A qualitative exploration of how health care workers in an inpatient setting in Norway experience working with patients who self-injure

Abstract

This study aimed to explore how health care workers think, feel and act when working with patients who self-injure. Eight health care workers who had extensive experience with patients who self-injure were recruited from a secure ward at a psychiatric hospital in Western Norway. Semi-structured interviews were conducted at the participants' workplace. The interviews were analysed using interpretative phenomenological analysis. Four themes emerged from the analysis: (1) “Before”: the frustration inherent in using coercive strategies; (2) “The Change”: from coercion to alliance; (3) “Now”: the experience of useful ways of working with self-injury; (4) “Thin line between Life and Death”: suicide attempt or self-injury? The first theme describes how the ward used to function before the changes described in the second theme occurred. The third theme and its sub-themes detail how undergoing the change process previously described led to a subjectively better way of working with self-injury. The fourth theme describes a new challenge that arose with the new way of thinking about and working with self-injury. The four themes form a chronological narrative of how the participants' understanding and treatment of self-injury changed with experience, and details the new ways of working with and understanding self-injury. The discussion section explores how the themes relate to each other and explores the findings in the light of psychological literature.

Keywords:

• self-injury
• qualitative research
• inpatient treatment
• coercion
• alliance

Notes

1. As most of the participants indicated that most of the patients they met who self-injured were female, either directly by statements such as “it's mainly young girls” and “in our ward, about 90% women”, or through using female pronouns when talking about their patients, female pronouns will be used when indicating a self-injuring patient where appropriate.

2. The participants used both the terms borderline personality disorder and emotionally unstable personality disorder to refer to this earlier patient group. Since the ICD-10 uses emotionally unstable personality disorder, this term will also be used throughout this paper.