Background: Deliberate self-harm is when an individual deliberately exposes themselves to an act that directly damage the individual's body. Many of those who intentionally injure themselves do so to deal with anxiety and the behavior is thus used as a kind of distraction from their feelings. Today's social outlook on self-injurious behavior is in general judgmental. To have an attitude is to be emotionally preset to a situation, person or an object. Patients who self-harm currently perceive care as negative, despite existing recommendations on how to care for the group of patients. The general nurse encounters this group of patients in many places, such as the emergency room and in health centers.   Aim: The aim of the study was to examine the nurse’s attitude towards patients who self-harm.   Method: General literature review based on ten articles where six were of quantitative design, one was qualitative and three were mixed method. Through critical review and selection criteria, the articles that responded to the purpose of the literature review were selected for further analysis.   Results: Three themes were extracted: The nurse’s preunderstanding, individual factors affecting the attitude and working conditions and its impact on the attitude.    Discussion: The results discussion the authors discusses education, stigma in the healthcare sector and the importance of reflecting attitudes. The authors themselves reflects on how the quality of the nurse and patient’s relationship could be more nursing in the future. Discussions are supported partly by Katie Eriksson's concept of "care suffering" as well as relevant studies and literature. / Bakgrund: Självskadebeteende är när en individ avsiktligt utsätter sig för handlingar som gör direkt skada på individens kropp. Många av de som avsiktligt skadar sig själva gör det för att hantera ångest. Dagens samhällssyn på självskadebeteende är överlag dömande. Att ha en attityd är att vara känslomässigt förinställd till en situation, person eller ett ting. Patienter med självskadebeteende uppfattar i dagsläget vården negativt, trots befintliga rekommendationer för bemötande. Allmänsjuksköterskan kommer i kontakt med denna patientgrupp på bland annat på akuten och vårdcentraler.   Syfte: Syftet var att undersöka sjuksköterskans attityd gentemot patienter med självskadebeteende.   Metod: En litteraturöversikt grundad på tio artiklar där sex var av kvantitativ design, en var kvalitativ och tre var mixed-method. Genom kritisk granskning samt urvalskriterier valdes de artiklar som svarade på litteraturöversiktens syfte ut för att analyseras vidare.   Resultat: Resultatet synliggjordes i tre huvudteman: Sjuksköterskans förförståelse, individuella faktorer som påverkar attityden samt arbetsförhållanden och dess påverkan på attityden.   Diskussion: I resultatdiskussionen diskuteras utbildning, stigmatisering i vårdsektorn samt vikten av att reflektera kring attityder. Författarna reflekterar över hur kvaliteten i sjuksköterske- och patientrelationen ska kunna bli mer vårdande i framtiden. Diskussionen stödjs delvis av Katie Erikssons teoribegrepp ”vårdlidande” samt relevanta studier och litteratur.

<p>The purpose of the study was to describe how women with deliberate self-harm behaviour experience they have been treated when conducting health care. The study has a qualitative and descriptive approach and data was collected with snowball sampling. Data was analysed with content analysis and ended up in three theme “Feeling of violation of integrity and autonomy”, “health care staff don´t have the courage to step in and take responsibility” and “ Personal confirmation and validation of feelings”. The results showed that many women with deliberate self-harm behavior feel that they have been badly treated when they conducting health care. Furthermore, the women in this study have experienced that their integrity and autonomy have been violated. In their opinion it was difficult to get adequate treatment. The women also felt that the health care staff had difficulties taking responsibility. On the occasions the women with deliberate self-harm felt that they have been treated satisfactorily, they experienced personal confirmation and a validation of feelings. In other words they felt respectfully treated and in their opinion the health care staff took time to listen. The women in this study consider adequate treatment of proffesionell personell of importance. The conclusion is that many of the women who cut themselves, get unsatisfactorily treated when they conduct health care and that the health care staff need knowledge concerning how to treat women with deliberate self-harm. In addition this study showed that more research is needed regarding how women with deliberate self-harm experience they are treated when conducting health care.