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      ‘Our Care through Our Eyes’. Impact of a co-produced digital educational programme on nurses’ knowledge, confidence and attitudes in providing care for children and young people who have self-harmed: a mixed-methods study in the UK

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          Abstract

          Objectives

          (1) To determine the impact of a digital educational intervention on the knowledge, attitudes, confidence and behavioural intention of registered children’s nurses working with children and young people (CYP) admitted with self-harm.

          (2) To explore the perceived impact, suitability and usefulness of the intervention.

          Intervention

          A digital educational intervention that had been co-produced with CYP service users, registered children’s nurses and academics.

          Setting

          A prospective, uncontrolled, intervention study with preintervention and postintervention measurement, conducted at a large acute NHS Trust in the UK.

          Participants

          From a pool of 251 registered children’s nurses and 98 participants were recruited to complete the intervention (response rate=39%). At follow-up, 52% of participants completed the postintervention questionnaire, with 65% (n=33) of those reporting to have completed the digital educational intervention.

          Primary outcome measures

          Attitude towards self-harm in CYP was measured using a 13-item questionnaire; knowledge of self-harm in CYP was measured through an adapted 12-item questionnaire; confidence in different areas of practice was measured through Likert Scale responses; self-efficacy for working with CYP who have self-harmed was measured through an adapted version of the Self-efficacy Towards Helping Scale; clinical behavioural intention was measured by the Continuing Professional Development Reaction Questionnaire. Semistructured interviews were undertaken with a purposive sample of participants.

          Results

          For those who completed the intervention (n=33), improvements were observed in knowledge (effect size, ES: 0.69), confidence, and in some domains relating to attitudes (effectiveness domain-ES: 0.49), and clinical behavioural intention (belief about consequences-ES:0.49; moral norm-ES: 0.43; beliefs about capability-ES: 0.42). Qualitative findings suggest participants experienced skill development, feelings of empowerment and reflection on own practice.

          Conclusions

          The effect of the intervention is promising and demonstrates the potential it has in improving registered children’s nurse’s knowledge, confidence and attitudes. However, further testing is required to confirm this.

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          Most cited references22

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          Making sense of qualitative data analysis: an introduction with illustrations from DIPEx (personal experiences of health and illness).

          This paper outlines an approach to analysing qualitative textual data from interviews and discusses how to ensure analytic procedures are appropriately rigorous. Qualitative data analysis should begin at an early stage in data collection and be highly systematic. It is important to identify issues that emerge during the data collection and analysis as well as those that the researcher may have anticipated (from reading or experience). Analysis is very time-consuming, but careful sampling, the collection of rich material and analytic depth mean that a relatively small number of cases can generate insights that apply well beyond the confines of the study. One particular approach to thematic analysis is introduced with examples from the DIPEx (personal experiences of health and illness) project, which collects video- and audio-taped interviews that are freely accessible through http://www.dipex.org. Qualitative analysis of patients' perspectives of illness can illuminate numerous issues that are important for medical education, some of which are unlikely to arise in the clinical encounter. Qualitative studies can also cover a much broader range of experiences - of both common and rare disease - than clinicians will see in practice. The DIPEx website is based on qualitative analysis of collections of interviews, illustrated with hundreds of video and audio clips, and is an innovative resource for medical education.
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            Hospital Presenting Self-Harm and Risk of Fatal and Non-Fatal Repetition: Systematic Review and Meta-Analysis

