Use of a think-aloud procedure to explore the relationship between clinical reasoning and solution-focused training in self-harm for emergency nurses

Self-harm is a risk factor for further episodes of self-harm and suicide. The most common service used by self-injurers is the emergency department. However, very often, nurses have received no special training to identify and address the needs of these patients. In addition this care context is typically biomedical and without psychosocial skills, nurses can tend to feel unprepared and lacking in confidence, particularly on the issue of self-harm. In a study that aimed to improve understanding and teach solution-focused skills to emergency nurses so that they may be more helpful with patients who self-harm, several outcome measures were considered, including knowledge, professional identity and clinical reasoning. The think-aloud procedure was used as a way of exploring and improving the solution-focused nature of nurses' clinical reasoning in a range of self-harm scenarios. A total of 28 emergency nurses completed the activity. Data were audiotaped, transcribed and analysed. The results indicated that significant improvements were noted in nurses' ability to consider the patients' psychosocial needs following the intervention. Thus this study has shown that interactive education not only improves attitude and confidence but enlarges nurses' reasoning skills to include psychosocial needs. This is likely to improve the quality of care provided to patients with mental health problems who present to emergency settings, reducing stigma for patients and providing the important first steps to enduring change - acknowledgment and respect.