Journal des soins infirmiers et des soins

Psychiatric Nurses Explanations of Self-Harming Behaviour in Secure Forensic Settings: A Multi-Method Phenomenological Investigation

Abstract

Peter T Sandy

Aim: This paper reports on a study that explores psychiatric nurses` explanations of self-harming behaviors in secure forensic psychiatric environments.
Background: There is evidence suggesting that there is a differential perception between psychiatric nurses and service users of the reasons for self-harming behaviors in secure settings. This gulf in perception, which may negatively impact on the care offered to service users, is a function of nurses’ lack of or limited knowledge of self-harm.
Yet, research concerning nurses’ reasons for service users’ self-harming behaviors is limited.
Methods: The study utilized a phenomenological methodology with semi-structured individual interviews (n=25) and focus group interviews (n=6x6). The data were analyzed thematically using Interpretative Phenomenological Analysis.
Results: The findings indicate that the behavior of self-harm does not have fixed causes rather it has multiple causes which, in the main, relate to affect regulation, limited coping skills, rigid institutional regime and practitioners` negative attitudes.
Conclusions: These findings have implications for practice and recommendations are made to improve this. Regular training and support should be provided for psychiatric nurses in secure environments in order to broaden their understanding of self-harm and its underlying motives. Improved understanding of self-harm may result in improved nurse-service user relationships and thus, safer and effective care provision.