目的 整合医护人员对非自杀性自伤患者的态度及照护体验,为探索非自杀性自伤管理方案并制订干预策略提供参考。方法 计算机检索Embase、CINAHL、Cochrane Library、PubMed、APA PsycArticles、APA PsycInfo、Psychology and Behavioral Sciences Collection、Web of Science、Scopus、中国知网、维普数据库、万方数据库、中国生物医学文献数据库、中华医学期刊全文数据库中关于医护人员对管理非自杀性自伤患者的体验的质性研究。文献质量评价后采用汇集性整合方法进行整合。结果 共纳入10篇文献,归纳为14个类别,得出4个整合结果：（1）医护人员负性情感反应突出;（2）医护人员对非自杀性自伤管理的多元应对;（3）医护人员在非自杀性自伤管理实践中的困境;（4）非自杀性自伤管理举措。结论 医护人员在应对非自杀性自伤患者时表现出负性情感,展现出多元的应对策略,仍面临多重困境,提升培训、完善心理健康服务以及提高社会公众对非自杀性自伤的认知是重要的管理举措。
Objective To synthesize healthcare providers’ attitudes toward and caregiving experiences of patients with non-suicidal self-injury (NSSI) and to provide reference for the management and intervention strategies for NSSI. Methods Literature retrieval was conducted in databases including Embase, CINAHL, Cochrane Library, PubMed, APA PsycArticles, APA PsycInfo, Psychology and Behavioral Sciences Collection, Web of Science, Scopus, China National Knowledge Infrastructure, VIP Database, Wanfang Data, China Biomedical Literature Database, and China Medical Journal Full-text Database for qualitative studies on healthcare providers’ experiences in managing NSSI patients. The quality of the selected studies was assessed, and the findings were synthesized using a meta-aggregation approach. Results A total of 10 studies were included, which were categorized into 14 themes and synthesized into 4 findings: (1) Prominent negative emotional responses among healthcare providers; (2) Diverse coping strategies for managing NSSI; (3) Challenges in practical management of NSSI; (4) Management measures for NSSI. Conclusion Healthcare providers exhibit negative emotional responses and employ diverse coping strategies when dealing with NSSI patients, yet they still encounter multiple challenges. More training, mental health services, and raising public awareness about NSSI are crucial for the management of NSSI patients.
[1] Leong CH, Wu AM, Poon MM.Measurement of perceived functions of non-suicidal self-injury for Chinese adolescents[J].Arch Suicide Res, 2014, 18(2):193-212.DOI:10.1080/13811118.2013.824828.
[2] Tang J, Li G, Chen B, et al.Prevalence of and risk factors for non-suicidal self-injury in rural China: results from a nationwide survey in China[J]. J Affect Disord,2018,226:188-195.DOI:10.1016/j.jad.2017.09.051.
[3] Moriya T, Sato H, Takeda K, et al.Two cases of nonsuicidal self-injury comprising partial autoamputation of the apex of the tongue[J]. Case Rep Dent,2020,2020:1-6.DOI:10.1155/2020/8691270.
[4] Liu R T, Walsh R, Sheehan AE, et al.Prevalence and correlates of suicide and nonsuicidal self-injury in children: a systematic review and Meta-analysis[J].JAMA Psychiat,2022,79(7):718-726.DOI:10.1001/jamapsychiatry.2022.1256.
[5] Taylor TL, Hawton K, Fortune S,et al.Attitudes towards clinical services among people who self-harm:systematic review[J].Br J Psychiatry,2009, 194(2):104-110.DOI:10.1192/bjp.bp.107.046425.
[6] Rayner G, Blackburn J, Edward K, et al.Emergency department nurse’s attitudes towards patients who self-harm: a Meta-analysis[J]. Int J Ment Health Nu,2019,28(1):40-53.DOI:10.1111/inm.12550.
[7] 胡雁, 郝玉芳. 循证护理学[M]. 北京:人民卫生出版社,2018:157-174.
[8] Lockwood C, Porritt K, Munn Z, et al. Chapter 2: Systematic reviews of qualitative evidence[EB/OL].(2023-11-08)[2023-12-20]. https://synthesismanual.jbi.global.
[9] 章薇. 手外科护理人员照护非自杀性自伤患者心理体验的质性研究[D]. 荆州:长江大学,2022.
[10] Macdonald S, Sampson C, Biddle L, et al.Theorising health professionals’ prevention and management practices with children and young people experiencing self-harm: a qualitative hospital-based case study[J].Sociol Health Ill,2021,43(1):201-219.DOI:10.1111/1467-9566.13211.
[11] Dickinson T,Wright KM, Harrison J.The attitudes of nursing staff in secure environments to young people who self-harm[J].J Psychiatr Ment Hlt, 2009, 16(10):947-951.DOI:10.1111/j.1365-2850.2009.01510.x.
[12] Mcgough S,Wynaden D,Ngune I,et al.Mental health nurses’ perspectives of people who self-harm[J].Int J Ment Health Nu,2021,30(1):62-71.DOI:10.1111/inm.12814.
