Working with patients who self-injure: an open label study of an educational intervention to upskill emergency nurses on non-suicidal self-injury

Non-suicidal self-injury (NSSI), deliberate damage to body tissue with no intent to die, is not engaged with suicidal intent but is the most reliable predictor of later suicidal behaviour. This makes efforts to reduce self-injury critical. Emergency departments can be the gateways to care for many people who have self-injured and optimal sites for interventions that promote recovery. However, emergency nurses have anecdotally reported that they lack training and feel ill-equipped to provide care for patients who self-injure. In this open label trial (where both participants and researchers were aware who received the intervention), all nurses in a metropolitan emergency department were invited to complete a multi-modal training programme designed to improve their knowledge, attitudes, confidence, and resilience, and reduce burnout related to caring for patients who self-injure. We also invited nurses to provide feedback in one-on-one interviews. Sixty nurses completed self-report measures at pre, post (immediately following training), and 1-month following training. Gains were seen immediately post-training in knowledge, empathy, self-compassion, and resilience, while reductions were seen in negative attitudes and burnout. In all cases these changes were maintained at 1-month follow-up. Eighteen nurses participated in interviews, who reported on the impact of the training on improving understanding of NSSI and confidence in working with patients who self-injure at both a personal and institutional level. They also identified barriers to implementing training, many of which require system-level changes within the health system. Findings suggest that training integrated within emergency settings can have a significant impact, not only on knowledge and confidence but on the wellbeing of emergency staff working with patients who self-injure.