[Preventing suicidal crisis and suicide]. / Prévenir la crise suicidaire et le suicide.

Suicide is not the inevitable outcome of a suicidal crisis. The people concerned are most often sensitive to preventive actions, which can prevent them from committing self-destructive acts. Preventing the suicidal crisis and suicide requires the involvement of healthcare professionals. It is also everyone's business.

Systematic review of interventions to improve constant observation on adult inpatient psychiatric wards.

Constant observation is frequently conducted on inpatient psychiatric units to manage patients at risk of harming themselves or others. Despite its widespread use, there is little evidence of the efficacy of the practice or of its impact on patients and nursing staff. Unnecessary use of this practice can be restrictive and distressing for all involved and can cause considerable strain on healthcare resources. We sought to review interventions aiming to improve the quality and safety of constant observation or to reduce unnecessary use of this restrictive practice on adult inpatient psychiatric wards. A systematic search conducted in December 2018 using PubMed, PsycINFO, CINAHL, EMBASE and Google Scholar identified 24 studies with interventions related to constant observation. Only 16 studies evaluated a total of 13 interventions. The most common intervention components were changes to team, education and training for staff, changes to record keeping and assessment, and involving patients in care. A range of outcome measures were used to evaluate interventions. Over half of the interventions showed some positive impact on constant observation. One study recorded patient feedback. All interventions were targeted towards mental health nurses. Overall, there is no consensus on how best to improve the safety and quality of constant observations or reduce its unnecessary use. Studies vary widely in design, intervention and outcome measures. Existing research does however suggest that teamwork interventions can improve the patient experience of constant observation and safely reduce their degree and frequency. Priorities for future research on constant observations are highlighted.

Comportamentos auto-lesivos na adolescência: intervenção do enfermeiro especialista em saúde mental e psiquiátrica / Self-injurious behaviors in adolescence: intervention of the specialist nurse in mental and psychiatric health

Os Comportamentos Auto-Lesivos (CAL) afirmam-se como uma problemática séria de saúde pública e mental que em 2018 afetou cerca de 20% dos adolescentes portugueses. Descrito como comportamento deliberado realizado por uma pessoa que tem intenção de provocar lesões a si mesmo, podendo existir ou não, intenção suicida, os CAL parecem ser uma estratégia adotada pelos adolescentes para regulação emocional, por existirem pensamentos e sentimentos negativos, associados à incapacidade e imaturidade de gerir as emoções e controlar os impulsos, comuns na adolescência. As abordagens terapêuticas descritas na literatura evidenciam a importância de desenvolver com os adolescentes, estratégias de identificação de emoções, sentimentos e reações comportamentais a processos intra e interpessoais, que por serem vivenciados de forma desajustada causam sofrimento mental. Para o desenvolvimento de competências do Enfermeiro Especialista em Saúde Mental e Psiquiátrica (EESMP) foi realizado um estágio com vertente hospitalar e comunitária. O estágio hospitalar teve como objetivo desenvolver técnicas psicoterapêuticas e socioterapêuticas, promotoras do desenvolvimento de competências de gestão emocional; sociais e de resolução de problemas em adolescentes que adotam CAL. As intervenções de enfermagem especializadas a esta população foram suportadas pela Teoria das Relações Interpessoais de Hildegard Peplau. A avaliação do risco clínico; a promoção do milieu therapy e o desenvolvimento de intervenções especializadas de enfermagem promoveram a diminuição do sofrimento associado, resultando na diminuição do risco de CAL. O estágio em contexto comunitário permitiu desenvolver competências de enfermagem no âmbito da promoção de saúde mental na primeira infância. Este relatório dá conta do percurso desenvolvido e agrega um conjunto de propostas de intervenção do EESMP no âmbito dos Comportamentos Auto-Lesivos na Adolescência.

