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Prison self-injury rate accelerates at four times the rise in population” (The Howard League for Penal Reform; 2008a) The rise in self-harm figures in forensic settings in 2003 may largely be due to the improvement in the reporting of self-harm levels in prisons in December 2002. However it does not account for the continued rise in self-harm figures during the years that followed. Despite the increase, there have been few interventions to support prisoners who self-harm, particularly in remand settings. For this purpose the Carousel programme was designed by a counselling psychologist specifically to meet the demands of the female remand population. The aim of this study was to evaluate the effectiveness of Carousel. Forty women who had a history of deliberate self-harm entered and completed the programme through means of self-referral. The study employed both a quantitative and qualitative methodology to evaluate the programme. Participants were interviewed and assessed both at the start and completion of Carousel. This included monitoring levels of self-harm incidents, levels of anxiety and depression using the 14-item Hospital Anxiety and Depression Scale (HADS) (Zigmond & Snaith, 1983), and coping levels using the 60-item Coping Styles Questionnaire (CSQ) (Roger, Jarvis & Najarian, 1993). Results showed a significant decrease in depression and anxiety, a reduction in self-harm levels and a change of coping styles in the desired direction. Qualitative methodology using content analysis was employed to ascertain the components of the programme which were deemed most helpful or unhelpful to the participants. Findings suggest that the most useful components within the programme are coping strategies, management of self-harm behaviours, antecedent, behaviour and consequence (ABC) sessions and the understanding of the brain and associated emotions with self-harm behaviours. Implications for counselling psychology and clinical practice are highlighted and limitations of the current study and directions for future research suggested within the report.

The aim of this study was to investigate how adults 25 years old and over describe the functions of their non-suicidal self-injury (NSSI) and to explore whether they report any changes in their experience with NSSI as they become older. Qualitative e-mail interviews were used in order to capture the participants’ experiences. The results of the study were analysed based on coping theory and previous research. The results indicate that, consistent with previous literature, adults self-injure for mostly the same reasons as adolescents – however, as the previous research shows adolescents are more likely to hurt themselves in order to communicate with others. The adults in the present sample report using problem-solving coping strategies to the same extent as emotion-focused strategies; a slight deviation from previous research which has suggested that people who self-injure are more likely to employ emotion-focused strategies. The participants of the study generally experience a feeling of increased control and deliberation of their self-injury as they have gotten older; hurting themselves has become a purposeful coping strategy. The results of this study might have implications for treatment of self-injury in adults; focusing the treatment on strengthening the adults’ autonomy and encouraging further problem-solving coping strategies might be beneficial.

Patients who self-harm reported negative staff attitudes towards them on presentation to an Emergency Department (ED). The present research aims to explore staff attitudes and behaviours (own and perception of others’) and the impact of this on behaviour, barriers and facilitators of effective treatment, and team identification and norms. Ten staff members from one ED were interviewed, representing all major professional groups working non-therapeutically in the ED. A thematic framework analysis was applied and cross-referenced with another researcher and participants for validation. Analysis identified the following themes: Beliefs about self-harm, attitudes and behaviours, influences on behaviour, and identity, culture and role; related through an overarching theme of balancing difference and diversity. Evidence of PI was found, although interviewees were able to accurately recognise a mixture of beliefs and attitudes in both themselves and others. Influences on behaviour and identity were important in gaining a contextual perspective, and the concept of a ‘fluid team’, relating to patient needs, was highlighted. Results suggest that exposure of the phenomenon of PI may be useful, in conjunction with training to minimise feelings of failure/frustration. This could increase understanding and improve patient care; however, further research is required prior to this. Team stability must, however, be considered. Limitations included restricted participation across one ED and a powerful advocate for mental health patients. Although this is positive for the department, it may set it apart from others.