</p> / <p>Syftet med studien var att beskriva hur kvinnor med självskadebeteende upplever att de blir bemötta då de söker hälso- och sjukvård. Studien var kvalitativ med deskriptiv design. Materialet till studien samlades in via nominerat urval. Materialet analyserades med kvalitativ innehållsanalys. De teman som framkom vid innehållsanalysen var ”Känsla av kränkning av integritet och autonomi”, ” Personal vågar ej kliva in och ta ansvar”, och ” Personlig bekräftelse samt validering av känslor”. Resultatet visade att många kvinnor med självskadebeteende upplever att de blir illa bemötta då de söker hälso- och sjukvård. Kvinnorna hade en upplevelse av kränkning av integritet och autonomi. De ansåg att det var svårt att få adekvat vård. Kvinnorna upplevde att hälso- och sjukvårdens personal inte vågade kliva in och ta ansvar. Vid de tillfällen som kvinnorna med självskadebeteende upplevde att de blev bra bemötta, upplevde de en personlig bekräftelse samt validering av sina känslor. Att de blev respektfullt bemötta och att hälso- och sjukvårdens personal tog sig tid att lyssna. Att få adekvat hjälp av professionell personal ansågs viktigt. Slutsatser från föreliggande studie är att många av de kvinnor som skär sig själva, blir illa bemötta då de söker hälso- och sjukvård. Att hälso- och sjukvårdens personal behöver kunskaper i bemötande av kvinnor med självskadebeteende, samt att mer forskning på hur självskadande kvinnor upplever bemötandet av hälso- och sjukvårdspersonal behövs.</p>

<p><strong>Bakgrund:</strong> Självskadebeteendet betraktas som ett folkhälsoproblem vilket har uppmärksammats mer på senare tid. Vårdpersonal möter denna patientgrupp inom olika vårdenheter då patienter med självskadebeteende kommer in på akutmottagningar för skador de vållat själv. <strong>Syftet </strong>var att beskriva faktorer som påverkar vårdpersonalens attityder gentemot patienter med självskadebeteende. <strong>Metod:</strong> Studien gjordes som en litteraturstudie där datainsamling genomfördes i databaserna Cinahl och PsycINFO. En granskning gjordes av sju artiklar som svarade på studiens syfte. <strong>Resultat:</strong> Betydande faktorer visade att vårdpersonalen yttrar olika emotionella uttryck så som frustration och medkänsla i kontakt med patienter med ett självskadebeteende, och andra avgörande faktorer som påverkar vårdpersonalens attityder, vilket kunde vara brist på tid och otillräcklig kompetens. <strong>Diskussion:</strong> För att kunna förstå denna patientgrupp bör underliggande faktorer belysas, vilket kan då påverka vårdpersonalens attityder gentemot patienter med självskadebeteende. <strong>Slutsats:</strong> Det finns ett behov av att identifiera faktorer som skapar negativa attityder inom sjukvården. Studier bekräftar att vårdpersonalen önskar ökad kompetensutbildning.</p> / <p> </p><p><strong>Background: </strong>Self-injury regarded as a public health problem which has attracted attention more recently. Caregivers face this group of patients in different care units where patients with self-injury come into the emergency room for injuries they caused themselves. <strong>Aim: </strong>The aim was to describe factors that affect nursing staff attitudes to patients with self-injury. <strong>Method: </strong>The study was done as a literature in which data collection was conducted in the databases Cinahl and PsycINFO. An examination was made of seven articles that responded to the study purpose. <strong>Results: </strong>Significant factors revealed that caregivers respond different emotional expressions as frustration and compassion in contact with patients with a self-injury, and other crucial factors that influence health professionals' attitudes, which could be a shortage of time and insufficient skills. <strong>Discussion: </strong>In order to understand this population should be highlighted underlying factors, which may then affect the health professionals' attitudes towards patients with self-injury. Conclusion: There is a need to identify factors that create negative attitudes in health care. Studies confirm that nursing staff would increase skills training.</p><p> </p>

