درک مراقبت های پرستاری در بیماران با خودآسیبی غیرخودکشی در واحد پذیرش روانی حاد: نظرات پرستاران روانپزشکی

Self-harm in the absence of suicidal intent is an underexplored area in psychiatric nursing research. This article reports on findings of a study undertaken in two acute psychiatric admission units in Ireland. The purpose of this study was to gain an understanding of the practices of psychiatric nurses in relation to people who self-harm but who are not considered suicidal. Semistructured interviews were held with eight psychiatric nurses. Content analysis revealed several themes, some of which will be presented and discussed in this article, namely, the participants' understanding of self-harm, their approach to care, and factors in the acute psychiatric admission setting, which impacted on their care. Recommendations for further research are offered.

Conclusion This study showed that the participants found it difficult to clearly describe their role when working with people who self-harm. Self-harm had many behaviors ascribed to it, and the participants did not differentiate between self-harm with suicidal intent and self-harm without suicidal intent in their practice. There was no consistent pattern to their practice, which was undoubtedly influenced by the lack of clear local and national policies and guidelines. Although the participants described a coherent approach at an individual level, there was no coherent approach at the unit level. Many contradictions, as well as tensions, were evident. The participants found it difficult to pay specific attention to people who self-harm; this could be explained by Hummelvoll and Severinsson's (2001) suggestion that therapeutic interventions in acute units are heterogeneous in relation to patient groups, making it difficult to differentiate between the specific needs of these diverse groups. Providing a physically safe environment and preventing self-harm were the key priorities for the participants. They described wanting to engage in therapeutic activities but were hindered due to factors such as lack of time, inconsistency of nursing staff, and the dominance of the medical model. Many demands were placed on the staff in the acute psychiatric admission environment. These demands were a prominent feature in the participants' discourse and dominated their responses. They had to compete between the approach they wished to adopt and the requirements and expectations of the units in which they worked. In summary, the psychiatric nurses engaged in a wide variety of practices, interventions, and strategies when working with people who self-harm but were strongly influenced by the structure of the acute psychiatric admission environment. It is recommended that this study is repeated but with a larger sample and with the involvement of patients and their families. In addition, there is a need to explore the nature and function of acute psychiatric admission units and psychiatric nursing practice within these units in Ireland. Although this has been explored in other countries, findings cannot easily be translated, as a country's health care system is culturally and contextually specific.