Management of self-cutting in psychiatric inpatient wards: attitudes of nursing staff and service users
Background: Self-harm is common in mental health inpatient settings. The most common form is self-cutting. Traditionally, interventions have aimed to extinguish the behaviour, but there is an increasing recognition of the need to utilise a 'harm reduction' model. Aims: Two systematic literature reviews were conducted: i) the attitudes of mental health nurses towards self-harm; ii) self-cutting as a specific form of self-harm. A questionnaire tool was then developed which sought to measure the attitudes of mental health nursing staff and service-users towards the management of self-cutting events in mental health wards. Methods: Systematic reviews: Three databases were searched using comprehensive terms, resulting in 18 and 26 papers respectively. Studies were critically reviewed and quality assessed. Preliminary work was conducted to identify current possible management strategies for inpatient self-cutting. Tool development: Principles from classical test theory were used to develop a tool to measure attitudes. Nurses and service users completed the tool. Results: Reviews: Qualitative interview studies with mental health nurses revealed positive and negative attitudes; questionnaire studies displayed more progressive attitudes among nurses towards this patient behaviour than other professional healthcare groups. Improved attitudes were noted in response to training. People who cut themselves are diverse in nature. Causes of cutting include affect regulation and tension reduction, but no single theoretical model accounts for all events. As such, treatment should be person-centred. Tool development: A valid and reliable questionnaire tool was developed which revealed significant differences in attitudes both between and within participant groups, particularly with regard to the use of harm minimisation techniques in ward settings. Utilisation rates of coercive methods such as intramuscular medication and control/restraint were higher than harm reduction techniques, but approval ratings showed opposite trends. Discussion: Disparities between the views of staff and service users might lead to management techniques that do not reflect patient priorities and may be detrimental to therapeutic relationships. Targeted training of nurses who are sympathetic to patients who self-harm may address these inconsistencies using harm minimisation strategies. Future studies should address the poor empirical framework of the various models attributed to self-cutting. The AMScQ should be further utilised to identify differing attitudes to self-harm management.
Mental health, Mental health nursing, Self-harm, Self-cutting, Nurse attitudes
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