Department of Psychology, Universities of Coventry and Warwick, Coventry, United Kingdom.
Department of Psychology, University of Warwick, Coventry, United Kingdom.
J Psychiatr Ment Health Nurs. 2022 Oct;29(5):744-754. doi: 10.1111/jpm.12806. Epub 2021 Dec 1.
WHAT IS KNOWN ON THE SUBJECT?: Nurses' experience challenges of managing risk, boundaries and emotional responses when working with people who self-harm. Adolescent self-harm is a growing problem, with rates increasing in the UK. Existing research has failed to differentiate and specifically explore nurses' experiences of working with adolescents who self-harm. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides an understanding of the impact of working with adolescents who self-harm in the community on nurses, and highlights recommendations to improve staff and patient experiences and care. Community CAMHS nurses experience personal and professional conflicts when working with adolescents who self-harm. They experience interpersonal conflicts balancing the needs of adolescents with the needs of the systems around them, and intrapersonal conflicts regarding experiencing mixed emotions, and balancing the care they want to provide with service pressures. Community CAMHS nurses experience feelings of self-doubt and shame due to their emotional responses, self-care behaviours, personal and professional boundaries. They use their feelings of pride, honour and enjoyment to manage these experiences. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses working in CAMHS should be provided with more opportunities for reflective practice and self-care, to enable reflection and learning regarding the emotional impacts and working with systems. Managerial investment is required to facilitate this. Nurses working with adolescents who self-harm in CAMHS could benefit from training regarding understanding and managing self-harm (such as dialectical behavioural therapy), and effectively working with families and people who support these adolescents (such as attachment-based family therapy). ABSTRACT: Introduction Nurses often work in the community with adolescents who self-harm. There is a lack of qualitative research exploring nurses' experiences of working with adolescents who self-harm. Aim This study aimed to gain an understanding of community nurses' experiences of working with adolescents who self-harm. Method Ten semi-structured interviews were conducted with registered nurses working in Child and Adolescent Mental Health Services (CAMHS) in the United Kingdom (UK). Results Data were analysed using interpretative phenomenological analysis (IPA). Two superordinate themes were identified, each consisting of two subordinate themes: personal and professional conflicts, describing interpersonal and intrapersonal conflicts the nurses experienced working with adolescents who self-harm and the systems around them, and personal and professional development, outlining processes of management of conflicts and development. Discussion Nurses feel conflicted about working with adolescents who self-harm within the context of working with systems surrounding the adolescent. They report positive experiences, which they use to reframe their experiences and feelings of shame as a result of their emotional responses, self-care behaviours and personal and professional boundaries. Implications for Practice Nurses working with adolescents who self-harm would benefit from training, reflective practice and self-care. CAMHS managers should encourage and invest in these areas.
已知信息：护士在与自残者打交道时，在管理风险、界限和情绪反应方面面临挑战。青少年自残是一个日益严重的问题，英国的自残率正在上升。现有研究未能区分并专门探讨护士在社区中与自残青少年合作的经验。文献新增内容：本文介绍了了解社区中与自残青少年合作对护士的影响，并强调了改善员工和患者体验和护理的建议。社区儿童和青少年心理健康服务（CAMHS）护士在与自残青少年合作时会遇到个人和职业冲突。他们在平衡青少年的需求与周围系统的需求时会遇到人际冲突，并在体验混合情绪和平衡他们想要提供的护理与服务压力时会遇到内在冲突。社区儿童和青少年心理健康服务护士会因为他们的情绪反应、自我保健行为、个人和职业界限而感到自我怀疑和羞耻。他们用自豪感、荣誉感和享受感来管理这些经历。对实践的意义：在儿童和青少年心理健康服务机构工作的护士应该有更多的机会进行反思性实践和自我保健，以促进对情绪影响和系统工作的反思和学习。需要管理层进行投资以促进这一点。在儿童和青少年心理健康服务机构中与自残青少年合作的护士可以从有关理解和管理自残（例如辩证行为疗法）以及有效地与这些青少年的家人和支持他们的人合作（例如基于依恋的家庭疗法）的培训中受益。摘要：介绍：护士经常在社区中与自残青少年一起工作。缺乏定性研究来探讨护士与自残青少年合作的经验。目的：本研究旨在了解社区护士与自残青少年合作的经验。方法：对英国儿童和青少年心理健康服务机构的 10 名注册护士进行了半结构化访谈。结果：使用解释现象学分析（IPA）对数据进行了分析。确定了两个超主题，每个主题都包含两个子主题：个人和职业冲突，描述护士在与自残青少年及其周围系统合作时所经历的人际和内在冲突，以及个人和职业发展，概述冲突管理和发展的过程。讨论：护士在与青少年及其周围系统合作的背景下，对与自残青少年合作感到矛盾。他们报告了积极的经验，这些经验使他们能够重新构建自己的经验，并减轻由于情绪反应、自我保健行为以及个人和职业界限而产生的羞耻感。对实践的影响：与自残青少年合作的护士将受益于培训、反思性实践和自我保健。儿童和青少年心理健康服务机构的管理人员应鼓励并投资于这些领域。
