1.IntroductionThe purpose of this review is to explore theliterature on mental health nursing interventions available to service userswho engage in deliberate self-harm on acute inpatient units. Hawton et al(2012) defines self-harm as deliberate self-poisoning or self-injury regardlessof the presence of suicidal intent. However, Mars et al.
(2014) suggests that self-harmwith suicidal intent should be considered completely separate from self-harmwithout suicidal intent. The term deliberate self-harm (DSH) will be usedthroughout this review to describe acts such as intentional cutting,scratching, burning, hanging and overdose along with more socially acceptedbehaviours such as smoking, substance abuse and dieting (National CollaboratingCentre for Mental Health 2014). Self-harm is an epidemic in Ireland at present,with The National Registry of Deliberate Self-harm in Ireland recording thenumber of self-harm presentations to hospitals to be 12,337 in 2010 (Griffin etal. 2017).
The most recent figure available is for 2016, which had 11,485presentations. Although figures have dropped between these six years, thenumber of presentations in 2016 was still 10% higher than in 2007, the yearbefore Ireland experienced economic recession (Griffin et al. 2017). It is importantto note that it is near impossible to produce accurate self-harm statistics asDSH is a private act, which many people struggle with in silence (Ogden &Bennett 2015). The aforementioned statistics were gathered from accident andemergency (A&E) departments only; however there are many other agenciesthat people can present to with self-harm which have not been accounted for(Reeves 2013). Therefore, these figures are much higher than calculated. Areview of the literature on this topic was carried out for various reasons. Acritical element of psychiatric inpatient care is to provide a safe environmentfor service users (Bowers et al 2005).
However, simply removing means ofself-harm in order to provide a safe environment as been widely criticized by serviceusers and nurses alike (O’Donovan 2007). Hence, the author felt it appropriateto conduct a review of current mental health nursing interventions available toservice users who self-harm on acute psychiatric wards as it is an area that isunder researched (Hawton et al 1999). In addition, it is recognised thatservice 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 studycarried out by (Sinclair et al 2011) found that service users who engage inself-harm as inpatients place the greatest financial strain on the health carebudget, thus, it would prove cost effective to investigate variousinterventions that could be implemented in acute mental health settings (Respondingto Self-Harm – An Evaluation of the Self-Harm Intervention Programme 2015). 2. SearchStrategyA broad search was carried out using databasesin order to obtain literature relating to mental health nursing interventionsfor inpatients that engage in deliberate self-harm. This search was undertakenin November 2017. An electronic databases search was conducted using the searchterms “deliberate self-harm”, “self mutilation”, “self wounding”,”self-injury”, “nursing intervention”, “psychological intervention”, “cognitivebehavioural therapy”, “self-destructive behaviour”, “psychiatric nursing” and”inpatient”.
The databases consulted were The British Nursing Index and Archiveand CINAHL (Cumulative Index to Nursing and Allied Health Literature) completewhich includes Allied & Complementary Medicine, PsychINFO, PsychARTICLESand PsychTests. The Boolean operator ‘AND’ and ‘OR’ were employed to narrowdown results and multiple search term combinations were employed. The searchinvolved setting various limiters. All searches were confined to Englishlanguage literature and peer reviewed to ensure the papers found were of areputable standard (Gerrish & Lacey 2010). The search was limited to fulltext literature to allow for thorough analysis. A time parameter of January2000 to present was set as the author wanted to includeonly the most recent and relevant studies in the literature review to reflectcontemporary clinical practice.
A focus on studies relating to mental healthnursing interventions for people who self-harm was implemented and any articlesthat lacked a nursing perspective or acute inpatient population were excluded. Theelectronic search of The British Nursing Index and Archive found 20 articles,of which 5 were deemed pertinent. An electronic search of CINAHL completeyielded 46 articles, of which 8 were found to be relevant.
It is recognisedthat electronic database searching does not identify all published material(Polit & Beck 2014). To overcome this, a manual hand search of thereference lists was conducted. A manual hand search is also encouraged in orderto avoid minimize bias (Vassar 2016). Of the 66 papers found in theaforementioned electronic searches, the reference lists of 19 studies werescanned for suitability and 3 research studies were deemed pertinent.Overall, this process yielded 16 relevantpapers; 8 were qualitative studies and 4 were quantitative studies (Appendix 1).
There was 1 literature review and 3 systematic reviews (Appendix 2) included inthis assignment. The literature included in this review originated from theUnited Kingdom (10), the Republic of Ireland (2), Norway (1), Sweden (1), SouthAfrica (1) and the Netherlands (1). The papers span through a period of January2001 to September 2017. Literature was not included if they were theoreticalpapers, philosophical papers, discussion papers, policy guidelines orconference papers. Pertinent literature was organized into meaningful groupsthrough the application of an inductive thematic analysis framework, duringwhich 7 repeated patterns of meaning became apparent.
These patterns werereviewed and were categorized into three relevant themes; some patterns weredisregarded due to lack of data while other patterns were combined to form onetheme (Braun & Clarke 2006). The first semantic theme centred oninterventions available to service users experiencing self-harm. The secondtheme put emphasis on staff attitudes and experiences of working with serviceusers who engage in self harm and how education intervention could change theseviews. The last emerging theme examined service users perception of howself-harm is managed within the services and also explored supervised self-harm.