Non-suicidal self-injury (NSSI) is a serious problem of public and mental health, that in 2018 affected almost 20% of the portuguese adolescent. Described as a deliberated behavior made by a person who as the intention to make injury to his self, with or without suicidal ideation, NSSI seems to be a strategy used by adolescents to emotional regulation, for existing bad thoughts and feelings, usually associated to the incapacity and immature to deal with their emotions and self-control, common at adolescence. Therapeutic approaches described at the literature evidence the importance of development with the adolescent strategies to identify emotions, feelings and reactions behavioral to intra and interpersonal processes, that experienced in an unsuitable mode, cause mental suffering. To the development of the skills of the mental health and psychiatry specialized nurse, was performer an internship at the community and at the hospital. The hospital internship aimed at the development of psychotherapeutic and social therapeutic techniques, promoting the development of emotional management skills; social skills and problem-solving skills at adolescents that commit NSSI. Specialized nursing interventions to this population were supported by the Theory of Interpersonal Relations by Hildegard Peplau. Risk assessment; the promotion of milieu therapy and the development of specialized nursing interventions promoted a reduction of the suffering associated, resulting in a decrease of the NSSI risk. The community internship allowed the development of the nursing skills within the scope of the promotion of mental health in the early childhood. This academic report gives an account of the course developed and adds a set of intervention proposals by the EESMP in the context of NSSI in Adolescence.

Self-harm presentations in emergency departments: staff attitudes and triage.

Addressing the rising incidence of self-harm and the demand this places on emergency departments (EDs) are UK Government healthcare priorities. A history of self-harm is linked with suicide risk, so self-harm is a public health issue. The ED is the first point of contact for many people who self-harm so it plays a pivotal role in access to services. Research has highlighted difficulties around triage and assessment in EDs of patients who self-harm, especially frequent attenders. The evidence base on patient experience related to addressing negative staff attitudes is lacking, despite their potent nature and impact on care. Limited knowledge of self-harm aetiology and clinical inexperience have been found to be fundamental to nurses' negative attitudes when dealing with patients who self-harm. This has been linked to negative patient outcomes, including a reluctance to engage with services. This article acknowledges positive changes that have been made and highlights the importance of the triage stage, which is a potential service improvement area, where it would be possible to start and drive positive change in the care of people who self-harm. To address knowledge gaps in education and management, clinical understanding of the aetiology of self-harm should be improved with the aid of education on self-harm cycles. Nurses should also be made aware of common myths surrounding self-harm, as these are barriers to care. Recommendations for practice include partnership working and the urgent need for formal education on this topic for all health professionals working in EDs.

Brief admission (BA) for patients with emotional instability and self-harm: nurses' perspectives - person-centred care in clinical practice.

Purpose: Emotional instability and self-harm pose major problems for society and health care. There are effective interventions in outpatient care, but when patients need inpatient care, nurses often struggle meeting their patient's needs. Brief admission (BA) is a newly implemented crisis intervention and novel form of inpatient care. The aim of this study is to describe nurses' experiences working with BA related to patients with emotional instability and self-harm. Methods: Eight nurses were interviewed according to a semi-structured interview guide. The data was analysed using qualitative content analysis. Results: Four main categories emerged regarding nurses' experiences with BA: provides security and continuity, fosters caring relationships, shifts focus towards patient's health and empowers the patient. The nurse's role shifted from "handling problems" to establishing caring relationships with a focus on the person's health and possibilities for recovering instead of psychiatric symptoms. Conclusions: Previous studies on patients' perspective of BA describe positive experiences such as increased autonomy and participation in the healthcare process. This study supports those findings, albeit from the perspective of nurses. Our findings suggest that BA may reduce work-related stress experienced by nurses while caring for persons with emotional instability and self-harm. BA may also support nurses in their ability to provide more meaningful and constructive psychiatric inpatient care.

If You Could Change 1 Thing to Improve the Quality of Emergency Care for Deliberate Self-harm Patients, What Would It Be? A National Survey of Nursing Leadership.

INTRODUCTION: Emergency departments increasingly treat patients for deliberate self-harm. This study sought to understand emergency department nursing leadership perspectives on how to improve the quality of emergency care for these patients. METHODS: ED nursing managers and directors from a national sample of 476 hospitals responded to an open-ended question asking for the 1 thing they would change to improve the quality of care for self-harm patients who present in their emergency departments. We identified and coded key themes for improving the emergency management of these patients, then examined the distribution of these themes and differences by hospital characteristics, including urbanicity, patient volume, and teaching status. RESULTS: Five themes regarding how to improve care for deliberate self-harm patients were identified: greater access to hospital mental health staff or treatment (26.4%); better access to community-based services and resources (26.4%); more inpatient psychiatric beds readily accessible (20.9%); separate safe spaces in the emergency department (18.6%); and dedicated staff coverage (7.8%). Endorsement of findings did not differ based on hospital characteristics. DISCUSSION: ED nursing leadership strongly endorsed the need for greater access to both hospital- and community-based mental health treatment resources for deliberate self-harm patients. Additional ED staff and training, along with greater continuity among systems of care in the community, would further improve the quality of emergency care for these patients. Broad policies that address the scarcity of mental health services should also be considered to provide comprehensive care for this high-risk patient population. KEY WORDS: Emergency department management of self-harm; Mental health care; Emergency nursing care.

