Aveyard H, Payne S, Preston N. A Post-graduate's guide to doing a literature review.Maidenhead: Open University Press; 2016

Aliakbari F, Parvin N, Heidari M, Haghani F. Learning theories application in nursing education. J Educ Health Promot. 2015; 4

Care Quality Commission. Right here, right now. People's experiences of help, care and support during a mental health crisis. Summary. 2015. (accessed on 8 February 2022)

Clarke D, Usick R, Sanderson A, Giles-Smith L, Baker J. Emergency department staff attitudes towards mental health consumers: a literature review and thematic content analysis. Int J Ment Health Nurs. 2014; 23:(3)273-284

Cleaver K, Meerabeau L, Maras P. Attitudes towards young people who self-harm: age, an influencing factor. J Adv Nurs. 2014; 70:(12)2884-2896

Conlon M, O'Tuathail C. Measuring emergency department nurses' attitudes towards deliberate self-harm using the Self-Harm Antipathy Scale. Int Emerg Nurs. 2012; 20:(1)3-13

Cullen SW, Diana A, Olfson M, Marcus SC. If you could change 1 thing to improve the quality of emergency care for deliberate self-harm patients, what would it be? A national survey of Nursing leadership. J Emerg Nurs. 2019; 45:(6)661-669

Department of Health. Preventing suicide in England. A cross-government outcomes strategy to save lives. 2012. (accessed 8 February 2022)

Egan R, Sarma KM, O'Neill M. Factors influencing perceived effectiveness in dealing with self-harming patients in a sample of emergency department staff. J Emerg Med. 2012; 43:(6)1084-1090

Giandinoto JA, Stephenson J, Edward K. General hospital health professionals' attitudes and perceived dangerousness towards patients with comorbid mental and physical health conditions: systematic review and meta-analysis. Int J Ment Health Nurs. 2018; 27:(3)942-955

Gibson R, Carson J, Houghton T. Stigma towards non-suicidal self-harm: evaluating a brief educational intervention. Br J Nurs. 2019; 28:(5)307-312

Evaluation of the crisis care concordat implementation. Final report. (Prepared by the McPin Foundation for Mind.). 2016. (accessed 8 February 2022)

Healthcare Quality Improvement Partnership. An introduction to analysing quality improvement and assurance data. 2018. (accessed 8 February 2022)

Hodgson K. Nurses' attitudes towards patients hospitalised for self-harm. Nurs Stand. 2016; 30:(31)38-44

Institute for Healthcare Improvement. Science of improvement: testing changes. 2022. (accessed 8 February 2022)

Jelinek GA, Weiland TJ, Mackinlay C, Gerdtz M, Hill N. Knowledge and confidence of Australian emergency department clinicians in managing patients with mental health-related presentations: findings from a national qualitative study. Int J Emerg Med. 2013; 6:(1)

Koning KL, McNaught A, Tuffin K. Emergency department staff beliefs about self-harm: a thematic framework analysis. Community Ment Health J. 2018; 54:(6)814-822

Masuku S. Self-harm presentations in emergency departments: staff attitudes and triage. Br J Nurs. 2019; 28:(22)1468-1476

McCarthy L, Gijbels H. An examination of emergency department nurses' attitudes towards deliberate self-harm in an Irish teaching hospital. Int Emerg Nurs. 2010; 18:(1)29-35

Mental Health Taskforce. The five year forward view for mental health. Mental Health Taskforce strategy report for the NHS in England. 2016. (accessed 14 February 2022)

Moen R, Nolan T, Provost L. Quality improvement through planned experimentation, 3rd edn. New York: McGraw-Hill; 2012

NHS England. Sustainable improvement team. The change model guide. 2018. (accessed 8 February 2022)

National Confidential Enquiry into Patient Outcome and Death. Treat as one. Bridging the gap between metal and physical healthcare in general hospitals. 2017. (accessed 8 February 2022)

National Institute for Health and Care Excellence. Self-harm in over 8s: short-term management and prevention of recurrence. Clinical guideline [CG16]: Overview. 2004. (accessed 8 February 2022)

National Institute for Health and Care Excellence. Self Harm:. Quality standard [QS34]. 2013. (accessed 8 February 2022)

Nursing and Midwifery Council. The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. (accessed 8 February 2022)

O'Connor S, Glover L. Hospital staff experiences of their relationships with adults who self-harm: A meta-synthesis. Psychol Psychother. 2017; 90:(3)480-501

Polit DE, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice, 9th. edn. Philadelphia (PA): Wolters Kluwer; 2018

Rayner G, Blackburn J, Edward KL, Stephenson J, Ousey K. Emergency department nurse's attitudes towards patients who self-harm: A meta-analysis. Int J Ment Health Nurs. 2019; 28:(1)40-53

Rees GH. Organisational readiness and Lean Thinking implementation: findings from three emergency department case studies in New Zealand. Health Serv Manage Res. 2014; 27:(1-2)1-9

Sands N, Elsom S, Colgate R, Haylor H, Prematunga R. Development and interrater reliability of the UK Mental Health Triage Scale. Int J Ment Health Nurs. 2016; 25:(4)330-336

Saunders KE, Hawton K, Fortune S, Farrell S. Attitudes and knowledge of clinical staff regarding people who self-harm: a systematic review. J Affect Disord. 2012; 139:(3)205-16

Taylor MJ, McNicholas C, Nicolay C, Darzi A, Bell D, Reed JE. Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Qual Saf. 2014; 23:(4)290-8

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

24 February 2022
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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