but instead demonstrate sensitivity toward patients’ forms of
communication. The participants indicated that they sought
an alliance with the patient and sought to understand the
patient and his/her self-harming behavior.
4.1.4. Being Emotionally Affected by Self-Harm Patients. The
participants experienced being in a relationship with a selfharm
patient as being unpleasant, provocative, and/or challenging
at times.They described that patient relapses could be
experienced as a “defeat.” Thus MHNs can become discouraged
or experience a sense of powerlessness. Furthermore,
the participants even expressed that the patient’s emotions
can be projected (transferred) onto MHNs themselves, and
that MHNs’ negative feelings can incite self-harm in a patient.
The participants also experienced that patients can crave a
personal, private closeness that MHNs are unable to provide:
“My feelings can be chaotic of lot of what I am
thinking can be projections from the patient. Well,
I am able to separate myself more now than when I
was new for example, capable of separating myself
from the patient’s feelings, for example, to stop this
projection storm (i12).”
According to participants, after caring for a patient and
putting effort into helping the patient recover, the patient’s
relapses can be experienced as a “defeat” and can give rise to
a feeling of inadequacy with regard to promoting recovery.
Instead of engaging patients in a close relationship, the participants
attempted to create a boundary between themselves
and the patients (but without rejecting the patients), so that
it was possible to separate themselves from their patients and
promote a professional relationship.
The participants mentioned experiencing a sense of intuition
at times, a “gut feeling” in regard to a patient’s impending
self-harm. They described this kind of intuition as a
combination of feelings, experience, and knowledge through
which they actively explore the here-and-now of a situation.
Knowledge of various psychological defense mechanisms and
countertransference and the ability to distinguish feelings and
emotions are examples of the knowledge that the participants
used during the reflection process:
“Gut feeling comes very fast - a combination of
knowledge, and experience in a way. You speak
on and off about that you “smell” things then. You
can, to be sure, capture [it] (i4).”
4.2. Promoting Well-Being through Nursing Interventions. The
second main category includes six subcategories: evaluating
and following-up of triggers, observing signs of risk
for self-harm, searching for prevention activities, allowing
and/or preventing external self-harm, taking responsibility
for patients’ wounds and injuries, and evaluating need for
medication.
4.2.1. Evaluating and Following-Up of Triggers. Triggers can
include situations, thoughts, and/or feelings that can generate
a need for direct self-harm: for example, being alone