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Self-harm presentations in emergency departments: staff attitudes and triage

12 December 2019
18 min read
Volume 28 · Issue 22


Addressing the rising incidence of self-harm and the demand this places on emergency departments (EDs) are UK Government healthcare priorities. A history of self-harm is linked with suicide risk, so self-harm is a public health issue. The ED is the first point of contact for many people who self-harm so it plays a pivotal role in access to services. Research has highlighted difficulties around triage and assessment in EDs of patients who self-harm, especially frequent attenders. The evidence base on patient experience related to addressing negative staff attitudes is lacking, despite their potent nature and impact on care. Limited knowledge of self-harm aetiology and clinical inexperience have been found to be fundamental to nurses' negative attitudes when dealing with patients who self-harm. This has been linked to negative patient outcomes, including a reluctance to engage with services. This article acknowledges positive changes that have been made and highlights the importance of the triage stage, which is a potential service improvement area, where it would be possible to start and drive positive change in the care of people who self-harm. To address knowledge gaps in education and management, clinical understanding of the aetiology of self-harm should be improved with the aid of education on self-harm cycles. Nurses should also be made aware of common myths surrounding self-harm, as these are barriers to care. Recommendations for practice include partnership working and the urgent need for formal education on this topic for all health professionals working in EDs.

The emergency department (ED) is often the first stop for people in need of immediate healthcare attention, including those with injuries related to self-harm. Self-harm has been acknowledged as a public health concern, both nationally and internationally (Murray et al, 2013). It requires a continuous review of the evidence base and innovation in practice.

This article examines the perceived negative attitudes of healthcare staff towards people who self-harm and discusses how to address these. The recently commissioned National Institute for Health Research project, which will investigate how to support and protect those who self-harm, led by Professor Rose McCabe at City, University of London (Quadir, 2019), is a good example of how self-harm and patient experience is high on the Government's healthcare agenda, especially in relation to exploring the evidence base to support service improvement.

This article draws on the literature to identify and highlight how perceived negative attitudes from healthcare staff regarding self-harm presentations can be addressed in EDs. A clear gap in research and education in relation to staff knowledge has been noted by the National Institute for Health and Care Excellence (NICE) (2018). An initial exploration of self-harm aetiology and causes will address the knowledge gap described by NICE (2018). This will set the scene for exploring the resulting negative attitudes held by healthcare staff, which are informed by common myths.

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