'There is no progression in prevention' - The experiences of mental health nurses working with repeated self-harm.

Caring for people who self-harm is an everyday experience for mental health nurses and an important part of their role. How mental health nurses respond to and support those who self-harm can have a significant impact on the outcomes for service users and their intentions to seek help in the future. Repeated self-harm can be a particularly challenging phenomenon as it is often misunderstood and can have a negative impact on the therapeutic relationship. This qualitative descriptive study aims to explore how mental health nurses understand and work with repeated self-harm. Nine nurses working in a range of mental health settings within one service participated in semi-structured interviews which were analysed thematically. Findings are presented in two themes exploring participants' perceptions and understanding of repeated self-harm, and the process of learning to work with repeated self-harm, and are reported in accordance with the consolidated criteria for reporting qualitative research guidelines (COREQ). Participants reported that nursing practice relating to repeated self-harm remains largely focused on maintenance of safety and prevention of self-harm despite the identification that this often does not work. It was accepted that there is sometimes a lack of understanding about the function of self-harm; however, participants reported understanding increased following specific education about self-harm. Participants also identified the potential for more empowering and recovery-orientated responses, including the utilization of harm reduction approaches, to the care of those who repeatedly self-harm.

Emergency department care for patients with mental health problems, a longitudinal registry study and a before and after intervention study.

OBJECTIVE: To describe the numbers and length of stay (LOS) of patients with mental health (MH) problems at a Dutch emergency department (ED) and the effect of a psychiatric intervention team (PIT) on patient flow. METHODS: A longitudinal design was used to assess number of MH presentations and LOS during a 3-year period (2014-2016). In 2017, we introduced a PIT during ED peak hours, to reduce LOS for patients with MH problems. We evaluate the effects of the PIT on patients' LOS with an 18-month before and after intervention study (2017-2018). RESULTS: Total number of ED presentations increased with 4%. Total number of MH presentations increased with 23% from 2014 to 2016. LOS increased by 28 min (95 min vs. 123 min) for all presentations, while not changing for MH presentations (2014: 195 min, interquartile range (IQR) 120-293 and 2016: 190 min, IQR 116-296). In the before and after intervention study, number of MH presentations increased with 36% while LOS decreased with 46 min (p < 0.001). CONCLUSIONS: The number of MH presentations increased over the three years while LOS remained similar. In the before and after intervention study, number of presentations increased even more while LOS decreased significantly. Specialist psychiatric input reduces ED LOS.

A nurse practitioner-led intervention for runaway adolescents who have been sexually assaulted or sexually exploited: Effects on trauma symptoms, suicidality, and self-injury.

BACKGROUND: Adolescent victims of sexual assault and exploitation suffer significant mental health distress including PTSD, self-harm, suicidal ideation, and attempts. OBJECTIVE: This longitudinal observational study investigated the Runaway Intervention Program's influence on trauma responses at 3, 6, and 12 months for adolescents who have run away at least once and have been sexually assaulted or exploited. PARTICIPANTS: Runaways (n = 362) received nurse practitioner (NP) home and community visits, intensive case management, and optional empowerment groups. SETTING: An urban Midwestern city's hospital-based Children's Advocacy Center. METHODS: Trauma responses were measured by the UCLA PTSD-RI index, past 30 days emotional distress scale, and self-harm, suicidal ideation, and suicide attempt questions. Repeated Measures ANOVA assessed trauma response changes over time. Growth curve analyses using intervention doses determined which aspects of the intervention predicted change. RESULTS: From program entry to 3 and 6 months, mean values decreased significantly for emotional distress (-0.67, -.91) self-harm (-.30, -.55), suicidal ideation (-.45, -.57), suicide attempts (-.58, -.61), and trauma symptoms (-11.8, -16.2, all p < .001) all maintained at 12 months. In growth curve models, NP visits independently predicted declines in emotional distress (-.038), self-injury (-.020), suicidal ideation (-.025) and attempts (-.032), while empowerment groups predicted trauma symptoms (-.525) and all others except suicide attempts. CONCLUSIONS: The program, especially NP community visits and empowerment group elements, decreased trauma responses in runaway youth with a history of sexual assault. Given high rates of PTSD and emotional distress among runaways, the Runaway Intervention Program offers promise for improving mental health outcomes.

