Being burdened and balancing boundaries: a qualitative study of nurses' experiences caring for patients who self-harm.

Although nurses encounter self-harm patients in various settings, self-harm has seldom been addressed in psychiatric nursing research. The research question was: 'What are nurses' descriptions of experiences of caring for psychiatric patients who self-harm?' The data were comprised of text based on narrative interviews with six nurses employed in a psychiatric hospital in Sweden. By using qualitative content analysis, two themes and seven sub-themes were constructed. The theme 'Being burdened with feelings' involved the sub-themes: 'Fearing for the patient's life-threatening actions', 'Feeling overwhelmed by frustration' and 'Feeling abandoned by co-workers and management'. The theme 'Balancing professional boundaries' involved the sub-themes: 'Maintaining professional boundaries between self and patient', 'Managing personal feelings', 'Feeling confirmed by co-workers' and 'Imagining better ways of care'. Of significance are the nurses' feelings of fear, frustration and abandonment creating the sense of being burdened. This study points to the importance of releasing these burdens, not only for the sake of the nurses, but to improve the care of the patients. The importance of increased knowledge, support and supervision for professionals working with people who self-harm, not only in psychiatric care, needs to be addressed in research, education and development of practice.

Struggling for hopefulness: a qualitative study of Swedish women who self-harm.

There has been an increase in the number of Swedish psychiatric patients who self-harm, yet self-harm is seldom described in published research. The aim of this study was to describe how people who self-harm experience received care and their desired care. Nine participants, all Swedish women who had been treated for inpatient or outpatient psychiatric care, narrated their experiences of care for self-harm. Using qualitative content analysis, two themes were formulated: 'Expecting to be confirmed while being confirmed fosters hopefulness'; and, 'Expecting to be confirmed while not being confirmed stifles hopefulness'. Each of these themes emerged from five subthemes that clustered around positive and negative aspects of being seen-not being seen, being valued-being stigmatized, being connected-disconnected, being believed-doubted, and being understood-not being understood. Of significance is for nurses to view persons who self-harm as human beings and to grasp the importance of being confirmed by staff that can foster hopefulness in persons who self-harm, yet realize the possibility of the paradoxical nature of hopefulness and being confirmed.