From judgement to understanding. The influence of positive attitudinal change towards self-harm on the behaviour of mental health nurses.
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Abstract Background. Over the last decade, many articles were published on the treatment of self-harm and there has been an emphasis on the role of professionals’ attitudes towards this behaviour. Literature shows that nurses experienced feelings of frustration, anger and fear when caring for self-harm patients. In response, several training programs were developed that aimed to positively influence nurses’ attitudes. However, the influence of these training programs on mental health nurses’ behaviour towards self-harm patients is unknown. Aim. To investigate the influence of attitudinal change towards self-harm on the behaviour of mental health nurses. Research questions. How do positive attitudinal changes towards self-harm influence the behaviour of mental health nurses? What factors contribute to these actual behavioural changes in nurses? Methods. Participants were selected by means of purposive sampling. Nurses from three psychiatric organisations were included who had positively changed attitudes after a Dutch training program. Data were collected through semi-structured interviews. The constant comparative method was used to analyse the data in the three coding stages of grounded theory. Results. Eleven mental health nurses participated in the study. Ten out of these eleven participants changed their behaviour after the training-program. They reported using less restrictive interventions, being more patient oriented and choosing a more empathic and exploratory approach than before the training. The changes were enabled by a positive atmosphere among colleagues and a non-directive ward-policy. The behavioural changes had mostly positive consequences on the care participants provided and on their work-satisfaction. Conclusion. The insights from this qualitative study indicate that nurses perceive positive attitudinal changes towards self-harm to influence their behaviour to self-harm patients. Recommendations. Future research should focus on patients’ experiences with nursing care after a self-harm training program. Also, observational research is needed into the nurse-patient interaction before and after nurses’ participation in self-harm training programs.