Bakgrund: Självskadebeteendet betraktas som ett folkhälsoproblem vilket har uppmärksammats mer på senare tid. Vårdpersonal möter denna patientgrupp inom olika vårdenheter då patienter med självskadebeteende kommer in på akutmottagningar för skador de vållat själv. Syftet var att beskriva faktorer som påverkar vårdpersonalens attityder gentemot patienter med självskadebeteende. Metod: Studien gjordes som en litteraturstudie där datainsamling genomfördes i databaserna Cinahl och PsycINFO. En granskning gjordes av sju artiklar som svarade på studiens syfte. Resultat: Betydande faktorer visade att vårdpersonalen yttrar olika emotionella uttryck så som frustration och medkänsla i kontakt med patienter med ett självskadebeteende, och andra avgörande faktorer som påverkar vårdpersonalens attityder, vilket kunde vara brist på tid och otillräcklig kompetens. Diskussion: För att kunna förstå denna patientgrupp bör underliggande faktorer belysas, vilket kan då påverka vårdpersonalens attityder gentemot patienter med självskadebeteende. Slutsats: Det finns ett behov av att identifiera faktorer som skapar negativa attityder inom sjukvården. Studier bekräftar att vårdpersonalen önskar ökad kompetensutbildning. / Background: Self-injury regarded as a public health problem which has attracted attention more recently. Caregivers face this group of patients in different care units where patients with self-injury come into the emergency room for injuries they caused themselves. Aim: The aim was to describe factors that affect nursing staff attitudes to patients with self-injury. Method: The study was done as a literature in which data collection was conducted in the databases Cinahl and PsycINFO. An examination was made of seven articles that responded to the study purpose. Results: Significant factors revealed that caregivers respond different emotional expressions as frustration and compassion in contact with patients with a self-injury, and other crucial factors that influence health professionals' attitudes, which could be a shortage of time and insufficient skills. Discussion: In order to understand this population should be highlighted underlying factors, which may then affect the health professionals' attitudes towards patients with self-injury. Conclusion: There is a need to identify factors that create negative attitudes in health care. Studies confirm that nursing staff would increase skills training.

The purpose of the study was to describe how women with deliberate self-harm behaviour experience they have been treated when conducting health care. The study has a qualitative and descriptive approach and data was collected with snowball sampling. Data was analysed with content analysis and ended up in three theme “Feeling of violation of integrity and autonomy”, “health care staff don´t have the courage to step in and take responsibility” and “ Personal confirmation and validation of feelings”. The results showed that many women with deliberate self-harm behavior feel that they have been badly treated when they conducting health care. Furthermore, the women in this study have experienced that their integrity and autonomy have been violated. In their opinion it was difficult to get adequate treatment. The women also felt that the health care staff had difficulties taking responsibility. On the occasions the women with deliberate self-harm felt that they have been treated satisfactorily, they experienced personal confirmation and a validation of feelings. In other words they felt respectfully treated and in their opinion the health care staff took time to listen. The women in this study consider adequate treatment of proffesionell personell of importance. The conclusion is that many of the women who cut themselves, get unsatisfactorily treated when they conduct health care and that the health care staff need knowledge concerning how to treat women with deliberate self-harm. In addition this study showed that more research is needed regarding how women with deliberate self-harm experience they are treated when conducting health care. / Syftet med studien var att beskriva hur kvinnor med självskadebeteende upplever att de blir bemötta då de söker hälso- och sjukvård. Studien var kvalitativ med deskriptiv design. Materialet till studien samlades in via nominerat urval. Materialet analyserades med kvalitativ innehållsanalys. De teman som framkom vid innehållsanalysen var ”Känsla av kränkning av integritet och autonomi”, ” Personal vågar ej kliva in och ta ansvar”, och ” Personlig bekräftelse samt validering av känslor”. Resultatet visade att många kvinnor med självskadebeteende upplever att de blir illa bemötta då de söker hälso- och sjukvård. Kvinnorna hade en upplevelse av kränkning av integritet och autonomi. De ansåg att det var svårt att få adekvat vård. Kvinnorna upplevde att hälso- och sjukvårdens personal inte vågade kliva in och ta ansvar. Vid de tillfällen som kvinnorna med självskadebeteende upplevde att de blev bra bemötta, upplevde de en personlig bekräftelse samt validering av sina känslor. Att de blev respektfullt bemötta och att hälso- och sjukvårdens personal tog sig tid att lyssna. Att få adekvat hjälp av professionell personal ansågs viktigt. Slutsatser från föreliggande studie är att många av de kvinnor som skär sig själva, blir illa bemötta då de söker hälso- och sjukvård. Att hälso- och sjukvårdens personal behöver kunskaper i bemötande av kvinnor med självskadebeteende, samt att mer forskning på hur självskadande kvinnor upplever bemötandet av hälso- och sjukvårdspersonal behövs.

