emergency nurses caring for clients who self-injure. Journal of Clinical Nursing, 18: p. 2838 – 2845 McCann, T., Clark, E., McConnachie, S., Harvey, I., (2005). Deliberate self-harm: Emergency department nurses' attitudes, triage and care intentions, Journal of Clinical Nursing, 16: p. 1704 – 1711 McElroy, A., Sheppard, G., (1998). The assessment and management of self-harming patients in an Accident and Emergency department: An action research project. Journal of Clinical Nursing, 8: p. 66 - 72 Sivakumar, S., Weiland, T. J., Gerdtz, M. F. et al., (2011). Mental health-related needs of clinicians working in Australian emergency departments: A national survey of self-reported confidence and knowledge. Emergency Medicine Australiasia, 23, p. 697-711 Read More