[13] Goodwin J, Kilty C, Meehan E, et al.Healthcare staff’s views on responding to suicide and self-harm: part II[J].Perspect Psychiatr C,2021,57(4):1743-1750.DOI:10.1111/ppc.12744.
[14] Murphy C, Keogh B, Doyle L.‘There is no progression in prevention’- the experiences of mental health nurses working with repeated self-harm[J]. Int J Ment Health Nu,2019,28(5):1145-1154.DOI:10.1111/inm.12626.
[15] Rees N, Porter A, Rapport F, et al.Paramedics’ perceptions of the care they provide to people who self-harm: a qualitative study using evolved grounded theory methodology[J]. Plos One,2018,13(10):e0205813.DOI:10.1371/journal.pone.0205813.
[16] Koning KL, Mcnaught A, Tuffin K.Emergency department staff beliefs about Self-Harm: a thematic framework analysis[J].Community Ment Hlt J,2018,54(6):814-822.DOI:10.1007/s10597-017-0178-8.
[17] Thomas JB, Haslam CO.How people who self-harm negotiate the inpatient environment: the mental healthcare workers perspective[J]. J Psychiatr Ment Hlt,2017,24(7):480-490.DOI:10.1111/jpm.12384.
[18] Griffiths R, Page L, Mcdougall T, et al.Staff responses to self-harm by children and young people in mental health inpatient settings: experiences and views of children and young people, parents and staff[J].Int J Ment Health Nurs,2023,32(4):1082-1093.DOI:10.1111/inm.13143.
[19] Saunders KE, Hawton K, Fortune S, et al.Attitudes and knowledge of clinical staff regarding people who self-harm: a systematic review[J]. J Affect Disord,2012,139(3):205-216.DOI:10.1016/j.jad.2011.08.024.
[20] Cummings J.Nonsuicidal Self-Injury[J].Am J Nurs,2023,123(6):44-47.DOI:10.1097/01.NAJ.0000938732.60723.b9.
[21] Doyle L, Sheridan A, Treacy MP.Motivations for adolescent self-harm and the implications for mental health nurses[J].J Psychiatr Ment Health Nurs,2017, 24(2-3):134-142.DOI:10.1111/jpm.12360.
[22] Marshman C,Hansen A,Munro I.Compassion fatigue in mental health nurses: a systematic review[J]. J Psychiatr Ment Health Nurs,2022,29(4):529-543.DOI:10.1111/jpm.12812.
[23] Turner BJ, Austin SB, Chapman AL.Treating nonsuicidal self-injury: a systematic review of psychological and pharmacological interventions[J].Can J Psychiatry,2014,59(11):576-585.DOI:10.1177/070674371405901103.
[24] 张瑞珂, 王玉秀. 基于危害分析与关键控制点理论的边缘型人格障碍住院患者非自杀性自伤行为护理管理实践[J]. 护理学报, 2022, 29(22):20-25. DOI:10.16460/j.issn1008-9969.2022.22.020.
[25] Lee SN, Kim HJ.The experiences of psychiatric mental health nurse practitioners with clinical supervision in south korea: a grounded theory approach[J].Int J Environ Res Public Health, 2022,19(23):15904.DOI:10.3390/ijerph192315904.
[26] Lebel J, Stromberg N, Duckworth K, et al.Child and adolescent inpatient restraint reduction: a state initiative to promote strength-based care[J]. J Am Acad Child Adolesc Psychiatry,2004,43(1):37-45.DOI:10.1097/00004583-200401000-00013.
[27] Nice. Self-harm: Assessment, management and preventing recurrence[EB/OL].(2022-09-30)[2023-12-20]. https://www.nice.org.uk/guidance/ng225.
[28] Griffiths R, Dawber A, Mcdougall T, et al.Non-restrictive interventions to reduce self-harm amongst children in mental health inpatient settings: systematic review and narrative synthesis[J]. Int J Ment Health Nurs,2022,31(1):35-50.DOI:10.1111/inm.12940.
[29] 何富容, 李梅枝, 龚沙, 等. 精神科护士的道德敏感性现状及其影响因素[J]. 护理学报, 2023, 30(16):19-23. DOI:10.16460/j.issn1008-9969.2023.16.019.
[30] 夏志春, 叶君荣, 邓秀荣, 等. 广东省精神卫生机构护士自我效能感现状调查[J]. 齐鲁护理杂志, 2018, 24(21):40-43. DOI:10.3969/j.issn.1006-7256.2018.21.011.
[31] Kool N, van Meijel B, Koekkoek B, et al.Improving communication and practical skills in working with inpatients who self-harm: a pre-test/post-test study of the effects of a training programme[J].BMC Psychiatry,2014,14:64.DOI:10.1186/1471-244X-14-64.
[32] Zhao X, Liu L, Hu C, et al.Necessity and feasibility of improving mental health services in China: a systematic qualitative review[J]. Int J Health Plann Manage,2017,32(3):363-371.DOI:10.1002/hpm.2437.
