Nienke Kool

Behavioral Change in Patients With Severe Self-Injurious Behavior: A Patient's Perspective

Semistructured interviews were conducted with 12 women who had successfully stopped self-injuring to gain an understanding of the process of stopping self-injury. The data were analyzed based on the grounded theory method. The researchers found that the process of stopping self-injury consists of six phases. Connection was identified as key to all phases of the process. Nursing interventions should focus on forging a connection, encouraging people who self-injure to develop a positive self-image and learn alternative behavior.

Improving communication and practical skills in working with inpatients who self-harm: a pre- test/post-test study of the effects of a training programme

BackgroundDiffering perspectives of self-harm may result in a struggle between patients and treatment staff. As a consequence, both sides have difficulty communicating effectively about the underlying problems and feelings surrounding self-harm. Between 2009 and 2011, a programme was developed and implemented to train mental health care staff (nurses, social workers, psychologists, psychiatrists, and occupational therapists) in how to communicate effectively with and care for patients who self-harm. An art exhibition focusing on self-harm supported the programme. Lay experts in self-harm, i.e. people who currently harm themselves, or who have harmed themselves in the past and have the skills to disseminate their knowledge and experience, played an important role throughout the programme.MethodsPaired sample t-tests were conducted to measure the effects of the training programme using the Attitude Towards Deliberate Self-Harm Questionnaire, the Self-Perceived Efficacy in Dealing with Self-Harm Questionnaire, and the Patient Contact Questionnaire. Effect sizes were calculated using r. Participants evaluated the training programme with the help of a survey. The questionnaires used in the survey were analysed descriptively.ResultsOf the 281 persons who followed the training programme, 178 completed the questionnaires. The results show a significant increase in the total scores of the three questionnaires, with large to moderate effect sizes. Respondents were positive about the training, especially about the role of the lay expert.ConclusionA specialised training programme in how to care for patients who self-harm can result in a more positive attitude towards self-harm patients, an improved self-efficacy in caring for patients who self-harm, and a greater closeness with the patients. The deployment of lay experts is essential here.

Psychiatric Nursing Care for Adult Survivors of Child Maltreatment: A Systematic Review of the Literature

PURPOSE To determine what is known from the literature about nursing care of psychiatric patients with a history of child maltreatment. CONCLUSIONS Psychiatric nurses underline the importance of a routine inquiry of child abuse on admission of patients to psychiatric care, but are reluctant to ask about child abuse. They often feel insufficiently competent to respond effectively to patients with a history of child maltreatment. PRACTICE IMPLICATIONS Psychiatric nurses need training in how to assess a history of child abuse and the late-life consequences of abuse in adult psychiatric patients. They also need to be trained to respond effectively to these patients.

Psychometric properties of the Dutch version of the Attitude Towards Deliberate Self‐Harm Questionnaire

The attitude of nurses and treatment staff is crucial in the treatment of patients who self-harm. However, many patients experience that attitude as negative. The aim of this study was to investigate the psychometric properties of the Dutch version of the Attitude Towards Deliberate Self-Harm Questionnaire. A total of 261 questionnaires were used to measure validity and reliability. Sensitivity to change was measured using a post-test measurement (n = 171) and a subgroup of 78 participants were given the questionnaire twice for test-retest measurement. Factor analysis revealed four factors explaining 33% of the variance. Cronbachs alpha values ranged 0.585-0.809, with 0.637 for the total scale. Intraclass correlation coefficient was assessed in order to estimate test-retest reliability, revealing the questionnaire was stable over time; the exception was factor 3, which had a value of 0.63. Sensitivity to change was found for the total score, factor one and two, and for three of the five items of factor three. We conclude that the Dutch version of the Attitude Towards Deliberate Self-Harm Questionnaire possesses adequate psychometric properties and is potentially an acceptable instrument for measuring the attitude of nurses and health-care staff towards patients who self-harm in Dutch-speaking countries.

P02-253 - Change in self-injurious behaviour: patients ‘perspectives

Introduction Patients and care providers have difficulty getting control of self-injurious behaviour. Nonetheless, there are patients who have succesfully stopped self-injury. Objectives The aim of this study was to gain understanding of the process of stopping self-injury and to identify the determinants contributing to that achievement. Methods Semi structured interviews were conducted with twelve women with a long history of severe self-injurious behaviour who eventually succeeded in stopping that behaviour. The data were analysed based on of the Grounded Theory Method. Results It was found that the process of stopping self-injury consists of six phases: - the phase of connecting and setting limits: feelings perceived as unsafe are explored, and ways of strengthening feelings of safety are pursued. This sense of safety allows patients to reach out more to others and themselves; - the phase of increased self-esteem with a further deepening of contact with the self; - the phase in which patients “learn to understand” themselves: increased self-understanding makes patients realise they can control their own lives; - in the phase of autonomy patients make active choices to increase control of their lives and immediate environment; - the phase of stopping self-injury: learning and using alternative strategies other than self-injury to cope with unbearable feelings; - the phase of maintenance focuses on preventing a relapse into self-injurious behaviour. Contact was identified as key to all phases of the process Conclusions Interventions should focus on making contact, encouraging people who self-injure to develop a positive self-image and learn alternative behaviour.