Ohälsa bland ungdomar i Sverige inkluderar flera typer av folkhälsoproblem där psykisk ohälsa ökar och drabbar allt fler, vilket bland annat tar sig uttryck i självskadebeteende. Denna uppsats behandlar relationen mellan självskadebeteende och andra riskbeteenden utifrån datamaterialet kopplat till Liv &amp; Hälsa ung i Sörmland. Det är en återkommande totalundersökning om levnadsvanor, riskbeteenden och hälsa bland elever i årskurs 7, 9 och 2 på gymnasiet. Enkäten besvarades av 2750 elever från årskurs 9 och 2770 elever från årskurs 2. Endast flickor i årskurs 9 (n=1313) och år 2 (n=1384) på gymnasiet inkluderas i denna uppsats. För att undersöka förekomst och skillnader bland populationen har en kvantitativ metod använts. Teorin att empowerment anses vara ett viktigt verktyg för hur samhället kan hjälpa individer att stärka och bygga upp sitt självförtroende och på det sättet öka hälsan bland ungdomar diskuteras. Resultaten visar att det är vanligare att de individer som självskadar sig även utför andra riskbeteenden som till exempel daglig rökning och snatteri jämfört med kontrollgruppen. Detta kan vara en indikator för att mer fokus bör läggas på att ytterligare forska kring detta område för att framtida preventiva åtgärder skall kunna minska antalet flickor som självskadar sig. / Unhealthiness among youths in Sweden includes several kinds of public health problems where mental illness is increasing and affecting more and more people, resulting in, for example, deliberate self-harm. This thesis discusses the relations between self-harm and other dangerous behaviors based on the data set from Liv &amp; Hälsa ung in Sörmland. It is a recurring total population survey about lifestyle, dangerous behaviors and health among pupils in year 7, 9 and second year at high school. The survey was answered by 2750 pupils in year 9 and 2770 pupils in year 2 at high school. Only girls in year 9 (n=1313) and year 2 (n=1384) at high school is included in this thesis. A quantitative method was used to investigate occurrence and differences among the population. The empowerment theory is discussed, which is considered to be an important tool in order for the society to help individuals strengthen their self confidence and in that way increase the health level among youths. The results show that it is more common that self-harming individuals are also engaged in other dangerous behaviors, such as daily smoking and shoplifting, in comparison to the control group. This could serve as an indicator that the area requires more research in order to develop future preventive measures to reduce the number of girls harming themselves.

This is a qualitative study aiming to illuminate and gain better understanding of deliberate self-harm. The study has a narrative perspective and is based on three women’s life stories, focusing on a period when they had an active self-harming behaviour. The study examines what the participants experienced as important to the initiation and the cessation of the deliberate self-harm. It is also examining identity performances and turning points which can be discerned in the life stories. The analysis is based on theories of the narrative perspective and on Erving Goffman's dramaturgical perspective. Our conclusions are that the participants of the study at the time prior to the self-harming behaviour felt as outsiders, and that they lacked strategies for dealing with emotions. We also found that functional relationships had an important role for the participants to enable the cessation of the deliberate self-harming behaviour. At the time when the participants managed to end the self-harming behaviour, they all had developed more functional relationships and did not feel the same alienation. They also feel that they have a different identity now than they had during the period of deliberate self-harm.         Keywords: Deliberate self-harm, identity performances, turning points, narrative   Nyckelord: Självskadebeteende, identitetsuttryck, vändpunkter, narrativ

