Bakgrund: Självdestruktiva handlingar betraktas som symptom på underliggande känslomässig ångest. Patienter som behöver vård för självdestruktiva handlingar ökar, såväl antalet patienter som behöver intensivvård. Tidigare forskning kring intensivvårdssjuksköterskans erfarenheter av att vårda patienter efter självdestruktiv handling är svåridentifierad, men den forskning som finns pekar på utmaningar för andra sjuksköterskor i vården av dessa patienter. Motiv: Antalet patienter som behöver intensivvård efter självdestruktiv handling ökar enligt statistik. Tidigare forskning har beskrivit vården som utmanande, men specifik forskning om intensivvårdssjuksköterskors erfarenheter saknas. Studien syftar till att bidra med ny kunskap för att förbättra vården av denna patientgrupp. Syfte: Att belysa intensivvårdssjuksköterskans erfarenheter av att vårda patienter efter självdestruktiv handling. Metod: Kvalitativ intervjustudie med induktiv ansats utfördes. Det var 8 stycken intensivvårdssjuksköterskor som arbetar på en intensivvårdsavdelning i norra Sverige som deltog i var sin semistrukturerad intervju som utfördes under två veckor under november år 2023. Kvalitativ innehållsanalys utfördes. Resultat: Resultatet presenterades genom tre huvudkategorier: emotionell påfrestning, utmanande möten med patienter och anhöriga samt behov av utbildning och vårdorganisatorisk samverkan. Under dessa presenteras sju subkategorier: känslor relaterat till att vilja hjälpa – men inte kunna, känslor relaterat till en självförvållad och återkommande skada, utmaningar med att agera professionellt och ha förståelse för patienten, upplevelsen av hopp och utmaningar i anhörigmötet, behov av utbildning samt önskan om samarbete med psykiatrin. Konklusion: Intensivvårdssjuksköterskor möter utmaningar och känslor vid vården av patienter efter självdestruktiva handlingar. Studien visar på kopplingen mellan fysiskt och psykiskt lidande hos dessa patienter. För patienten betonar studien behovet av mer personcentrerad och förebyggande vård. För vårdaren understryker den komplexa emotionella reaktioner och behovet av ökad kompetens och stöd. Resultaten kan förbättra vården genom holistisk syn och medvetenhet om det existentiella lidandet. För verksamheten betonas vikten av samarbete och utbildning för att förbättra vården av dessa patienter. / Background: Self-destructive acts are considered symptoms of underlying emotional distress. The number of patients requiring care for self-destructive acts is increasing, including those needing intensive care. Previous research on intensive care nurses' experiences in caring for patients after self-destructive acts is challenging to identify, but existing research highlights challenges for other nurses in caring for these patients. Motivation: The statistics indicate an increasing number of patients requiring intensive care after self-destructive acts. While previous research has described the care as challenging, specific research on intensive care nurses' experiences is lacking. The study aims to contribute new knowledge to enhance the care for this patient group. Aim: To illuminate the experiences of intensive care nurses in caring for patients after self-destructive acts. Method: A qualitative interview study with an inductive approach was conducted. Eight intensive care nurses working in a northern Swedish intensive care unit participated in individual semi-structured interviews conducted over two weeks in November 2023. Qualitative content analysis was performed. Results: The results were presented through three main categories: emotional strain, challenging encounters with patients and relatives, and the need for education and organizational collaboration. Within these, seven subcategories were presented: feelings related to wanting to help but being unable to, feelings related to self-inflicted and recurring injuries, challenges in acting professionally and understanding the patient, the experience of hope and challenges in encounters with relatives, the need for education, and the desire for collaboration with psychiatry. Conclusion: Intensive care nurses face challenges and emotions in caring for patients after self-destructive acts. The study highlights the connection between physical and psychological suffering in these patients. For the patient, the study emphasizes the need for more person-centered and preventive care. For the caregiver, it underscores complex emotional reactions and the need for increased competence and support. The results can improve care through a holistic approach and awareness of existential suffering. For the organization, the importance of collaboration and education to enhance the care for these patients is emphasized.

