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A&E staff show ‘frustration, anger and hostility’ towards people who self-harm, claims study

Self-harm is ‘often a precursor to suicide’.



Self Harm

Emergency care nurses often find treating patients who self‐harm emotionally challenging.

Nursing staff working in emergency departments often struggle to fully understand self-harm, according to the findings of an international research project.

The study, titled Emergency department nurses’ attitudes towards patients who self‐harm and carried out by experts at the University of Huddersfield alongside an overseas partner, found that staff often hold negative attitudes towards people who self‐harm.


Nursing staff across several countries, including the UK, Australia, Sweden, Finland, Brazil, and Taiwan, were found to show frustration, anger, and hostility towards people presenting to emergency departments with self-harm.

“Research both nationally and internationally suggests that emergency care nurses find treating patients who self‐harm emotionally challenging.  Ambivalence, powerlessness, and helplessness are commonly manifested in the development of negative attitudinal beliefs towards these patients,” write the authors, who also state that there is a “compelling relationship” between self‐harm and suicide.

Understanding self-harm can save lives.

“It is predicted that one in 25 patients presenting to emergency departments for self‐harm will die by suicide within the next five years, demonstrating the importance of this area in healthcare to save lives.”

The article states that: “A fundamental factor in the development and maintenance of negative attitudes was a lack of training and education, whilst positive attitudes were attributable to being knowledgeable about self‐harm”.

The study recommends that emergency department staff should receive focused education so that they understand the psychology behind self-harm, which the authors state, is often a precursor to suicide.

Education should also include ongoing clinical supervision where staff can explore their attitudes and beliefs in a non-threatening environment.

Professor Ousey, a co-author of the study, confirmed that there will be further collaborative research in the topic, leading to greater support for healthcare professionals so they understand why people commit self-harm in the first place and to develop strategies to help.

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.



Nurse with patient in bed

Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.


Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 




A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.


Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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