Engaging Service Users – Resources for Qualitative Research (CRSI Workshop 10 th June 2009)

1. Engaging Service Users – Resources for Qualitative Research(CRSI Workshop 10th June 2009) An example of qualitative research Helena O Connor

2. Title of Study: Mental health nurses experiences of risk assessment of patient self harm in an Irish PICU. Helena O Connor MSc ,HDIP ,BSc, DIP Psych N; RPN Clinical Nurse Specialist Risk Analysis

3. Qualitative Research This presentation will outline how qualitative research was conducted in a PICU as part of Masters Degree in University College Cork in 2008.

4. Background to the study • Marked changes in delivery of mental health services in Eire over last twenty years • Government Policy iniatives • Quality & Fairness A Health System for You Department of Health (2001). • Reach put National Strategy for action on suicide prevention (HSE 2005) • Mental Health Commission 2004(2005) states that all nurses are expected to carry out risk assessments.

5. Aim • This study aimed to gain an understanding of mental health nurses` experiences of nursing patients who self harm, including their risk assessment experiences in a psychiatric intensive care unit. A qualitative descriptive approach was undertaken. The sample consisted of seven registered nurses from a PICU in one Health Service Executive (HSE). Data was collected using semi – structured interviews and analysed using content analysis. • This study endeavoured to gain an understanding of mental health nurses` experiences of risk assessment of patients who self harm in a psychiatric intensive care unit.

6. Introduction: • This study was an explanatory study looking at mental health nurses experiences of risk assessment of patient self harm in a PICU. The objectives of the study were: 1) To describe mental health nurses experiences of nursing patients who self-harm. • 2) To describe mental health nurses experiences of assessing risk of patients who self harm including use of multidisciplinary risk assessment documentation. • 3. To describe factors which influence and impact on mental health nurses, nursing patients who self harm in a PICU

7. Classification of self harm • Self harm was categorised without suicidal intent. • Self harm behaviour included cutting, cigarette burning, starvation, patients tying various garments around their neck without the desire to cause death and banging their heads and limbs off walls.

8. Sample • This study was carried out by conducting interviews with mental health nurses who had experiences of carrying out risk assessments with patients who self-harm in a PICU. The sample was fully qualified staff, of certificate, diploma or degree training.

9. Procedure: • Data was collected using semi-structured interviews lasting approximately 45 minutes. • The interviews were recorded using a Dictaphone, strictly for data collection purposes. • These interviews were held on an individual basis, and at a time and place mutually agreeable. All information was treated on a strictly confidential basis.

10. Benefits: • Participants contributed to the nursing body of knowledge. The desired outcome of the study was to inform about the current experiences of mental health nurses experiences of risk assessment of patient self harm in a PICU. • Additional support in terms of education and training may be identified by undertaking this study.

11. Inclusion Criteria • 1. MHNs working within the PICU. • 2. MHNs registered as psychiatric nurses employed by the Health Service Executive. • 3. MHNs who agree to participate in the study. • 4. Those with a minimum of two years experience.

12. Exclusion Criteria: • Those due to leave the PICU due to change in employment circumstances or retirement before the completion of this study estimated to be May 2008.

13. Risks: • Participants were informed that adverse effects were not expected from participation in this study. However, if emotional distress was evident the following steps would be taken. • Participants can withdraw from the interview process at any time. • Participants will be given time at the end of the interview to reflect and ventilate any adverse feelings with the researcher.

14. Confidentiality: • All information gathered during these interviews was strictly confidential, as would the origin of the mental health services, which would be merely referred to as an Irish PICU. • Confidentiality was ensured in the following manner; a) All data was coded, b) all data was seen only by the researcher, c) all information will held in a computer and had a password to access information in the researchers home, d) all data kept on hard copy was be kept in a locked drawer in the researchers home and all transcripts and tapes of the interviews were kept in a locked drawer in the researchers home.

15. Voluntary Participation: • Participation in this study was voluntary. • Permission: The study was approved by the ethics committee of the hospital and the ethics committee of Cork University Hospital.

16. Methodology; • A qualitative descriptive approach was undertaken. The sample consisted of seven registered nurses from a PICU in one Health Service Executive (HSE). Data was collected using semi – structured interviews and analysed using content analysis.

17. Findings; • Analysis of the data identified mental health nurse’s varied awareness and nursing practices when conducting risk assessments with patients who self harm. Four themes emerged; Nurses understanding of self harm behaviour, nurses understanding of risk assessment, risk assessment nursing practices and the role of education for nurses` conducting risk assessments with people who engage in self harm behaviour.

18. Recommendations; • It is recommended that there is a need to examine policies and develop guidelines for working with people who self harm. The effectiveness of risk assessment approaches for working with people who self harm needs to be evaluated. In service training is needed to inform nurses of evidence based structured risk assessment practices for working with people who self harm.