Working effectively with clients who self-injure using a solution focused approach

Abstract

In Australia, the most common service used by self-injurers is the emergency department. Even though nurses are the key clinician available to such patients, nurses have usually received no special training to identify and address the needs of these clients. Building on the knowledge that emergency nurses feel ill-prepared, lack clear frameworks for practice and are thus vulnerable to subtle discourse tensions such as managing versus caring, and diagnosing versus understanding, an intervention was conducted and evaluated to enhance understanding and build proactive nursing skills. It was centred on a nursing philosophy known as solution focused nursing (SFN) – a model of care developed by author to orient care away from a deficit model. Deficit models tend to be reactive and centred on presenting problems. SFN is designed to move nurses' perspective towards a proactive, strengths orientation, the aim of which is to assist them to instill hope in the client and motivate him/her to take the next steps needed for change and recovery. Nurses in two Australian emergency departments completed questionnaires before and after participating in SFN training focused on working with complex clients who self-harm. A comparison group of nurses also completed questionnaires. Results indicated some benefits of the intervention; there were improvements in participants' perception that nursing is strengths oriented and in nurses' satisfaction with their skills. Yet, there were no significant improvement in nurses' reports of their professional self-concept. There is merit in: broadening access to the intervention, so that more nurses in other contexts can learn a strengths model of care and apply it to their practice; and extending the research to measure sustained learning outcomes and improvements to practice.