<p>The aim with this study was to learn about the experiences of field workers and welfare officers in the field of possible self-harm behavior among young people.Our problem was: Do field workers and welfare officers treat young people with deliberate self-harm differently and - How do field workers and welfare officers describe deliberate self- harm?</p><p>Our study was conducted through qualitative semistructured interviews with twelve interviewee’s.The result of this study shows that there is a difference in how young people with self-harm behavior are being treated - based on their gender.One possible cause for this result could be the old tradition mindset of viewing boys and girls differently – and thus, treating them differently when they seek help.Our study shows there is a possibility of treating boys and girls differently – which shows that we made a thought-provoking point</p>

The aim with this study was to learn about the experiences of field workers and welfare officers in the field of possible self-harm behavior among young people.Our problem was: Do field workers and welfare officers treat young people with deliberate self-harm differently and - How do field workers and welfare officers describe deliberate self- harm? Our study was conducted through qualitative semistructured interviews with twelve interviewee’s.The result of this study shows that there is a difference in how young people with self-harm behavior are being treated - based on their gender.One possible cause for this result could be the old tradition mindset of viewing boys and girls differently – and thus, treating them differently when they seek help.Our study shows there is a possibility of treating boys and girls differently – which shows that we made a thought-provoking point

This thesis investigated the experience of taking part in a psychosocial assessment following an episode of self-harm from the service user perspective. Psychosocial assessments are a key aspect of self-harm management in secondary care, designed to identify needs and risk and determine further care. This study utilised interpretative phenomenological analysis to privilege the voices of service users and produce in-depth, contextualised understandings of the experience of assessment and its impact on future help-seeking and engagement with services. Data collection consisted of semi-structured interviews with thirteen participants soon after their hospital attendance; follow-up semi-structured interviews were also completed with seven participants three months later, to explore patient-derived outcomes from assessment and hospital attendance. The lived experiences of participants were characterised by two main features: experiences of life as a struggle and of the self as “less than”. As a result of these struggles and experiences of powerlessness and devaluation, participants mostly saw self-harm and suicide as a natural progression in their narratives. Expressions of suicidal intent reflected a struggle between a desperate desire for change and hopelessness in the face of current circumstances. The key message gained from participants’ accounts of assessment was that the interaction with staff had the power to reinforce or challenge hopelessness and negative self-evaluations. In addition, the way an assessment was conducted had influence beyond the hospital: as an experience which created or reinforced expectations for future instances of help-seeking; as a deterrent or an encouragement to seek help; and as the first step along the path to change. Unfortunately, participants’ experiences of aftercare were dominated by a sense of stagnation due to the failure of services to follow through with promises of aftercare, which affected their attitudes towards future help-seeking and towards themselves. This thesis is the first study to utilise an in-depth idiographic methodology to explore and contextualise the service user experience of psychosocial assessment following self-harm within the wider circumstances of their lives. It demonstrates how patient-staff interactions within the hospital and after discharge can affect future help-seeking through reinforcing or challenging the hopelessness and self-negativity of patients.

Suicide is the second leading cause of death for youth in Canada and it is estimated that anywhere between 2-47% of North American youth among community and clinical populations have engaged in self-harming behaviours. As people turn to online communities to engage in conversations about self-harm and suicide, researchers and practitioners are curious about the implications for youth who engage in support-oriented Internet chat rooms and forum boards. The focus of most literature to date has been concerned with identifying the potential benefits and harms of online support for vulnerable individuals, and these studies have typically sought to measure outcomes rather than processes. The purpose of this thesis is to expand upon emerging poststructural queries about the implications of mainstream ideas about self-harm and suicide in order to invite alternate ways of responding to these issues. This study analyzed the discourses that made self-harm and suicide intelligible on an online support forum, examined how these discourses informed performances of helping, and reflected upon the subjectivities that became available to young people and trained helpers through these conversations. Excerpts from an inactive, public support-oriented Internet forum served as the site of analysis. The use of discourse analysis helped to illustrate several key findings that highlight limitations about current approaches to prevention and intervention with self-harm and suicide; namely, that psychological, pathological and professionalized discourses about self-harm and suicide locate the site of intervention within the distressed individual and conceal the sociopolitical and historical contexts that influence self-destructive behaviours. / Graduate / 0628 / 0630 / 0534 / aubreyanne@shaw.ca