            Background Non-fatal self-harm is one of the most frequent reasons for emergency hospital admission and the strongest risk factor for subsequent suicide. Repeat self-harm and suicide are key clinical outcomes of the hospital management of self-harm. We have undertaken a comprehensive review of the international literature on the incidence of fatal and non-fatal repeat self-harm and investigated factors influencing variation in these estimates as well as changes in the incidence of repeat self-harm and suicide over the last 30 years. Methods and Findings Medline, EMBASE, PsycINFO, Google Scholar, article reference lists and personal paper collections of the authors were searched for studies describing rates of fatal and non-fatal self-harm amongst people who presented to health care services for deliberate self-harm. Heterogeneity in pooled estimates of repeat self-harm incidence was investigated using stratified meta-analysis and meta-regression. The search identified 177 relevant papers. The risk of suicide in the 12 months after an index attempt was 1.6% (CI 1.2–2.4) and 3.9% (CI 3.2–4.8) after 5 years. The estimated 1 year rate of non-fatal repeat self-harm was 16.3% (CI 15.1–17.7). This proportion was considerably lower in Asian countries (10.0%, CI 7.3–13.6%) and varies between studies identifying repeat episodes using hospital admission data (13.7%, CI 12.3–15.3) and studies using patient report (21.9%, CI 14.3–32.2). There was no evidence that the incidence of repeat self-harm was lower in more recent (post 2000) studies compared to those from the 1980s and 1990s. Conclusions One in 25 patients presenting to hospital for self-harm will kill themselves in the next 5 years. The incidence of repeat self-harm and suicide in this population has not changed in over 10 years. Different methods of identifying repeat episodes of self-harm produce varying estimates of incidence and this heterogeneity should be considered when evaluating interventions aimed at reducing non-fatal repeat self-harm.
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              Reasons for deliberate self-harm: comparison of self-poisoners and self-cutters in a community sample of adolescents.

              To compare motives and premeditation between adolescent deliberate self-poisoners and self-cutters. In a sample of 6,020 pupils aged 15 and 16 years who completed a self-report questionnaire, those who had deliberately cut themselves in the previous year (n = 220) were compared with those who had taken overdoses (n = 86). More adolescents who took overdoses than those who cut themselves said that they had wanted to die (66.7% versus 40.2%, chi2 = 14.94, p <.0001) and had wanted to find out if someone loved them (41.2% versus 27.8%, chi2 = 4.14, p =.042). Female self-cutters were more likely than male self-cutters to say that they had wanted to punish themselves (51.0% versus 25.0%, chi2 = 9.25, p =.002) and had tried to get relief from a terrible state of mind (77.2% versus 60.9%, chi2 = 4.78, p =.029). More self-cutters than self-poisoners had thought about the act of self-harm for less than an hour beforehand (50.9% versus 36.1%, chi2 = 5.25, p =.021). There are differences between adolescents' motives for overdoses and for self-cutting, and also gender differences in the reasons for self-cutting. The often impulsive nature of these acts (especially self-cutting) means that prevention should focus on encouraging alternative methods of managing distress, problem-solving, and help-seeking before thoughts of self-harm develop.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Open (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2017
                4 May 2017
                : 7
                : 4
                : e014750
                Affiliations
                [1 ] departmentSchool of Health Sciences , Faculty of Medicine and Health Sciences, University of Nottingham , Nottingham, UK
                [2 ] departmentNottingham Children’s Hospital and Neonatology , Family Health Division, Nottingham University Hospitals NHS Trust , Nottingham, UK
                [3 ] departmentChildren and Families Research , Centre for Technology Enabled Health Research, Coventry University , Coventry, UK
                [4 ] NHS Improvement , London, UK
                [5 ] departmentNUH Institute of Nursing and Midwifery Care Excellence, Corporate Division , Nottingham University Hospitals NHS Trust , Nottingham, UK
                [6 ] departmentDigestive Diseases, NIHR Nottingham Biomedical Research Centre , Nottingham University Hospitals NHS Trust and the University of Nottingham , Nottingham, UK
                [7 ] departmentThorneywood Child and Adolescent Mental Health Service , Nottinghamshire Healthcare NHS Foundation Trust , Nottingham, UK
                Author notes
                [Correspondence to ] Dr Joseph C Manning; joseph.manning@ 123456nottingham.ac.uk
                Author information
                http://orcid.org/0000-0002-6077-4169
                Article
                bmjopen-2016-014750
                10.1136/bmjopen-2016-014750
                5623397
                28473515
                33376de2-f7fe-45c5-b639-0eab3cd08ffa
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 14 October 2016
                : 10 January 2017
                : 17 February 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000386, Burdett Trust for Nursing;
                Categories
                Nursing
                Research
                1506
                1715
                Custom metadata
                unlocked

                Medicine
                suicide & self-harm,education & training,registered nurse,mental health,co-production,health informatics

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