Background: Non-suicidal self-injury (NSSI), deliberate damage to body tissue with no intent to die, is not engaged with suicidal intent, but is the most reliable predictor of later suicidal behaviour. 7% of people presenting to emergency departments (ED) for self-injury die by suicide within 9 years. This makes efforts to reduce self-injury critical. On average, NSSI is observed 3 years before a suicide attempt, providing a critical window for early intervention. EDs are the gateways to care for many people who have self-injured, and optimal sites for interventions that promote recovery. However, ED nurses have told us that they lack training and feel ill-equipped to provide care for people who self-injure. Fortunately, nurses who receive NSSI training report greater empathy, self-confidence, and improved quality of patient care. Improving nurses’ knowledge, skills, and confidence has potential to reduce self-injury, and subsequent suicide risk for these patients.
Methods: A coaching model of NSSI training has been delivered at Royal Perth Hospital ED to upskill nursing staff. The coaching model combined online learning modules with face-to-face coaching and was developed by emergency nurses, mental health, nurses, people with lived experience, and research psychologists. A registered nurse and individual with lived experience delivered face-to-face training. Self-report surveys were conducted with staff: pre, post and one month after completion of the NSSI training. The surveys measured the impact of this coaching model on nurses’ knowledge, attitudes, empathy, confidence, self-compassion, and resilience in relation to people who have self-injured.
Results: 138 nurses were trained and 60 completed all surveys. Significant gains were seen in empathy, knowledge & comfort, self-compassion, compassion satisfaction, confidence, and resilience, and decreases in negative attitudes and signs of burnout. In all cases gains were maintained at one-month follow-up.
Conclusion: The coaching model of NSSI training is an effective approach to educating ED nurses on best practices for people who self-injure, potentially enhancing patient outcomes. Participants have expressed interest in extending this coaching model to other common mental health issues seen in ED. We have now taken these learnings and developed a Massive Open Online Course (MOOC) making training available around the world.