Improving the knowledge and skills of emergency department and mental health nurses to work therapeutically with patients who self-injure

Dr Irene Ngune1, Mrs Carrie Janerka1, Prof Diane Wynaden1, A/Prof Penelope Hasking1, Prof Clare Rees1, A/Prof Karen Heslop1, Dr Shirley McGough1

1Curtin University, Bentley, Australia

Non-suicidal self-injury (NSSI) falls within the spectrum of self-harm and includes behaviours such as cutting the skin and self-battery. NSSI generally begins around 14 years of age, with representations to hospital common. Increased frequency of self-injury has been linked to an increased risk for accidental death. Nurses who are skilled to work with people who self-injure can provide compassionate and professional care, hence reducing the person’s potential for future self-injury admissions.

Aim: The purpose of this study was to explore emergency department (ED) and mental health nurses’ understanding and experiences of working with people who present because of self-injury, and identify strategies that can enhance care for this group of patients.

Method: An online survey of emergency and mental health nurses across Australia. Participants’ knowledge, attitude and confidence in managing people who self-injure were measured.

Findings: A sample of 101 nurses (78% female; mean age = 41.96, SD = 11.42), including 54 ED nurses and 47 mental health nurses completed the survey. There was no significant difference in knowledge of NSSI between mental health and ED nurses (81.1% vs. 79.5%). Both groups of nurses had low negative attitude and high positive empathy however, mental health nurses perceived to have a less negative attitude (p=0.034), more confidence (p=0.000) and higher empathy (p=0.000) in caring for patients who self-injure than ED nurses. Knowledge was positively correlated with empathy (r=0.366, n=92, p=0.000) and confidence (r=0.373, n=92, p=0.000), but was negatively correlated with attitude (r=-0.539, n=92, p=0.000). Nurses with 6-10 years of specialty nursing experience were shown to have the highest levels of knowledge, attitude and confidence.

Conclusion: Further exploration of factors which impact nurses’ attitudes towards NSSI, particularly those with >10 years experience is required. Results of this study could inform future training for ED and mental health nurses.


Carrie is a Lecturer at Curtin University for the Graduate Certificate in Critical Care Nursing, and a Clinical Nurse at Fiona Stanley Hospital ED. She has over 15 years of emergency nursing experience in tertiary, rural and remote settings, and specialises in emergency nursing education. Carrie has completed a Master of Clinical Nursing (Emergency) and is currently embarking on a PhD. She is involved in emergency nursing research, instructs on a trauma course and is a member of various CENA Committees.