though patients are undergoing an acute crisis, the danger
for suicide attempts or self-harm is still very high six months
after a self-harm episode [45], and it is important to prevent
suicide. Many patients bring equilibrium into their lives and
achieve peace through self-harm, but because of physiological
dependency the need for physical pain increases. Simeon et
al. [46] found that cutting can create a dream-like condition
for an individual, which can be compared to illicit drug use,
and that this can promote repetitive self-harm because of
the need to experience this mood change. Consequently, a
systematic evaluation of suicide risk should be included in
normal treatment routines.
A nonjudgmental approach by MHNs emerged as being
central to the creation of a dialogue with patients where
patients feel accepted. It can be inhibitory if MHNs do not
know the patient they are caring for and follow-up care can
become more provisional. It is also important for MHNs to
have a professional role and balance closeness and distance
in nurse-patient relationships, which should be predictable
and supportive over time. This way of relating to patients
promotes participation and empowerment. A partnership,
as part of a therapeutic relationship, where mutual trust,
humanistic caring, and a nonjudgmental attitude exist, promotes
person-centered nursing [47, 48].
The participants believed in patients’ abilities and rational
sides and bore hope for their recovery, even when the
patients themselves did not have such hope. Lindgren et
al. [49] stressed the importance of hopefulness and that
patients feel confirmed and receive support as determinants
in the reduction and discontinuation of self-harm. Weber
[50] found that patients have hope in the construction of their
identity, something that supports that MHNs should use hope
as an intervention. By showing hope in relation to patients,
trust and faith are demonstrated in patients and patients’ own
resources.
Person-centered mental health nursing is more than the
therapeutic relationship; it also includes the way services and
organizations work [51]. It is problematic that most units do
not allocate time for follow-up. Preventing repetitive selfharm
requires follow-up from all members of the health care
team over time and, primarily, from the MHN who cared for
the self-harm patient during the patient’s acute phase [52].
The participants in this study described the nurse-patient
relationship as being very challenging.Through their manner,
patients stimulate feelings in MHNs that can awaken powerful
extremes: from compliance to chaos. The actual study also
shows the importance of the care philosophy of the nursing
community as a whole and even nurses’ ability to cooperate
among themselves so that patients do not perceive any staff
disagreement, which can promote patient anxiety. Earlier
studies have shown that the greatest stress factor to affect
MHNs is their feelings of responsibility for patients’ selfharm
[53]. In this study the participants facilitated a reflective
dialogue with their patients and experienced that, over time,
their own feelings toward patients were transformed into
greater compassion through the relationship. Patients must
be allowed to feel difficult emotions and express emotions
without being judged in order to develop positive self-esteem
and get in contact with themselves [54].