Bakgrund: Självskadebeteende är ett sedan länge förekommande fenomen som kan vara framträdande hos patienter med en oförmåga att reglera affekter. Det innebär ett lidande för patienterna och det bidrar till en känslomässig påverkan hos sjuksköterskorna. För att skapa en gynnsam omvårdnadsrelation behövs resurser, kunskap, kompetens och stöd för sjuksköterskorna i omvårdnaden. Syfte: Beskriva sjuksköterskans erfarenheter och upplevelser av att vårda patienter med självskadebeteende. Metod: Data samlades in från sex sjuksköterskor genom kvalitativa semi-strukturerade intervjuer med stöd av en intervjuguide. Materialet har analyserats med kvalitativ innehållsanalys. Resultat: Det framkom fyra kategorier "Att självskada", "Behov av kompetens", "Ge omvårdnad" och "Känslomässig påverkan". Sjuksköterskorna lyfte svårigheter i omvårdnaden, behovet av kompetens och den känslomässiga påverkan de drabbades av i mötet med patienter med självskadebeteende. Slutsats: Självskadebeteende skapar många olika känslor hos sjuksköterskorna, både positiva och negativa. Sjuksköterskorna upplevde att patienter med självskadebeteende var en svår, men intressant grupp att arbeta med. Tidsbrist, stress och upprepade självskadehandlingar var påfrestande och de känslor som uppkom hos sjuksköterskorna var inte alltid lätta för dem att hantera. Sjuksköterskorna poängterade vikten av att fånga upp patienter i tid men beskrev även svårigheterna i att kunna göra det. Sjuksköterskorna efterfrågade utökat stöd, kunskap och bättre resurser för att känna sig trygga i sin yrkesroll samt för att kunna erbjuda patienter med självskadebeteende en god och säker omvårdnad. / Background: Self-harm behavior is a long-standing phenomenon and is often prominent in the inability to regulate emotions. It creates suffering for the patients and it provides an emotional impact of the nurses. In order to create a favorable caring relationship resources needed, expertise and support for nurses in nursing. Purpose: Describe nurses' experiences of caring for patients with self-harm behavior. Method: Data were collected from six nurses through qualitative semi-structured interviews with the support of an interview guide. The material was analyzed using qualitative content analysis. Results: It emerged four categories "to self-harm," "Need for skills", "Giving care" and "emotional impact". The nurses lifted the difficulties in the care, the need for skills and the emotional impact they suffered in the meeting with patients with self-harm behavior. Conclusion: Patients with self-harm behavior have an emotional impact on nurses, giving them both negative and positive feelings. The nurses felt that patients with self-harm behavior were a difficult, but interesting group to work with. Lack of time, stress and repetitive self-harm behavior were stressful for the nurses. The nurses requested more support, knowledge, competence and resources to feel safe and strong in their professional capacity and to able to offer a high-quality care for the patients.

Denna studie undersökte varför vissa ungdomar både rapporterar höganivåer av kriminalitet och självskadebeteende samt hur detta hängerihop med att utsätta andra för aggressiva handlingar och att själv bliutsatt för aggressivitet av andra. Som teoretisk utgångspunkt användescoercion-teorin som förklarar varför vissa barn och ungdomar både ärutsatta för andras aggressioner och utsätter andra för aggressionerutanför hemmet. Studien grundas på data som bestod av självrapporterfrån en longitudinell studie vid namn Sju skolor. Studien genomfördesi en mellanstor svensk stad. Totalt deltog 1482 ungdomar varav 52procent var män. Resultaten visade att det fanns en grupp ungdomarsom rapporterade höga nivåer av både kriminalitet ochsjälvskadebeteende. Utmärkande för denna grupp var att de bådeutsatte andra för aggressiva handlingar samtidigt som de själv blevutsatta för andras aggressivitet. Denna kunskap kan användas av olikamyndigheter vid förebyggande insatser för ungdomar som harproblem med kriminalitet och självskadebeteende. / This study examined the association between delinquent behaviorsand self-harm in adolescents, and how mutual hostility interactbetween exposing others and being exposed. Data was based on selfrapportsin a longitudinal study called Seven schools and wereperformed in a medium sized city in Sweden. The study including1482 participants, among them 52 percent were males. The resultshowed that those adolescents who reported high levels of delinquentbehavior and high levels of self-harm were both exposed and exposesothers to hostility. Coercion theory was used to explain the mutualhostility.