Background Self-harm is a major and growing public health issue among young people worldwide. Self-harm is an important risk factor for suicide, which is one of the leading causes of death for young people. Although suicide rates are declining overall, this trend is not seen in young people. Young people with mental distress and/or suicidal thoughts are reluctant to seek help, and often drop out of treatment initiated after a self-harm episode. Many young people who self-harm have had contact with healthcare before their first self-harm episode, but often for reasons other than suicidal thoughts or psychiatric problems. In this context, physical illness is associated with increased risk for self-harm and suicide among young people. The present thesis investigated how young people perceived the help and support they received before and after an episode of self-harm. A further aim was to map the inpatient somatic healthcare contacts young patients had before an episode of self-harm, and determine any relationship to risk for self-harm and suicide. Method Four studies were conducted using qualitative and quantitative methods. Participants were people aged 16-24 years. The definition of self-harm was based on the intentional self-harm criteria in the International Classification of Diseases, tenth revision, which includes all forms of self-harm without ascribing suicidal intent. In the first two studies, 10 respective 9 participants with a first healthcare contact for self-harm were interviewed during 2009-2011. The interviews covered participants’ knowledge and experience of professional care before their healthcare contact for self-harm. Participants were interviewed a second time 6 months later about their experiences with professional care during the period since their initial interview. Qualitative content analysis was used for all interviews. For the next two studies, we selected 16,235 participants with a first hospitalisation for self-harm during 1999-2009 from the Swedish National Inpatient Register. These cases were compared with matched controls to determine the odds of having been admitted with a non-psychiatric diagnosis during the year preceding the self-harm admission. To assess risk for suicide, data were retrieved from the Swedish Cause of Death Register for all deceased participants until 2013, and group differences were determined using survival analysis. Results In the first interview, participants described how they wanted more information on where they could turn for professional help. They also wanted different help-seeking pathways and emphasised the importance of the quality of professional contact. After 6 months, participants stressed the importance of being able to rely on professionals and treatment. Their life circumstances significantly affected their treatment, and practical help was appreciated. The register studies showed that young people admitted for self-harm were more likely to have been hospitalised with symptomatic diagnoses such as abdominal pain and syncope/collapse, and somatic illnesses such as epilepsy and diabetes mellitus type 1. A higher proportion of cases (4.5%; women 2.6%, men 8.8%) died during the study period than controls (0.3%; women 0.2%, men 0.6%) (p&lt;0.001). For both cases and controls, a higher proportion of those with a previous somatic admission died from suicide during the study period than those without a somatic admission (cases: 4.2% vs. 2.8%, p&lt;0.05). For cases with a somatic admission, the hazard ratio was 1.43 (95% confidence interval 1.04-1.98) compared with those without somatic admissions (controlled for age, sex and psychiatric admission). Survival of cases with a previous somatic admission compared with those without was 98.4% versus 99.2% after the first year, 97.8% versus 98.9% after the second year, and 95.5% versus 96.9% after the tenth year. Conclusion These findings suggest that healthcare providers need to find new ways to reach young people at risk for suicidal behaviour. Access to professional help should be easy and direct. Treatment for young people after self-harm should be flexible, and be receptive to input from the patient. The importance of and need for basic practical help should not be overlooked. Somatic healthcare contact provides an opportunity for intervention, particularly as psychiatric problems can manifest as physical symptoms, and physical illness is a risk factor for self-harm and suicide.

