"You want to do what!?! What would that look like?" Harm-minimisation & self-harm. A model for practice.

All nurses regardless of their field of practice work to the ethical principles which underpin their Professional Code of Conduct (Nursing & Midwifery Council, 2008). The first such principle inherent in any healthcare... [ view full abstract ]

All nurses regardless of their field of practice work to the ethical principles which underpin their Professional Code of Conduct (Nursing & Midwifery Council, 2008). The first such principle inherent in any healthcare professional code is that of non-maleficence or ‘First, do no harm!’ (Beauchamp and Childress, 2001; Barker and Buchannan-Barker, 2012). Despite this ethical underpinning, the literature shows that current practices in working with people who self-harm are having the opposite effect; Nurses’ responses are often uniform and inflexible (Fish et al, 2011). Current interventions are perceived as restrictive, which in turn appear to only work to increase rates of self-harm (Birch et al, 2011; James et al, 2012a; James et al, 2012b; McHale & Felton, 2010). This is a clear indication that a change from current practice is required. One such possible change is to embrace a Harm reduction approach to working with people who self-harm. This is endorsed by the recent NICE (2011) guidelines for the management of self-harm. The guidelines recognise that getting someone who uses self-harm as a coping mechanism to stop engaging in this behaviour is unrealistic, as Pembroke (2007) argues the approach is about allowing people a valid method of “[…] survival until survival is possible by other means” (p.166). There are a number of case studies detailing this approach in the nursing literature. This paper aims to gather together all the available evidence and produce a working model which nurses could use when working alongside people who self-harm.