Emergency department staff attitudes toward people who self-harm: exploring the influences of norms and identity.

Patients who self-harm report negative staff attitudes toward them on presentation to an emergency department. Applying a thematic framework analysis to interviews with 10 staff members from one emergency department, the present research explored staff attitudes and behaviors (their own and the perception of others') and the impact of these attitudes on behavior, and the role of team identification and norms. Located within an overarching theme of balancing difference and diversity in relation to patients who self-harm, analysis identified themes related to beliefs about self-harm, the perceived barriers and facilitators to working effectively with patients, and the importance of identity, culture, and roles. Analysis also revealed the presence of pluralistic ignorance, whereby individuals perceive that others' (negative) actions reflect stable (negative) attitudes but do not perceive this for themselves. Thus, increasing knowledge and awareness of pluralistic ignorance may be a useful addition to training to minimize feelings of failure and frustration and increase understanding and improve patient care.