Selbstvergiftung in der Akutmedizin – 2005–2012 Zusammenfassung Ziel. Beschreibung des Trends der akuten Selbstvergiftung in der Notfall- und Intensivmedizin. Methode. Elektronische Akten erwachsener Patienten, die zwischen 2005 und 2012 wegen einer akuten Selbstvergiftung infolge eines Selbstmordversuches (Selbstmordgruppe), einer Berauschung (Intoxikationsgruppe) oder Medikamentenüberdosierung zwecks Schmerzlinderung (Überdosierungsgruppe) in der Notaufnahme des Universitätsklinikums Leipzig eingewiesen worden waren, wurden ausgewertet. Ergebnisse. 3533 Patienten (62,6 % männlich) wurden identifiziert, mit einem Anstieg von 305 Fällen im Jahre 2005 auf 624 in 2012. Die Aufnahmerate bezogen auf die Gesamtaufnahmen stieg von 1,2 % im Jahre 2005 auf 1,9 % im Jahre 2012 an. 31,7 % der Patienten waren < 25 Jahre alt. Die Ursachen der Selbstvergiftung waren Suizidversuch (18,1 %), Intoxikation (76,8 %) und Medikamentenüberdosierung (2,9 %). Bei 80 Fällen war eine genaue Gruppenzuordnung nicht möglich. Während psychotrope Medikamente bei 71,6 % der Suizidversuche angewandt wurden, war Alkoholintoxikation die Ursache bei 80,1 % der Fälle in der Intoxikationsgruppe. Selbstvergiftung mit mindestens zwei Substanzen lag bei 52,0 % der Suizidversuche, 10,3 % der Intoxikationsgruppe und 29,7 % der Gruppe mit Medikamentenüberdosierung vor. Während die Alkoholintoxikation nach wie vor am häufigsten vorkam, gab es eine drastische Zunahme der Intoxikationen mit Cannabinoiden, Crystal Meth und Gamma- Hydroxybuttersäure in den Jahren 2011 und 2012. Eine Aufnahme auf die Intensivstation war bei 16,6 % der Fälle erforderlich. Es gab 22 Todesfälle (0,6 % der gesamten Studienpopulation), von denen 15 aus der Suizidgruppe (2,3 %), vier aus der Intoxikationsgruppe (0,15 %), und drei aus der nicht eindeutig zugeordneten Gruppe (3.8 %) waren. Zusammenfassung. Akute Selbstvergiftung ist ein zunehmendes medizinisches Problem. Psychotrope Medikamente stellen nach wie vor die häufigsten Suizidversuchsmittel dar. Obwohl die Alkoholintoxikation weiterhin am häufigsten vorkommt, nehmen illegale Drogen als notfallmedizinischer Einweisungsgrund zu. / Self-poisoning in the acute care medicine 2005–2012 Abstract Objective. To describe the trend of acute self-poisoning in the emergency and intensive care. Methods. Electronic charts of adults who presented to the emergency department of the University Hospital Leipzig with selfpoisoning following a suicide attempt (suicide group), intoxication (intoxication group), drug overdose for relief of pain or discomfort (drug overdose group) between 2005 and 2012 were analyzed. Results. 3533 adults (62.6 % males) were identified, with the yearly admissions increasing from 305 in 2005 to 624 in 2012. The admission rate in relation to the total emergency department admissions also increased, from 1.2 % in 2005 to 1.9 % in 2012. 31.7 % of the patients were younger than 25 years. The reasons for self-poisoning were suicide attempt (18.1 %), intoxication (76.8 %) and drug overdose (2.9 %). The reason could not be clearly classified in 80 patients. Psychotropic drugs were used in 71.6 % of suicide attempts, while alcohol was the sole cause of intoxication in 80.1 % of cases in the intoxication group. Self-poisoning using at least two substances was observed in 52.0 % of the suicide attempts, 10.3 % of those with intoxication and 29.7 % of those with drug overdose. While alcohol remains the most common cause of intoxication, there was a drastic increase in the consumption of cannabinoids, Crystal Meth and gamma-hydroxybutyrate in the years 2011 and 2012. ICU admission was necessary in 16.6 % of the cases. There were 22 deaths (0.6 % of the study population), of whom 15 were in the suicide group (2.3 %), four (0.15 %) in the intoxication group, and three in the not clearly classified group (3.8 %). Conclusion. Acute self-poisoning is an increasing medical issue. Psychotropic drugs remain the most common means of suicide attempt. Although alcohol intoxication is very frequent, intake of illicit drugs as the cause of emergency admission is increasing.

Awareness of sexual exploitation has increased over the past decade. However, physical and psychological health needs, risks, health seeking behaviour and use of health services by sexually exploited young people have been inadequately explored. Methodology/method Phase 1: descriptive, phenomenological, approach to encourage young people involved in or vulnerable to sexual exploitation to describe their personal accounts of health, risks, health seeking and support. Phase 2: quantitative methodology consisting of a questionnaire survey with professionals supporting young people involved in or vulnerable to sexual exploitation. Data analysis Phase 1: phenomenological approach to data analysis (Giorgi, 1985). Phase 2: questionnaire data were analysed using software S.P.S.S. and thematic content analysis (Burnard, 2006). Results/findings Intentional self harm and substance misuse were concordant themes from phase 1 and 2. Novel themes that emerged from this study included a taxonomy of risk behaviours related to health, and the use of youth offending teams for health support Conclusion A significant range of physical and psychological health problems were reported alongside risks to health and barriers to health support for sexually exploited young people. Psycho-social vulnerability factors undermine health and impact on health seeking behaviour.

