Adolescent with self-harm behaviour, a challenge for the nurse in a hospital emergency unit

Izhodišča: Prevalenca samopoškodbenega vedenja pri mladostnikih iz leta v leto narašča in predstavlja vse večji javno zdravstveni problem. V pričujočem diplomskem delu smo želeli poudariti pomen ustreznega pristopa medicinske sestre v urgentni ambulanti k mladostniku, ki se je namerno samopoškodoval in z raziskavo ugotoviti ali imajo medicinske sestre zadostno znanje za celostno obravnavo mladostnika s samopoškodbenim vedenjem. Metode: V raziskavi je sodelovalo 50 medicinskih sester in zdravstvenih tehnikov enega izmed Urgentnih centrov v severovzhodni Sloveniji. Uporabljen raziskovalni inštrument je bil anketni vprašalnik, sestavljen iz 20 vprašanj. Rezultati: Opažamo, da medicinske sestre in zdravstveni tehniki sicer poznajo pojem namernega samopoškodovanja, a so med petimi tipičnimi prepoznavnimi znaki namernega samopoškodovanja prepoznali v povprečju tri znake. Medicinske sestre in zdravstveni tehniki zaznavajo pomanjkanje znanja glede pristopa k mladostniku, ki se je namerno samopoškodoval ter so se o samopoškodbenem vedenju mladostnika pripravljeni dodatno izobraževati. Ugotovili smo, da delovna doba in delovne izkušnje medicinskih sester in zdravstvenih tehnikov v Urgentnem centru ne vplivata na število prepoznanih osnovnih znakov namernega samopoškodovanja pri mladostniku. Pozitiven statistično značilen vpliv delovnih izkušenj na urgenci pa se kaže na zavedanje o pomembnosti pridobitve zaupanja in ustrezne komunikacije med mladostnikom in medicinsko sestro za pridobitev soglasja za nadaljnje postopke in posege (p=0,031rs=0,319). Sklep: Pomanjkanje znanja ustreznega pristopa medicinske sestre k mladostniku, ki se je namerno samopoškodoval, je ugotovljeno v mnogih raziskavah, pri čemer zaposleni v psihiatričnih bolnišnicah niso izjema. Menimo, da bi lahko pri reševanju tega problema pomembno vlogo odigrale izobraževalne ustanove, ki bi več pozornosti namenile učnim vsebinam s področja psihiatrične zdravstvene nege. Hkrati pa bi lahko izvajali dodatna izobraževanja za zaposlene v zdravstveni negi, ki prihajajo v stik z mladostniki s samopoškodbenim vedenjem.Background: The prevalence of adolescent self-injury behaviour is rising every year and represents a growing problem for the public health services. In this thesis we wanted to emphasize the importance of the emergency department nurse to the adolescents that performed a deliberate self-injury and establish whether emergency department nurses have sufficient knowledge to provide comprehensive treatment for adolescent with self-injury behaviour using quantitative research method. Methods: 50 emergency department nurses and technicians from the one of the Emergency centres in north eastern part of Slovenia have been involved in this research. Applied research instrument was a survey questionnaire containing 20 questions. Results: We can conclude that emergency department nurses and technicians are familiar with the term of self-injury in adolescent, but among five typical indicators of self-injury they have only managed to identify three on average. Emergency department nurses and technicians are aware of the lack of knowledge on how to approach to the adolescent who performed deliberate self-injury and would like to educate in that field. We have concluded that years of service and work experience of the nurses and technicians in the emergency centre have no effect on the number of recognized typical indicators of a self-injury behaviour in adolescents. Statistically positive affect of working experience in the emergency room represents itself in higher awareness of obtaining a trust and establishing appropriate communication between the nurse and the patient to obtain their consent for further procedures and interventions (p=0,031rs=0,319). Conclusion: The lack of appropriate knowledge of emergency department nurses on how to approach to the adolescent who has performed a deliberate self-injury is a known fact of many researches where medical staff from psychiatric hospitals are no exception. We believe that educational institutions have an important role in solving this problem which would involve educational institutions devoting more time and efforts to educational content in the field of psychiatric nursing care. At the same time educational institutions could organize additional education courses for medical staff that are in contact with adolescents with self–injury behaviour