1. intentional cutting, scratching, burning, hanging and overdose


The purpose of this review is to explore the
literature on mental health nursing interventions available to service users
who engage in deliberate self-harm on acute inpatient units. Hawton et al
(2012) defines self-harm as deliberate self-poisoning or self-injury regardless
of the presence of suicidal intent. However, Mars et al. (2014) suggests that self-harm
with suicidal intent should be considered completely separate from self-harm
without suicidal intent. The term deliberate self-harm (DSH) will be used
throughout this review to describe acts such as intentional cutting,
scratching, burning, hanging and overdose along with more socially accepted
behaviours such as smoking, substance abuse and dieting (National Collaborating
Centre for Mental Health 2014). Self-harm is an epidemic in Ireland at present,
with The National Registry of Deliberate Self-harm in Ireland recording the
number of self-harm presentations to hospitals to be 12,337 in 2010 (Griffin et
al. 2017). The most recent figure available is for 2016, which had 11,485
presentations. Although figures have dropped between these six years, the
number of presentations in 2016 was still 10% higher than in 2007, the year
before Ireland experienced economic recession (Griffin et al. 2017). It is important
to note that it is near impossible to produce accurate self-harm statistics as
DSH is a private act, which many people struggle with in silence (Ogden &
Bennett 2015). The aforementioned statistics were gathered from accident and
emergency (A&E) departments only; however there are many other agencies
that people can present to with self-harm which have not been accounted for
(Reeves 2013). Therefore, these figures are much higher than calculated. A
review of the literature on this topic was carried out for various reasons. A
critical element of psychiatric inpatient care is to provide a safe environment
for service users (Bowers et al 2005). However, simply removing means of
self-harm in order to provide a safe environment as been widely criticized by service
users and nurses alike (O’Donovan 2007). Hence, the author felt it appropriate
to conduct a review of current mental health nursing interventions available to
service users who self-harm on acute psychiatric wards as it is an area that is
under researched (Hawton et al 1999). In addition, it is recognised that
service users who self-harm are one of the most challenging groups to work with
(Barstaw 1995, Clarke & Whittaker 1998, Huband & Tantam 1999). Lastly,
due to the nature of this condition and the input that is required, a study
carried out by (Sinclair et al 2011) found that service users who engage in
self-harm as inpatients place the greatest financial strain on the health care
budget, thus, it would prove cost effective to investigate various
interventions that could be implemented in acute mental health settings (Responding
to Self-Harm – An Evaluation of the Self-Harm Intervention Programme 2015).




2. Search

A broad search was carried out using databases
in order to obtain literature relating to mental health nursing interventions
for inpatients that engage in deliberate self-harm. This search was undertaken
in November 2017. An electronic databases search was conducted using the search
terms “deliberate self-harm”, “self mutilation”, “self wounding”,
“self-injury”, “nursing intervention”, “psychological intervention”, “cognitive
behavioural therapy”, “self-destructive behaviour”, “psychiatric nursing” and
“inpatient”. The databases consulted were The British Nursing Index and Archive
and CINAHL (Cumulative Index to Nursing and Allied Health Literature) complete
which includes Allied & Complementary Medicine, PsychINFO, PsychARTICLES
and PsychTests. The Boolean operator ‘AND’ and ‘OR’ were employed to narrow
down results and multiple search term combinations were employed. The search
involved setting various limiters. All searches were confined to English
language literature and peer reviewed to ensure the papers found were of a
reputable standard (Gerrish & Lacey 2010). The search was limited to full
text literature to allow for thorough analysis. A time parameter of January
2000 to present was set as the author wanted to include
only the most recent and relevant studies in the literature review to reflect
contemporary clinical practice. A focus on studies relating to mental health
nursing interventions for people who self-harm was implemented and any articles
that lacked a nursing perspective or acute inpatient population were excluded. The
electronic search of The British Nursing Index and Archive found 20 articles,
of which 5 were deemed pertinent. An electronic search of CINAHL complete
yielded 46 articles, of which 8 were found to be relevant. It is recognised
that electronic database searching does not identify all published material
(Polit & Beck 2014). To overcome this, a manual hand search of the
reference lists was conducted. A manual hand search is also encouraged in order
to avoid minimize bias (Vassar 2016). Of the 66 papers found in the
aforementioned electronic searches, the reference lists of 19 studies were
scanned for suitability and 3 research studies were deemed pertinent.

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Overall, this process yielded 16 relevant
papers; 8 were qualitative studies and 4 were quantitative studies (Appendix 1).
There was 1 literature review and 3 systematic reviews (Appendix 2) included in
this assignment. The literature included in this review originated from the
United Kingdom (10), the Republic of Ireland (2), Norway (1), Sweden (1), South
Africa (1) and the Netherlands (1). The papers span through a period of January
2001 to September 2017. Literature was not included if they were theoretical
papers, philosophical papers, discussion papers, policy guidelines or
conference papers. Pertinent literature was organized into meaningful groups
through the application of an inductive thematic analysis framework, during
which 7 repeated patterns of meaning became apparent. These patterns were
reviewed and were categorized into three relevant themes; some patterns were
disregarded due to lack of data while other patterns were combined to form one
theme (Braun & Clarke 2006). The first semantic theme centred on
interventions available to service users experiencing self-harm. The second
theme put emphasis on staff attitudes and experiences of working with service
users who engage in self harm and how education intervention could change these
views. The last emerging theme examined service users perception of how
self-harm is managed within the services and also explored supervised self-harm.