Emergency department nurse's attitudes towards patients who self-harm: A meta-analysis.

Self-harm is a major challenge to public health. Emergency department (ED) nurses treat significant proportions of patients with self-harm injuries, and positive therapeutic patient-nurse interactions are imperative to the physical and psychological outcome of this vulnerable patient group. Research, both nationally and internationally, suggests that treating those with self-harm injuries is emotionally challenging, and ambivalence, powerlessness, and ineffectiveness are commonly manifested in negative attitudes towards these patients. Following the PRISMA guidelines, this systematic review with meta-analyses examined the attitudes of ED nurses towards patients who self-harm, based on currently available evidence. The following databases were searched: CINAHL complete; Medline complete; PsycARTICLES; PsycINFO; The Allied and Complementary Medicine Database; Health Source: Nursing/Academic Edition; PsycEXTRA; and Psychology and Behavioural Sciences Collection. Clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant reports to identify additional studies, were also searched. Five studies were included in the meta-analysis. The Self-Harm Antipathy Scale (SHAS) was used as an outcome in two studies appropriate for meta-analysis. The Attitudes Towards Deliberate Self-Harm Questionnaire (ADSHQ) scale was used as an outcome in three studies appropriate for meta-analysis. Results demonstrated limited empathy and negativity towards patients who self-harm, indicating a requirement for education and supervision of ED staff, where the SHAS or the ADSHQ can be used to monitor attitude change. Self-harm educational content for ED staff should include areas of knowledge building including explanations and causes of self-harm; range, forms, and functions of self-harm; staff responses to self-harm; assessment, management, and interventions; professional practice issues.

Unplanned extubations in general intensive care unit: A nine-year retrospective analysis.

BACKGROUND AND AIM: Unplanned extubation (UE) in Intensive Care Units (ICU) is an indicator of quality and safety of care. UEs are classified in: accidental extubations, if involuntarily caused during nursing care or medical procedures; self-extubation, if determined by the patient him/herself.  In scientific literature, the cumulative incidence of UEs varies from 0.3% to 35.8%. The aim of this study is to explore the incidence of UEs in an Italian university general ICU adopting a well-established protocol of tracheal tube nursing management and fixation. METHODS: retrospective observational study. We enrolled all patients undergone to invasive mechanical ventilation from 1st January 2008 to 31st December 2016. RESULTS: in the studied period 3422 patients underwent to endotracheal intubation. The UEs were 35: 33 self extubations (94%) and 2 accidental extubations (6%). The incidence of UEs calculated on 1497 patients intubated for more than 24 hours was 2.34%. Instead, it was 1.02%, if we consider the whole number of intubated patients. Only in 9 (26%) cases out of 35 UEs the patient was re-intubated. No deaths consequent to UE were recorded. CONCLUSIONS: The incidence of UEs in this study showed rates according to the minimal values reported in scientific literature. A standardized program of endotracheal tube management (based on an effective and comfortable fixing system) seems to be a safe and a valid foundation in order to maintain the UE episodes at minimum rates.

Harm-reduction approaches for self-cutting in inpatient mental health settings: Development and preliminary validation of the Attitudes to Self-cutting Management (ASc-Me) Scale.

