This study addresses self-injury among patients receiving care in forensic psychiatry.
Background:
Self-injury is common among patients diagnosed with borderline personality disorder, bipolar disorder with elements of depression and schizophrenia. Self-injury affects both the patient as well as their surroundings.
Objective:
To describe nurses' experiences of caring for patients with self-injurious behavior in forensic psychiatric care.
Method:
A qualitative approach was applied. Data were collected through semi-structured interviews with eight nurses. The data were thereafter analysed with an inductive and manifest content analysis.
Results:
The results are presented according to two categories: ‘caring that evokes emotions' and ‘caring that requires teamwork’.
Discussion:
In the present study, we demonstrate a duplicitous problem in which carers are divided over what is expected of them as responsible and professional caregivers and their perceived lack of skills and their frustration.
Conclusion:
Viewing self-injury as a complex expression of mental illness, we recommend that further research is needed in this area — especially in the forensic psychiatric care context, where long term health care relationships are involved.
DaffernM., & HowellsK.Self-harm and aggression in dangerous severely personality disordered inpatients of a high secure hospital. Psychiatry, Psychology and Law2009; 16: 150–154.
2.
EkseliusL.HerlofsonJ.LundhL-G.LundinA.MårtenssonB. & ÅsbergM.Psykiatri. Första upplagan. Lund: Studentlitteratur; 2009.
3.
MadgeN.HawtonK.McMahonE.CorcoranP.LeoD.WildeE.FeketeS.HeeringenK.YstgaardM. & ArensmanE.Psychological characteristics, stressful life events and deliberate self-harm: Findings from the Child & Adolescent Self-harm in Europe (CASE) Study. European Child & Adolescent Psychiatry. 2011; 20: 499–508.
4.
WeinbergM-R.The experience of deliberate self-harm. A grounded theory study: Canada. University of British Colombia; 2007.
5.
OverlandS.Självskadebeteende. Första upplagan. Lund: Studentlitteratur; 2010.
6.
FeltonA. & McHaleJ.Self-harm. What's the problem? A literature review of the factors affecting attitudes towards self-harm. Journal of Psychiatric and Mental Health Nursing. 2010; 17: 732–740.
7.
JohanssonA.Självskada: En etnologisk studie av mening och identitet i berättelser om skärande. Umeå: Institutionen för Omvårdnad Umeå. Doktorsavhandling; 2010
8.
BosmanM. & MeijelB.Perspectives of mental health professionals and patients on self-injury in psychiatriy: A litterature review. Archives of Psychiatric Nursing. 2008; 22: 180–189.
9.
Austin-PayneH. & WheatleyM.Nursing staff knowledge and attitudes towards deliberate self-harm in adults and adolescents in an inpatient setting. Behavioural and Cognitive Psycotherapy. 2009; 37: 293–309.
10.
LindgrenB-M.Self-harm — hovering between hope and despair. Experiences and interactions in a health care context. Umeå: Institutionen för Omvårdnad Umeå. Doktorsavhandling; 2011
11.
BowersL. & CrowderM.Nursing staff numbers and their relationship to conflict and containment rates on psychiatric wards—A cross sectional time series Poisson regression study. International Journal of Nursing Studies. 2012; 49: 15–20.
12.
HawtonK.FarrellS.FortuneS. & SaundersK.E.A.Attitudes and knowledge of clinical staff regarding people who self-harm: A systematic review. Journal of Affective Disorder. 2011; 10: 1–12.
13.
WinshipG.The attitudes of nursing staff in secure environments to young people who self-harm. Journal of Psychiatric and Mental Health Nursing. 2009; 16: 947–951.
14.
GraneheimU-H. & LundmanB.Qualitative content analysis in nursing resarch: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004; 24: 105–112.
15.
BeckC & PolitD. Nursing researche: Generating and assessing evidence for nursing practice. Åttonde upplagan. Philadelphia: Wolters Kulwer/Lippincott Williams & Wilkins. 2008.
CreswellJ.W.Qualitative inquiry & research design — choosing among five approaches (2nd ed). Thousands Oaks: Sage Publications; 2007.
18.
Declaration of Helsinki (2008). Ethical Principles for Medical Research Involving Human Subjects. World Medical Association (WMA). [online] available at: http://www.wma.net/en/30publications/10policies/b3/ [Accessed 21 November 2012].
19.
CorriganO.Empty ethics: The problems with informed consent. Sociology of Health & Illness. 2003; 25 (3), 768–792
20.
LindströmU.Å.Ensamhetskänslan sviker inte — En kvalitativ studie rörande patienters upplevelser av vårdkultur och vårdrelation på psykiatriskt sjukhus. Rapport 6/95. Vasa: Åbo Akademi, Institutionen för vårdvetenskap; 1995.
21.
LindströmU.Å.Psykiatrisk vårdlära. Falköping: Liber Utbildning AB; 1994.
22.
CarlssonG.Det våldsamma mötets fenomenologi — om hot och våld i psykiatrisk vård. Doktorsavhandling. Växjö: Institutionen för vårdvetenskap och socialt arbete. ActaWexionensia. Nr 32/2003.
23.
ErikssonK.Den mångdimensionella hälsan — verklighet och visioner. Vasa sjukvårdsdistrikt SKN. Vasa: Åbo Akademi, Institutionen för vårdvetenskap; 1995.
24.
LévinasE.Etik och oändlighet: Samtal med Philippe Nemo (ÖstlingBrutus, Trans.) Éthique et infini: Dialogues avec Philippe Nemo. Stockholm: Symposium Bokförlag & Tryckeri AB (original work published 1982); 1988.
25.
Socialstyrelse (2005). Innehållet i den rättspsykiatriska vården. Delrapport till Nationell psykiatrisamordning 2005–2007.
26.
JacobJ-D.GagnonM & HolmesD. Nursing so-called monsters: On the importance of objection and fear in forensic psychiatric nursing. Journal of Forensic Nursing. 2009; 5: 153–161.
27.
EnarssonP.Mellan frihet och trygghet personalgemensamt förhållningssätt i psykiatrisk omvårdnad. Institutionen för Omvårdnad Umeå. Doktorsavhandling; 2012.
28.
Salzmann-EriksonM.LützénK.IvarssonA-B.ErikssonH. (2011). Achieving equilibrium in a culture of stability — cultural knowing in nursing on psychiatric intensive care units. Issues in Mental Health Nursing. 2011; 32(3): 255–265.
29.
HögbergU.Att vårdas eller fostras. Den rättspsykiatrisk vårdande och traditionens grepp. Växjö; 2008.