Bakgrund: Forskning visar att den psykiska ohälsan hos barn och ungdomar ökar, inte minst när det gäller flickor i tonåren. Detta leder till att flickorna får ångest som de hanterar genom att utveckla ett självskadebeteende. Skolsköterskorna har möjlighet att uppmärksamma dessa flickor genom det dagliga hälsofrämjande omvårdnadsarbetet.   Syfte: Syftet med studien var att beskriva skolsköterskors erfarenhet av att möta flickor med ett självskadebeteende. Metod: I studien användes en kvalitativ metod och resultatet analyserades genom innebördsanalys. Sex skolsköterskor intervjuades via e-postintervju. Resultat: Studien resulterade i tre innebördsteman som var: flickorna uppmärksammas på olika vis, erfarenhet av samarbete och skapa goda relationer. Konklusion: Studien visade att skolsköterskorna möter flickorna med självskadebeteende antingen via hälsosamtal eller genom att omgivningen larmar om att flickorna mår dåligt. Studien visar också att skolsköterskorna upplever frustration när samarbeten med externa aktörer så som barn och ungdomspsykiatrin inte fungerar och mycket av ansvaret läggs på skolsköterskorna. Studien visade även att samverkan med vårdnadshavare är viktigt i arbetet med flickorna. / Background: Research shows that mental disorders in children and adolescent is increasing, especially when it comes to teenage girls. This may increase anxiety in some girls, which they might handle by developing self-harm behavior. School nurses are able to pay attention to these girls through daily health promotion nursing work. Aim: The aim of the study was to describe the school nurse’s experience of meeting girls with self-harm behavior. Method: A qualitative method was used in the study and the result was analyzed according to meaning analysis. Six school nurse were interviewed by email interviews. Result: The study resulted in three meaning subjects; the girls are noted differently, experience of cooperation and create good relationships. Conclusion: The study showed that the school nurses meet girl with self-harm behavior, either through health interviews or by the environment warning that the girls feel bad. The study also shows that school nurses are experiencing frustration when cooperation with external actors such as children and adolescent psychiatry does not work and much of the responsibility is left with the school nurses. The study also showed that cooperation with parents is important when working with these girls.

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Student Number : 9304796E - MA research report - School of Psychology - Faculty of Humanities / The central aim of this research was to ascertain the psychological meaning of, and motivation for body piercing in a sample of female body modifiers. It was decided to conduct research on the psychology of body piercing because although medical, anthropological and social research has been conducted into piercing practices and body modification, very little has focused on the underlying psychological meanings and motivations associated with body modification. Furthermore, the focus of this study was limited to women because it was felt that had both genders been included, possibly gender based differences would have caused the scope of the research project to become too wide. By focusing specifically on women, it was felt that a deeper understanding of the underlying psychological motivations for the piercing of the female body could be explored. For the purposes of this research, the operational definition of body piercing is defined as that which does not echo mainstream fashion trends or promote Eurocentric, socially sanctioned ideals of beauty. The participants needed to have pierced body parts (excluding their earlobes), and the piercings or the piercing process should hold specific significance and meaning for them. Participants who had pierced body parts only for aesthetic reasons were excluded from this study. Those who were included attributed more than just a decorative function and aesthetic value to their body piercings. In other words, they deviated from mainstream piercing practices in terms of the meanings they attach to their piercings. Some of the piercings and piercing practices and processes undertaken by the participants represent a departure from the ‘norm’, and have been described as bordering on pathological. The research sought to identified commonalities and differences amongst the participants and to understand their experiences and behaviour within the context of psychodynamic feminist frameworks. Broadly defined, feminism is a movement organized around the belief that men and women are/should be socially, politically and economically equal. Contemporary feminism, which influences perceptions of female body modification, is split into two distinct strands: one school of feminism views body modification as a form of self-injury and self-mutilation while the other holds that it is a positive resistance in the face of gender norms (Pitts, 2003). This was taken into account in this study. Given that the participants were all women, and that the relationship between body modification and social structures of power/authority are a central concern in feminist literature (Atkinson, 2002), this paradigm was chosen because it provides an appropriate and relevant framework within which to explore the underlying motives and meaning of body piercing for female body piercers. Their attitudes, meaning making processes and relationships with their bodies in relation to their piercings are used to uncover the significance of their body projects and their decisions to be pierced. The central themes which emerged through the thematic data analysis are related back to the feminist literature. Psychoanalysis explores repressed or unconscious impulses, object relations, anxieties, and internal conflicts. For this reason, a psychodynamic framework was used to provide a context within which to explore the unconscious motivations, anxieties and defenses employed by the participants. Freud’s theories of masochism are examined in an attempt to further understand the female body piercer. These are placed within a general psychodynamic framework, and the works of Bowlby, Fonagy, Kernberg, Malan and Winnicott are used to support the findings of the research. The research is based in the qualitative paradigm, with the aim of exploring and describing the body modifier’s thoughts, fantasies, feelings and experiences around being pierced. The data gathered was analyzed using thematic content analysis to elucidate the participants’ reasons for choosing to modify their bodies, and to highlight the meanings of these practices in the context of the their personal histories. In total, six participants were interviewed, although one interview was not included for analysis as it was felt that the data gathered from this interview, while not contradicting the rest of the data gathered, was superficial in content and did not contribute to the research. The excluded participant spoke very broadly and did not really offer much personal information as to the meaning and motives behind her piercings. The research explored the history of body modification, definitions of body modification and body projects, issues pertaining to identity, body image and self concept, expanded consciousness and altered states of being, pain and sadomasochism, the pathologizing of body modification, feminist perspectives on body modification and psychodynamic explanations for body modification. Although much literature abounds on body modification practices, very little is of academic significance. Furthermore, few studies have been conducted into this area from a psychological perspective. In this regard, the writings of Favazza (1996), Featherstone (2003) and Vale & Juno (1989) were used to provide a context within which to place this study. Research papers by Atkinson (2002) and Dennes (2005) also proved particularly useful, and will be discussed in the following chapter.