Syftet med denna kunskapsöversikt var att belysa olika aspekter av det kunskapsläge som finns idag sett till icke-suicidalt självskadebeteende bland unga kvinnor. Uppsatsens frågeställning var: Hur konstrueras och beskrivs ämnet icke-suicidalt självskadebeteende hos unga kvinnor i valda delar av forskningslitteraturen? Uppsatsen är en selektiv kunskapsöversikt som består av 11 primärdokument och resultaten analyserades med hjälp av en socialkonstruktionistisk teoribildning. Resultaten visade att kvinnor är överrepresenterade vad gäller icke-suicidalt självskadebeteende med fokus på att skära/rispa sig, men att det kan bero på vad forskaren väljer för inkluderings- och exkluderingskriterier i sin studie. Primärdokumenten vittnar om olika orsaker till varför unga kvinnor avsiktligen skadar sig själva, såväl inre som yttre faktorer är avgörande och samspelar med varandra. De unga kvinnorna upplevde att skärandehandlingen var ett effektivt sätt att hantera negativa känslor och att känna emotionell lättnad. Det fanns en stark korrelation mellan självskadehandlingar och dysfuntionella familjeförhållanden. Att självskada genom att skära samt rispa sig blev ett sätt att kanalisera svåra känslor men även att kommunicera med omgivningen då de unga kvinnorna inte lärt sig att på ett mer välgörande sätt uttrycka svåra känslor. De unga kvinnorna internaliserar omgivningens förväntningar – att vara ”den självskadande” – och skapar utifrån dessa en identitet. / The purpose of this systematic review was to highlight different aspects of the state of knowledge available today in terms of non-suicidal self-injury among young women. The question at issue was: How does the research literature – selected parts of it – construct and discuss the topic of non-suicidal self-harm in young women? The paper is a selective knowledge survey consisting of 11 primary document and the results were analyzed using a social constructionist theory. The results showed that women are overrepresented in terms of non-suicidal self-injury with a focus on cutting/scratch, but it may depend on what the researcher selects for inclusion and exclusion criteria in their study. Primary documents show various reasons why young women deliberately harm themselves, both internal and external factors are crucial and interact with each other. The young women felt that the cutting action was an effective way to deal with negative emotions and to feel emotional relief. There was a strong correlation between self-harm acts and dysfunctional family relationships. The young women learned to self-harm as a way to channel hard feelings but also to communicate with the environment because they had not learned to communicate difficult emotions in a more beneficial way. The young women internalize the expectations of - to be "the self-harming young woman” - and creates an identity from these expectations.

Syftet med studien är att analysera olika rapporter gällande sex som självskadebeteende samt varför unga skadar sig själva med sex. Sex som självskada är inte lika synligt som andra typer av självskador som att skära sig eller att bränna sig. Utifrån de utvalda rapporterna som utgör empirin vill vi undersöka varför ungdomar genomför skadliga handlingar genom sex och också vilka skillnader och likheter som framkommer i rapporterna. Vi vill belysa sex som självskada och få en ökad förståelse för ämnet. Vårt empiriska material består av fem olika rapporter med en koppling till sex som självskada. Även om vårt fokus huvudsakligen är icke suicidala självskador hos unga, så är det viktigt att nämna att det är en högre risk för självmordstankar om det finns ett självskadebeteende. Vi har använt oss av textanalys som är en kvalitativ metod när vi analyserade rapporterna. Vårt resultat visade på fem återkommande teman. Dessa är orsaker till sex som självskada, begreppet sex som självskada, kön- och åldersskillnader, ond cirkel samt bemötande och behandling. Dessa teman har sedan kopplats till teorier om genus, identitet och sexualitet med en utgångspunkt i socialkonstruktivism. / The aim of the study is to analyse different reports regarding sex as a self-injurious behaviour and why adolescents harm themselves through sex. Sex as a self injury is not as visible as other types of deliberate self harm such as cutting or burning skin and it can be anyone around you. Based on selected reports as our empirical material we want to acknowledge why youngsters conduct harmful actions through sex and also what differences and similarities the reports share. We want to pay attention to the topic of sex as a self injury and gain an increased understanding of it. Our empirical material consist of five different reports with a connection to sex as self injury. Although our focus is mainly on non-suicidal self injury among adolescents, it is important to mention that there is a higher risk of suicidal thoughts in connection to self injurious behaviour. We have analysed the reports through a qualitative method, text analysis. Our results showed fives recurring themes. These are causes of sex as self injury, differences in how the concept is used, differences among age and gender, vicious cycle and treatment. The themes are then connected to theories such as gender, sexuality and identity with a premisses of social construction.