previously in life and who because of this is vulnerable in
relationships with other people.
This study shows that MHNs seek person-centered solutions
and ways of promoting individual patients’ well-being.
Health in person-centered nursing is linked to personal
well-being, and standard nursing interventions may not be
appropriate for every nursing interaction in person-centered
nursing [30]. According to Barker and Buchanan-Barker [31],
the Tidal model starts with an evaluation of how disturbed a
person is, his/her need for security, and whether the person
can begin to tell his/her story. Interventions through acute
services may limit the risk of physical harm but often fail
to address the patient’s underlying emotional insecurity [31].
Researchers have studied the Tidal model in various acute
mental health care studies, and the results from these studies
indicate that a reduction in self-harm and suicide attempts
occurs when the Tidal model is employed [40, 41]. In a
study by Ruddick [42], MHNs sought to help patients explore
their inner world so that fragmentation could be turned into
wholeness, despair into hope, and conflict into harmony.
An interesting finding from this study is that the participants
consciously observed and focused on interpreting and
understanding the triggers and signs of self-harm and therefore
had good possibilities to prevent self-harm in a goaloriented
manner through diversion. The participants sought
to promote person-centered nursing by helping patients
learn to articulate their pain, recognize their triggers, and/or
use other strategies to divert physical suffering and modify
their behavior. The participants also sought to help develop
patients’ ability to cope with internal and external triggers,
which can reduce their need for self-harm. The participants
promoted an individual learning process, which included
an attempt to truly understand and support each individual
patient, and showed patients various types of self-treatment
in order to empower the patients to engage in less direct selfharm
over time.
A central finding is the varying approach to whether
patients should be allowed to engage in mild or moderate
self-harm when admitted to a unit. At two clinics, patients
were allowed self-harm tools but were encouraged to return
them to nurses when not in use. The participants wanted
to be present with patients both when self-harm was being
stopped or being committed. Those participants who allowed
patients to self-harm while admitted to a unit often saw that
the patients after a short while felt better and experienced
self-control over their suffering. Still, staff control can create
a power struggle between patients and nurses and, in
certain cases, can even cause more self-harm. In this study,
participants reported that patients with a history of selfharm
received both emotional and practical support and were
allowed to self-harm in order to create physical pain and
reduce mental distress. Patients accustomed to using knives
or razorblades could be given the possibility to continue using
these tools. Thus the participants supported the patients in
becoming aware of their own feelings [43]. This way of working
entails that MHNs must be able to stand the insecurity
of transferring some control to the patient. Nevertheless,
many people are forcibly admitted to acute mental health
units because they are a danger to themselves [44]. Even