Litteraturöversikten belyser den typ av självskadebeteende som medför ytliga eller måttliga hudskador, där beteendet inte avser leda till suicid. Vårdande utgör sjuksköterskans specifika kompetensområde. Sjuksköterskan bär ansvaret att se patienten ur ett holistiskt perspektiv, med respekt för individens integritet, anatomi och värdighet. Sjuksköterskans förhållningssätt påverkar hur vårdmötet utformas, vilken forskning påvisar att patientgruppen upplever bristande. Attityder blir därmed avgörande för ett adekvat vårdande Syfte: Syftet var att belysa sjuksköterskans attityder till att vårda patienter med självskadebeteende. Metod: Arbetet baseras på en litteraturöversikt, där 10 artiklar av kvalitativ eller kvantitativ metod granskades. Underlaget ger en övergripande bild av dagens aktuella kunskaper inom det valda området. Resultat: Resultaten visade en del positiva, dock huvudsakligen negativa attityder. Resultatet tydliggör sjuksköterskors förståelse, känslor och förhållningssätt till patienter med självskadebeteende. Sjuksköterskornas känslor påverkades av deras kunskaper om självskadebeteende, vilken i sin tur påverkade deras handlingar. Sjuksköterskornas kompetens hade en direkt inverkan på attityderna, och vice versa. Diskussion: I resultatdiskussionen relateras valda delar utifrån centrala begrepp som framkom i översiktens resultat, mot Tidsvattenmodellen av omvårdnadsteoretikerna Phil Barker och Poppy Buchanan-Barker. Sjuksköterskornas bristande kunskap, upplevda omvårdnadsansvar samt emotionella påverkan, är faktorer med stor inverkan på sjuksköterskors attityder i vården av patienter med självskadebeteende. Dessa faktorer är avgörande för möjligheterna till framtida förbättringar inom området. / The literature review highlights the type of superficial or moderate skin injuries, where the behavior does not intend to lead to suicide. Caring constitutes the nurse's specific skills. Hence, the nurse is responsible for seeing the patient through a holistic perspective, respecting the individual's integrity, anatomy and dignity. This becomes a basis for how the care encounter will be designed, with research showing that these patients experience lacking. Hence, attitudes determine the quality of the care given. Aim: The purpose was to illuminate the nurse's attitudes to care for patients with self-harm behaviour. Method: The method that forms the basis of our work is a literature review. Ten articles, of qualitative and quantitative nature, have been reviewed. These gave an overall picture of current knowledge in the field chosen Results: The results showed some positive but mostly negative attitudes. The results of the work clarify nurses’ understanding, feelings and approaches to patients who self-harm. Nurses feelings towards self-harm were influenced by their knowledge and understanding, which affected their actions and approaches. Nurses’ skills showed a direct impact on the attitudes toward the patients, and vice versa Discussion: Selected parts are related to key concepts as expressed in the results of the survey, against the Tidal model of Phil Barker and Poppy Buchanan-Barker. The nurse's lack of knowledge, the nurses' perceived nursing responsibility and the emotional impact, are all factors that greatly affect the attitudes of nurses in the care of patients with self-harm behaviour. These are crucial factors for the possibility of future changes in the area