Experiences of registered general nurses who care for patients presenting with self-harm to the emergency department in Ireland. (September 2021)

• Record Type: Journal Article
• Authors: Mulhearne, Patrick; Cotter, Patrick; O'Shea, Maria; Leahy-Warren, Patricia
• Is Part Of: International emergency nursing. Volume 58(2021)
• Publication Date: 2021-09
• Subjects: Self-harm -- Emergency department -- Registered nurses -- Experiences -- Ireland; Emergency nursing -- Periodicals; 616.025
• DOI: 10.1016/j.ienj.2021.101047
• Languages: English
• ISSNs: 1755-599X

Abstract

Highlights: Self-harm is an umbrella term used to define any act of deliberate self-injury or self-poisoning carried out by an individual regardless of their intent or motivation (National Institute of Clinical Excellence, NICE, 2013). It is the direct and deliberate damage to a person's own body without the explicit aim of dying as a result of the actions [2] People who engage in self harm are at a greater risk of subsequently dying by suicide [3] . Patients that presented to ED following self-harm without a life threating physical injury were not seen as requiring urgent intervention regardless of their triage category. Priority was given to their physical symptoms with their mental health needs considered the remit of the mental health team. The physical infrastructure of ED coupled with the dynamic fast pace of the clinical area is an inappropriate environment in caring for patients who have self-harmed. Nurses in ED struggle in assessing and providing adequate care for patients who have self-harmed. There is a level of uncertainty in dealing with this patient group. A deficit of specific self-harm education and training was highlighted by participants. This study found that ED nurses were unsure of their practice with self-harm patients but they held an empathic and positive outlook when dealing with these patients. ED nurses are conscious that self-harm can equate to frequent attendances to ED and they are mindful not to let this influence the care they provide. However, at times, the conduct of patients can result in staff having feelings of frustration towards patients who self-harm. Abstract: Background: There are a substantial number of self-harm presentations to emergency departments (EDs) yearly throughout Ireland. Nurses often struggle with the psychosocial nursing interventions required when caring for patients who present following self-harm. Aim: To explore the experiences of registered general nurses (RGN) who care for patients presenting with self-harm to the ED in Ireland. Method: A qualitative descriptive study design was used to explore experiences of RGNs in caring for patients with self-harm in the emergency department. Data was collected using one to one interviews with a purposive sample of nine RGNs working in ED. Transcripts were analysed using Burnard's thematic content analysis framework. Results: Three themes emerged: 1) waiting for assessment/treatment in an unsuitable environment 2) caring for self-harming patients from a nursing perspective and 3) nurses' perceptions of self-harming patients. Conclusion: Overall ED nurses hold a positive attitude towards patients who self-harm but acknowledge that barriers and challenges do exist when caring for this patient group. This study highlights the need for specific training on caring for patients who present to ED following self-harm.