Thomas J B, Haslam C O
Cumbria Partnership Foundation Trust, UK.
School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
J Psychiatr Ment Health Nurs. 2017 Sep;24(7):480-490. doi: 10.1111/jpm.12384. Epub 2017 May 19.
WHAT IS KNOWN ABOUT THE SUBJECT?: Self-harm plays a function, commonly in the form of distress management. There has been little focussed exploration of how individuals who use self-harm to manage distress cope when prevented from self-harm in an inpatient environment and how staff respond to this issue.
This paper uses the experiences of mental health staff to add to the existing knowledge that self-harm has a functional role and supports the notion that interventions for self-harm should focus on the origins of distress. It describes the potential consequences that focussing on prevention of self-harm as opposed to actually managing distress may have on service-users, how staff attempt to manage these consequences and factors that may impact on staff interventions to prevent further distress/harm. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings suggest that mental healthcare staff should aim to understand the function of self-harm, use this understanding to develop an individualized care plan with the aim of managing distress and identify barriers to the effectiveness of the interventions so they can be worked around.
Introduction Literature describes self-harm as functional and meaningful. This creates difficulties for service-users detained in an inpatient environment where self-harm is prevented. Aim Mental healthcare staff were interviewed to build on existing evidence of issues with the prevention approach and explore, from a staff perspective, how self-harm prevention impacts on service-users, how they manage distress and how this impacts on staff and their approach to care. Methods Qualitative methods were used to allow unexpected themes to arise. Ten semi-structured interviews were carried out with mental healthcare staff and thematically analysed. Findings and discussion The findings provide new evidence on the benefits and limitations of the inpatient environment for individuals who self-harm. Findings indicate that being unable to self-harm can lead to a continuation of distress and subsequent potentially harmful attempts to manage distress. Staff described experiencing a struggle for control in preventing self-harm, leading to increasingly harmful methods of self-harm. Alternatively some staff were able to support service-users with distress management. We discuss factors influencing which of these 'paths' service-users followed. Implications Considerations for care planning including understanding self-harm, using individualized care planning and attending to barriers are outlined with the ultimate aim of reducing distress and the impact of prevention of self-harm.
关于该主题已知的信息有哪些？：自我伤害发挥着一种功能，通常表现为情绪困扰管理的形式。对于那些通过自我伤害来管理情绪困扰的人，在住院环境中被阻止自我伤害时如何应对，以及工作人员如何应对这个问题，目前几乎没有针对性的探讨。
本文利用心理健康工作人员的经验，补充了关于自我伤害具有功能性作用的现有知识，并支持这样一种观点，即针对自我伤害的干预措施应关注情绪困扰的根源。它描述了专注于预防自我伤害而非实际管理情绪困扰可能对服务使用者产生的潜在后果，工作人员如何试图应对这些后果，以及可能影响工作人员预防进一步困扰/伤害的干预措施的因素。
对实践的启示是什么？：研究结果表明，精神卫生保健工作人员应旨在理解自我伤害的功能，利用这一理解制定个性化的护理计划，以管理情绪困扰，并识别干预措施有效性的障碍，以便能够绕过这些障碍。
引言 文献将自我伤害描述为具有功能性和意义性。这给被拘留在住院环境中且自我伤害被阻止的服务使用者带来了困难。目的 对精神卫生保健工作人员进行访谈，以基于现有关于预防方法问题的证据，并从工作人员的角度探讨自我伤害预防如何影响服务使用者，他们如何管理情绪困扰，以及这如何影响工作人员及其护理方法。方法 采用定性方法以使意外主题得以出现。对十名精神卫生保健工作人员进行了半结构化访谈并进行了主题分析。结果与讨论 研究结果为住院环境对自我伤害者的益处和局限性提供了新的证据。结果表明，无法进行自我伤害可能导致情绪困扰持续，并随后引发潜在有害的管理情绪困扰的尝试。工作人员描述了在预防自我伤害方面经历的控制权争夺，导致自我伤害的方式越来越有害。或者，一些工作人员能够支持服务使用者进行情绪困扰管理。我们讨论了影响服务使用者走哪条“道路”的因素。启示 概述了护理计划的注意事项，包括理解自我伤害、使用个性化护理计划和关注障碍，最终目标是减少情绪困扰以及预防自我伤害所带来的影响。
