Emergency nurses’ perceptions of the health care system and how it impacts provision of care to people who self-harm

Abstract

BackgroundSelf-harm is a deliberate act to cause physical harm to oneself. People who self-harm are at greater risk for suicide than people who do not self-harm. Emergency nurses are first responders to many people who present to the emergency department (ED) with self-harm. The care they provide can influence future presentations to the emergency department and long-term outcomes. AimThe aim was to explore ED nurses’ experiences of working with people who self-harm. MethodsSemi-structured interviews were conducted with 18 emergency nurses from different locations in Australia in 2019. Elo and Kyngäs’ inductive content analysis research method guided all stages of the research. ResultsThe category “health care system” emerged from the data. It comprised five subcategories: (i) Complexity of the work environment; (ii) ED staff attitudes and care provision; (iii) the mental health patient; (iv) facilitators and barriers to providing care to people who self-harm; and (v) lack of community resources. DiscussionThis study found there were several factors influencing ED nurses’ knowledge, skills and confidence in caring for people who self-harm and several factors influenced their experience. ConclusionWhile participants felt confident to manage the physical injuries associated with self-harm, they were less confident to engage with the person about their self-harm. The article provides guidance for ED nurses to assess and intervene with people who present with self-harm.