Emergency department staff attitudes towards people who self-harm and the influences of norms on behaviour

Abstract

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.