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Hospital staff experiences of their relationships with adults who self-harm: a meta-synthesis

O'Connor, Sophie; Glover, Lesley


Sophie O'Connor

Lesley Glover


Purpose This review aimed to synthesize qualitative literature exploring inpatient hospital staff experiences of their relationships with people who self-harm. Methods Nine studies were identified from a systematic search of five research databases. Papers included the experiences of physical health and mental health staff working in inpatient settings. The studies employed various qualitative research methods and were appraised using an adapted quality assessment tool (Tong, Sainsbury, & Craig, 2007). A meta-synthesis was conducted using traditional qualitative analysis methods including coding and categorizing data into themes. Results Three main themes derived from the data. ‘The impact of the system’ influenced the extent to which staff were ‘Fearing the harm from self-harm’, or were ‘Working alongside the whole person’. A fear-based relationship occurred across mental health and physical health settings despite differences in training; however, ‘Working alongside the whole person’ primarily emerged from mental health staff experiences. Systemic factors provided either an inhibitory or facilitative influence on the relational process. Conclusions Staff experiences of their relationship with people who self-harm were highlighted to have an important impact on the delivery and outcome of care. Increasing support for staff with a focus on distress tolerance, managing relational issues, and developing self-awareness within the relationship may lead to a more mutually beneficial experience of care. Equally, structure, clarity, and support within inpatient systems may empower staff to feel more confident in utilizing their existing skills. Practitioner points •Working with people who self-harm can be emotionally challenging and how staff cope with this can significantly impact on the engagement of staff and patients. •Increasing the skills of staff in managing relational issues and tolerating distress, as well as providing support and reflective practice groups may be useful in managing emotional responses to working with people who self-harm. •Refining the supportive, procedural, and environmental structures surrounding the caregiving relationship may help enable better integration of physical and mental health care.


O'Connor, S., & Glover, L. (2017). Hospital staff experiences of their relationships with adults who self-harm: a meta-synthesis. Psychology and Psychotherapy: Theory, Research and Practice, 90(3), 480-501.

Journal Article Type Article
Acceptance Date Dec 30, 2016
Online Publication Date Dec 30, 2016
Publication Date 2017-09
Deposit Date May 19, 2017
Publicly Available Date Jan 10, 2018
Journal Psychology and psychotherapy : theory, research and practice
Electronic ISSN 2044-8341
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 90
Issue 3
Pages 480-501
Keywords Self-harm; Self-injury; Relationship; Experience; Hospital; Accident and emergency; Staff; Metasynthesis; Inpatient; Care; Perceptions; Attitudes; Nurses; Doctors
Public URL
Publisher URL
Additional Information Authors' accepted manuscript of article: O'Connor, S. and Glover, L. (2017), Hospital staff experiences of their relationships with adults who self-harm: A meta-synthesis. Psychol Psychother Theory Res Pract, 90: 480–501. doi:10.1111/papt.12113


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