WHAT IS KNOWN ON THE SUBJECT?: Nurses in mental health inpatient settings use a range of methods to try and help service users who self-harm Harm-reduction approaches are intended to help service users reduce the impact of their self-harm rather than simply to prevent them self-harming Harm-reduction techniques might be helpful for people who cut themselves because there are some clear ways harm can be minimized such as providing advice about cutting No one has previously tried to measure whether harm-reduction techniques are more or less acceptable to mental health practitioners and service users than traditional methods. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper describes the development of the Attitudes to Self-cutting Management scale. It met the criteria required of a good measurement tool. Each method of managing self-cutting has a unique acceptability profile Harm-reduction methods like advising on wound care and providing a first aid kit are endorsed by nurses and former service users Nurses providing sterile razors or remaining present during self-cutting attract more divergent opinions but are preferred to seclusion and restraint. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses should talk through the approaches to management with service users and agree which techniques are preferred. ABSTRACT: Introduction Harm-reduction approaches for self-harm in mental health settings have been under-researched. Aim To develop a measure of the acceptability of management approaches for self-cutting in mental health inpatient settings. Methods Stage one: scale items were generated from relevant literature and staff/service user consultation. Stage two: A cross-sectional survey and statistical methods from classical test theory informed scale development. Results/Findings At stage one, N = 27 staff and service users participated. At stage two, N = 215 people (n = 175 current mental health practitioners and n = 40 people with experience of self-cutting as a UK mental health inpatient) completed surveys. Principal components analysis revealed a simple factor structure such that each method had a unique acceptability profile. Reliability, construct validity and internal consistency were acceptable. The harm-reduction approaches "advising on wound care" and "providing a first aid kit" were broadly endorsed; "providing sterile razors" and "maintaining a supportive nursing presence during cutting" were less acceptable but more so than seclusion and restraint. Discussion The Attitudes to Self-cutting Management scale is a reliable and valid measure that could inform service design and development. Implications for practice Nurses should discuss different options for management of self-cutting with service users. Harm-reduction approaches may be more acceptable than coercive measures.

[The practice of special observation in adults in the German-speaking part of Switzerland - a descriptive cross-sectional study]. / Die Praxis der psychiatrischen Intensivbetreuung bei Erwachsenen in der Deutschschweiz ­ eine deskriptive Querschnittstudie.

The practice of special observation in adults in the German-speaking part of Switzerland - a descriptive cross-sectional study Abstract. INTRODUCTION: Psychiatric Special Observation (PSO) is an intervention often used by nurses to prevent service users of harming themselves or to protect others. The intervention ranges between control and therapy and is resource intensive. Despite the widespread use of PSO, there is still no data on the practice of the intervention in Switzerland. AIM: What is the current practice of PSO in adults in psychiatric hospitals in the German-speaking part of Switzerland? METHOD: Descriptive cross-sectional study. Nurses from inpatient psychiatric services in the German-speaking part of Switzerland completed a questionnaire based on a concept analysis of PSO. RESULTS: 538 questionnaires were analysed. PSO was more often conducted intermittent than as constant observation. In more than one out of four cases, suicidality reasoned as a cause for prescription. Nurses generally used standardized instruments to assess the risk of harming oneself or others. The duration of PSO lasted eight hours or more in three out of four cases. In every fifth case, there was no validation of the need of the intervention taking place during one shift. Nurses have a neutral attitude towards the intervention and are experiencing no or weak negative feelings during performance of PSO. CONCLUSIONS: The results suggest that there is an inconsistent performance of PSO in Switzerland as well as in other countries. The validation of the need of the intervention is insufficient. To facilitate PSO as a justified performance, the preparation of an interprofessional guideline is recommended.

[An overview of suicide risk in adolescence]. / Un état des lieux du risque suicidaire à l'adolescence.

Suicidal behaviour in adolescence is a major public health issue. It is the consequence of a sum of individual, relational and environmental difficulties that weaken the subject in a period of great vulnerability. The main aspects of their care consist in developing a good therapeutic link and adapting the adolescent's environment. Prevention is the concern of everyone, especially healthcare professionals who are regularly consulted before suicidal acts.

[Links between self-harm and suicidal behaviour in adolescents]. / Liens entre conduites automutilatoires et suicidaires chez les adolescents.

Nonsuicidal self-injury (NSSI) and suicidal behaviour (SB) are both important issues in adolescent health care. The fact that they frequently coexist means that it is important to consider the nature of the link between them and the ways they are understood. Suicide and self-injury share the same risk factors. Integrated models envisage NSSI as a gateway enabling teenagers to acquire a capability for suicide. The act short-circuits the thought process and the intention to die underlying the act appears difficult to assess.