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Nursing staff confidence and knowledge when caring for people with self-harm injuries: a service improvement study

24 February 2022
16 min read
Volume 31 · Issue 4


The knowledge and confidence of nursing staff can impact re-harming rates of patients with self-harm injury. This service improvement study sought to address the knowledge, confidence and practice issues for staff nurses and healthcare assistants (HCAs) caring for patients who had presented to the emergency department (ED) with self-harm injury. The knowledge and confidence of nursing staff was reported using Likert-style questionnaires in a longitudinal study, framed within one Plan, Do, Study, Act (PDSA) cycle. Attitudes and challenges to patient care were also sought to inform future practice. The findings, based on the responses of 10 nurses and 5 HCAs, showed an increase in knowledge and confidence among both staff groups following the education session. Of the 15 who participated, 5 provided feedback to a reflective questionnaire to assess their views 30 days after the intervention. Quantitative data revealed a perception in an increase in the standard of care. The study found that both knowledge and confidence in supporting individuals presenting with self-harm in the ED improved at 30 days post-educational intervention. The numbers in the study were small and challenge transferability, however, service improvement theory is concerned with identifying measures of success rather than statistical reliability.

Self-harm is associated with a wide range of mental health problems, including borderline personality disorder, depression, bipolar disorder, schizophrenia, and drug and alcohol use issues (Department of Health, 2012). Information from the Care Quality Commission (CQC) (2015) shows that there are geographical pockets within England with a higher incidence of emergency department (ED) admissions due to self-harm. For example, the ED in which this study took place has around double the attendance rates for self-harm than the national average. This may be due to a lack of child and adolescent mental health services supporting young people, who may then use self-harm to self-regulate.

Research indicates that the negative attitudes of nursing staff towards patients who self-harm lead to poor-quality patient care and an increased likelihood of re-harming (Gibson et al, 2019). Patient perception of stigmatisation may be felt acutely by those who present to an ED for treatment and is often evidenced in psychological research (Cleaver et al, 2014).

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