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Patient – caregiver interaction and experiences of care among patients who self-harm, next of kin´s and caregivers.

Research project Self-harm is described as a way of dealing with severe mental suffering and often referred to as a coping strategy, and as a survival strategy. In this project we define self-harm as a repeated, impulsive behaviour where tissue damage occurs, yet it is not a suicide attempt. Instead of wishing to die, the person who self-harm wish to be relieved from anxiety.

The prevalence of self-harm in a general population is estimated to between 2 and 6 percent, more common among women.The overall aim of this project is to explore the interaction between patients who self-harm and their caregivers and also to illuminate experiences of care among persons who self-harm, next of kin’s and caregivers. This project consists of five studies. Studies I and II are published and further studies are planned; -Interviews with next of kin´s to persons who slef-harm about their experiences. Participant observations are planned in two psychiatric wards aiming to; - illuminate the interaction between patients who self-harm and their caregivers. - explore the activities that caregivers and patients perform.

Head of project

Project overview

Project period:

2009-05-05 2012-06-30

Funding

Finansår , 2007, 2008, 2009

huvudman: Britt-Marie Lindgren, finansiar: Ebba Danelius stiftelse, y2007: 30000, y2008: , y2009: ,

huvudman: Sture Åström, finansiar: Psykiatrifonden, y2007: 210000, y2008: , y2009: ,

huvudman: Britt-Marie Lindgren, finansiar: Ebba Danelius stiftelse, y2007: , y2008: , y2009: 15000,

Participating departments and units at Umeå University

Department of Nursing

Research area

Public health and health care science

Project description

Self-harm is described as a way of dealing with severe mental suffering and often referred to as a coping strategy, and as a survival strategy. In this project we define self-harm as a repeated, impulsive behaviour where tissue damage occurs, yet it is not a suicide attempt. Instead of wishing to die, the person who self-harm wish to be relieved from anxiety.

The prevalence of self-harm is problematic to estimate due to the use of different concepts of self-harm and also because many persons who self-harm never seek hospital care. However, the prevalence of self-harm in a general population is estimated to between 2 and 6 percent. There are contradictory opinions whether or not there is gender differences according to sex in prevalence of self-harm. Some authors report no differences while others report that self-harm is more common among women.

The overall aim of this project is to explore the interaction between patients who self-harm and their caregivers and also to illuminate experiences of care among persons who self-harm, next of kin’s and caregivers.

This project consists of five studies, and studies I and II are carried out and published (Lindgren et al. 2004; Wilstrand et al. 2007).

Results from study I and II

Nine women who self-harm were interviewed about their experiences of care. Their narratives viewed a struggle for hopefulness which was depending on weather the caregivers managed to foster or stifle hopefulness. The results showed the importance of staffs’ ability to understand, confirm and respect the persons who self-harmed as human beings (Lindgren et al. 2004).

Six registered nurses were interviewed about their experiences of caring for patients who self-harm. They worked in four acute psychiatric wards in a psychiatric clinic in northern Sweden. The results showed that caring for those who self-harm is experienced as a burden. The nurses described feelings of uncertainty and fear, for example, the risk of having to face a complete suicide. The nurses felt that they had to be on their guard all the time. In addition, the nurses felt abandoned by co-workers and the management. The importance of releasing these burdens, not only for the sake of the nurses, but to improve the care of the patients is mediated in the interviews (Wilstrand et al. 2007).

In summery, the results from study I and II showed that persons who self-harm experienced care as inferior and that it did not satisfy their needs. Caregivers felt powerless and burdened when not being able to identify and satisfy needs.

Study III

The aim of this study is to illuminate the meaning of facing health care as narrated by next of kin’s to persons who self-harm. Fifteen narrative interviews, analyzed by phenomenological hermeneutical analysis is planned.

Study IV

The aim of this study is to illuminate the interaction between patients who self-harm and their caregivers. Sixteen participant observational sequences, approximately two hours per sequence, are planned in two psychiatric wards. Tape recorded reflective dialogues with caregivers and patients will be carried out in connection with the observations. The transcribed text from observations and reflective dialogues will be analyzed from its content.

Study V

To further illuminate the interaction between patients who self-harm and their caregivers structured observations will be conducted. This study aims to explore the activities that caregivers and patients perform. Their activities will be registered, with whom they perform the activity and where the activity takes place, by using the instruments PAC (Patient Activities Classification) and NAC (Nurse Activities Classification). Data will be analyzed using descriptive statistics.

The results from this project will build new knowledge about care and treatment and lived experiences of persons who self-harm, next of kin’s and caregivers. The results offer possibilities to develop more suitable nursing care methods for in-patient care and form the basis of an intervention programme for patients who self-harm. Furthermore, the research will contribute to reduced experiences of suffering, shorter treatment periods and reduced time of sick leave among persons who self-harm.