O'Connor Sophie, Glover Lesley
Department of Psychological Health and Wellbeing, University of Hull, UK.
Psychol Psychother. 2017 Sep;90(3):480-501. doi: 10.1111/papt.12113. Epub 2016 Dec 30.
This review aimed to synthesize qualitative literature exploring inpatient hospital staff experiences of their relationships with people who self-harm.
Nine studies were identified from a systematic search of five research databases. Papers included the experiences of physical health and mental health staff working in inpatient settings. The studies employed various qualitative research methods and were appraised using an adapted quality assessment tool (Tong, Sainsbury, & Craig, 2007). A meta-synthesis was conducted using traditional qualitative analysis methods including coding and categorizing data into themes.
Three main themes derived from the data. 'The impact of the system' influenced the extent to which staff were 'Fearing the harm from self-harm', or were 'Working alongside the whole person'. A fear-based relationship occurred across mental health and physical health settings despite differences in training; however, 'Working alongside the whole person' primarily emerged from mental health staff experiences. Systemic factors provided either an inhibitory or facilitative influence on the relational process.
Staff experiences of their relationship with people who self-harm were highlighted to have an important impact on the delivery and outcome of care. Increasing support for staff with a focus on distress tolerance, managing relational issues, and developing self-awareness within the relationship may lead to a more mutually beneficial experience of care. Equally, structure, clarity, and support within inpatient systems may empower staff to feel more confident in utilizing their existing skills.
Working with people who self-harm can be emotionally challenging and how staff cope with this can significantly impact on the engagement of staff and patients. Increasing the skills of staff in managing relational issues and tolerating distress, as well as providing support and reflective practice groups may be useful in managing emotional responses to working with people who self-harm. Refining the supportive, procedural, and environmental structures surrounding the caregiving relationship may help enable better integration of physical and mental health care.
本综述旨在综合定性文献，探讨住院医院工作人员与自我伤害者关系的经历。
通过对五个研究数据库进行系统检索，确定了九项研究。论文包括在住院环境中工作的身体健康和心理健康工作人员的经历。这些研究采用了各种定性研究方法，并使用一种改编的质量评估工具（Tong、Sainsbury和Craig，2007年）进行评估。使用传统的定性分析方法进行元综合，包括对数据进行编码和分类成主题。
数据得出三个主要主题。“系统的影响”影响了工作人员“害怕自我伤害带来的伤害”或“与完整的人一起工作”的程度。尽管培训存在差异，但基于恐惧的关系在心理健康和身体健康环境中都存在；然而，“与完整的人一起工作”主要源于心理健康工作人员的经历。系统因素对关系过程产生了抑制或促进影响。
工作人员与自我伤害者关系的经历被强调对护理的提供和结果有重要影响。增加对工作人员的支持，重点关注痛苦耐受性、管理关系问题以及在关系中培养自我意识，可能会带来更互利的护理体验。同样，住院系统内的结构、清晰度和支持可能会使工作人员更有信心运用他们现有的技能。
与自我伤害者合作在情感上具有挑战性，工作人员应对此的方式会显著影响工作人员和患者的参与度。提高工作人员管理关系问题和忍受痛苦的技能，以及提供支持和反思实践小组，可能有助于管理与自我伤害者合作时的情绪反应。完善围绕护理关系的支持性、程序性和环境结构，可能有助于实现更好的身心健康护理整合。
