Nurses' management of deliberate self-harm in an acute residential setting
The study aimed to address the question of what represents the most therapeutic response when a client self-harms on an acute inpatient mental health unit. The null hypothesis was that nurse response type would have no bearing on how long it was before a client went on to self-harm again. Pilot studies and qualitative analysis led to the development of questionnaires which sought to measure nurse-client interactions across four dimensions: 1) The content of what the nurse said to the client; 2) The length of time the nurse spent with the client; 3) The emotional tone of the response; and 4) The strength of emotion expressed by the nurse. The participants were 19 inpatients and 29 nurses who described incidents of self-harm. Nurses and clients completed questionnaires describing the nurse's response type the first time that a client self-harmed during a new admission. Most of the statistical analyses supported the null hypothesis that nurse response type has no bearing on how long it is before a client engages in self-harm again. There was no evidence that the content, duration or emotional tone of a nurse's response had any bearing on how long it was before the client self-harmed again. The only statistically significant finding was that nurses perceiving themselves to be more strongly emotional was correlated with a longer delay before self-harm was repeated. A finding not directly related to the hypotheses was that nurses and clients perceived behaviour differently. There was poor agreement in terms of their perceptions of the number of minutes that an interaction lasted, how strongly emotional the nurse was, and the severity of the clients' self-harm. The implications of these findings are discussed, together with suggestions for future research.