“That we give a vision of something...it can actually
also work...but I have completely accepted
that you are not thinking of it now (i15).”
It can be time-consuming to inspire hope in others,
according to one participant. When a patient is suffering
from physical unease and unable to verbalize why he/she
engages in self-harm, it is difficult for him/her to understand
that his/her need to self-harm can be reduced or stopped.
According to the participant, this entails being a cotraveler
during repeat hospital/care admissions and guiding the
patient’s recovery as a process or a learning situation for the
patient:
“It is difficult to converse when they do not know
anything else than anger... a lump in the stomach
or something like that. But what I can also say here
is that there is help available. Try to create hope
that there can be improvement in the future. But
it can take time then (i12).”
4.1.3. Being in a Reflective Dialogue to Promote the Patient’s
Verbal Expressions. The participants spent time with each
patient and engaged the patient in a dialogue about the
patient’s situation: what signs appear when a patient feels
the urge to self-harm, and whether the patient should
communicate with nurses before or after an act of self-harm.
They were clearly focused on having a reflective dialogue that
could promote the patients’ verbal expressions.
The participants experienced that a patient can learn to
manage his/her emotional fluctuations in other ways than
through self-harm. They sought to help patients verbalize
those feelings related to the self-harm situation. Patients are
vulnerable and the participants demonstrated sensitivity to
patients’ various forms of communication. As a consequence,
they therefore sought to help patients articulate their feelings
through dialogue instead of self-harm:
“It is a type of helplessness in the relationship. The
feelings...you cannot express yourself. You are not
capable of sorting and everything is chaos. They
need help putting it into words (i8).”
Patients are vulnerable and watchful for transgressions,
so it is therefore important that MHNs do not reject patients