Tyrimo tikslas - nustatyti save žalojančių ir turinčių savižudiškų tendencijų 16-19 metų mokinių asmenybės savybių ypatumus. Tyrime dalyvavo 174 mokiniai (71 mergaitė ir 103 berniukai). Siekiant atskleisti paauglių agresyvumo bruožą, buvo pasirinktas A. H. Buss ir M. Perry (1992) Agresijos klausimynas (angl. The Buss–Perry Aggression Questionnaire), tyrime naudojamos dvi agresyvumo skalės: fizinė agresija ir priešiškumas. Savigarbai matuoti, pasirinkta M. Rosenberg (1965) Savigarbos skalė (angl. Rosenberg Self-Esteem). Siekiant atskleisti paauglių saviveiksmingumo bruožą, pasirinkta R. Schwarzer ir M. Jerusalem (1995) Saviveiksmingumo skalė (angl. General Self-Efficacy scale). Impulsyvumo savybei matuoti pasirinkta E. S. Barratt (1995) Motorinio impulsyvumo skalė (angl. Motor Impulsiveness, Baratt Impulsiveness Scale). Neurotiškumo savybei matuoti buvo pasirinkta H ir S. Eysenck klausimyno (EPQ) (1986) neurotiškumo skalė. Sąmoningai save žalojančiam elgesiui matuoti naudota V. Jonušės (2010) sudaryta skalė, o savižudiškų tendencijų turinčiam elgesiui L. Šeibokaitės (2008) sudaryti klausimai. Rezultatai rodo, kad sąmoningai save žalojantys, turintys savižudiškų tendencijų ir tik turintys savižudiškų tendencijų berniukai pasižymi didesniu nurotiškumo, impulsyvumo, priešiškumo lygiu bei tik turintys savižudiškų tendencijų pasižymi ir didesniu fizinės agresijos lygiu, palyginus su to nedarančiais berniukais. Kontroliuojant savybių tarpusavio ryšius impulsyvumo, fizinės... [toliau žr. visą tekstą] / The aim - to identify personality traits characteristics between 16-19 age school children with deliberate self-harm and suicidal behavior The study included 174 school children (71 females and 103 males). A. H. Buss ir M. Perry (1992) Aggression Questionnaire was applied to measure school children aggression; two scales used in this study: hostility, physical aggression. To measure self-esteem was chosen M. Rosenberg (1965) Self-Esteem scale. To measure children‘s self-efficacy were applied R. Schwarzer ir M. Jerusalem (1995) General Self-Efficacy scale. Impulsivity was measured by E. S. Barratt (1995) Motor Impulsiveness, Baratt Impulsiveness Scale. To measure neuroticism were applied H and S. Eysenck personality questionnaire (EPQ) (1986). To measure deliberate self-harm we used the scale created by V.Jonušė (2010), for suicidal tendencies – questions created by L. Šeibokaitė (2008). The results show that boys who deliberately self-harm and show suicidal behavior, and those who have only suicidal tendencies, but don‘t self-harm, have a higher impulsivity, hostility, neuroticism levels and those who have only suicidal tendencies also have higer physical aggression level, compared with boys who don‘t show such behavior. Controlling the relations between personality traits, impulsivity, hostility and physical aggression importance for boys self-harm and suicidal behavior disappears. Boys self-esteem and self-efficacy are not related to boys deliberately self-harm and... [to full text]

BACKGROUND: Mental disorders amongst students, has increased, and foremost amongst girls. One way to regulate their emotions, is by deliberate self-harm. Due to their profession, school nurses have the ability to detect self-harm amongst students, and can therefor give them a good professional support. AIM: The aim of this study is to describe the school nurse's experience of deliberate self-harm amongst students. METHOD: The study is based on thirteen interviews with school nurses, via e-mail. The e-mails were then analyzed with an inductive qualitative content analysis. RESULTS: Four major categories were identified; how the pupil handles a feeling, different ways to identify, the signification of cooperation and the pupil need optimum support. The school nurse usually identifies deliberate self-harm at open reception and in healthcare conversations. A majority of the school nurses had unsatisfactory experiences when cooperating with child and adolescent psychiatric, and when cooperating with social services. CONCLUSION: School nurses need to be educated in deliberate self-harm amongst students; and guidance for all school nurses when in contact with student who self-harm themselves should be mandatory. Cooperation between social services, the school and child and adolescent psychiatric need to develop further. / BAKGRUND: Psykisk ohälsa bland elever har ökat och främst bland flickor. Ett sätt att hantera starka känslor kan vara genom självskada. Skolsköterskan är bland annat den profession som kan upptäcka självskadebeteende bland elever och därigenom ge stöd. SYFTE: Syftet med denna studie var att undersöka skolsköterskors erfarenheter när det gäller elever med självskadebeteende. METOD: Tretton mejlintervjusvar från skolsköterskor som analyserats utifrån kvalitativ innehållsanalys med induktiv ansats. RESULTAT: Fyra kategorier identifierades, att eleven hanterar upplevd känsla, att identifiering kan ske via olika forum, att samarbete är betydelsefullt och att eleven behöver optimalt stöd. Skolsköterskorna pekar på att självskadebeteendet är ett sätt att reglerar känslor men även att söka och få bekräftelse. Skolsköterskan identifierar ofta självskadebeteende på den öppna mottagningen eller vid hälsosamtalet. Externt samarbete menar mer än hälften av skolsköterskorna har brister och då i samarbetet med Barn och ungdomspsykiatrin (BUP) samt socialtjänst. Samarbete med föräldrar är något som skolsköterskan ser som viktigt. När inte skolans resurser angående stöd är tillräckligt söks stöd externt för eleven. SLUTSATS: Skolsköterskor behöver utbildning kring elever med självskadebeteende. Handledning för alla skolsköterskor i psykisk ohälsa borde vara obligatoriskt. Elevhälsa, BUP och socialtjänst behöver utveckla ett fungerande samarbete.

Introduction: In Pakistan there is dearth of research on deliberate self-harm (DSH) and its predictors among adolescents. While the lack of research in Pakistan can be partly attributed to the sacrilegious status, criminalization and stigmatization attached to DSH, it is also an attribute of paucity of Urdu versions of the standardized psychological instruments. Previous research in developed countries has indicated that attachment theory can be used as a useful framework to understand the development of austere psychopathologies like DSH, as well as for studying pathways of interaction of interpersonal and intrapersonal factors of psychopathologies. In this study, standardized psychological instruments are translated into Urdu language as a first step. These instruments are then used to study pathways of interaction of interpersonal and intrapersonal factors of DSH, conceptualized within attachment framework. Method: The study was conducted in two steps. In step 1, Youth Health Risk Behavior Survey (YHRB), Inventory of Interpersonal Problems-32 (IIP-32) and Significant Others Scale (SOS), were translated into Urdu language. Along with these scales, Urdu translated versions of Hospital Anxiety and Depression Scale (HADS), Adolescent Relationship Scales Questionnaire (ARSQ), Life Events scale (LES) from CASE questionnaire and Family Affluence Scale-II (FAS-II) were reviewed for accuracy of translation through expert judgement and psychometric evaluation. Secondly, a cross sectional survey was conducted with 1290 adolescents (10 - 19 years age) using the translated Urdu versions of the instruments and demographic pro forma. Structural equation modelling was used to study the pathways of associations between predictors of DSH. Results: The extensive process of translation resulted in establishment of semantic, content, technical and construct equivalence of the translated instruments with the original English versions. Multiple imputation was performed to account for missing values in SPSS 20. Important structural adaptations were made in the scales based on factor analyses conducted in M plus. After modifications, all scales showed satisfactory CFI (≥ 0.90) and RMSEA (≤ 0.06). Results of the survey indicated that the prevalence of DSH (with, without and ambivalent suicidal intentions) was 7%. Two SEM models were constructed involving both mediation and moderation pathways. Results of Model 1 showed association of attachment with DSH was double mediated by social support, depression and anxiety. Model 2 also confirmed association of attachment with DSH with double mediation through relationship style problems, depression and anxiety. In order to understand the contextual picture of the concepts studied in this research both SEM models were also constructed by controlling for demographic factors. This resulted in confirming age, gender and family affluence as significant contributors but with very small effects. Discussion and conclusion: In the present study translation of the instruments helped in building a reservoir for future research. The results of translation and validation of instruments indicated that cultural differences, language needs and age must be accounted for while using standardized psychological instruments. Taking into consideration specific cultural and demographic background of Pakistan, this study also confirms the key role of attachment in influencing interaction of predictors of DSH. It is suggested that intrapersonal and interpersonal factors are influential points of intervention for designing clinical, school and community based awareness and prevention programs for DSH. The thesis also discusses the implications for policy guidelines along with recommendations for future research and other applications of the study.