1
|
Silva C, Tsay CJ. HARMFUL ATTRIBUTIONS: THE ROLE OF MIND PERCEPTION. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2019; 38:788-809. [PMID: 38264083 PMCID: PMC10805455 DOI: 10.1521/jscp.2019.38.9.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Introduction Drawing from literature in social and clinical psychology, we explore mechanisms associated with the lack of empathy for people who engage in self-injurious behaviors. Methods Using implicit and explicit measures across three samples, we tested whether knowledge of prior self-injury impacts observers' empathy, perceived agency, perspective taking, and willingness to help a target individual. Results We found in Studies 1-2 that observers report decreased empathy, perceive less agency, and make more dispositional attributions toward a person who engages in deliberate self-injury, compared to accidental injury. Study 3 indicates that observers perceive a target who engaged in deliberate self-injury to have lower agency. Furthermore, when evaluating a target who has been victimized, observers report less empathy, compassion, and likelihood of helping if the target has a history of deliberate self-injury. Perceived agency accounted for decreased empathy, whereas empathy accounted for lower likelihood of helping. Discussion Our findings imply that observers may be better able to empathize with people with a history of self-injury if they focus on the agency of the individual and situational causal explanations for the behavior.
Collapse
Affiliation(s)
- Caroline Silva
- University of Rochester School of Medicine and Dentistry
| | | |
Collapse
|
2
|
James K, Samuels I, Moran P, Stewart D. Harm reduction as a strategy for supporting people who self-harm on mental health wards: the views and experiences of practitioners. J Affect Disord 2017; 214:67-73. [PMID: 28284098 DOI: 10.1016/j.jad.2017.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/01/2017] [Accepted: 03/05/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Harm reduction has had positive outcomes for people using sexual health and substance misuse services. Clinical guidance recommends these approaches may be appropriately adopted by mental health practitioners when managing some people who self-harm. There has, however, been very little research in this area. METHODS We explored practitioners' views of harm reduction as a strategy for supporting people who self-harm. The Self Harm Antipathy Scale (SHAS) was administered to a random sample of 395 mental health practitioners working on 31 wards in England, semi-structured interviews were then conducted with 18 survey respondents. RESULTS Practitioners who had implemented the approach reported positive outcomes including a reduction in incidence and severity of self-harm and a perceived increase in empowerment of service users. Practitioners with no experience of using harm reduction were concerned that self-harm would increase in severity, and were unsure how to assess and manage risk in people under a harm reduction care plan. Some fundamentally disagreed with the principle of harm reduction for self-harm because it challenged their core beliefs about the morality of self-harm, or the ethical and potential legal ramifications of allowing individuals to harm themselves. LIMITATIONS This study was conducted solely with practitioners working on inpatient units. The majority of staff interviewed had no experience of harm reduction and so their concerns may not reflect challenges encountered by practitioners in clinical practice. CONCLUSIONS Harm reduction is being used to support people who self-harm within inpatient psychiatry and some practitioners report potential benefits of this approach. However, this raises particularly complex practical, ethical and legal issues and further research is needed to assess the safety, acceptability and efficacy of the approach.
Collapse
Affiliation(s)
- Karen James
- Kingston University and St George's University of London, Joint Faculty of Health, Social Care and Education, London, SW17 ORE United Kingdom.
| | - Isaac Samuels
- Person with lived-experience of self-harm, United Kingdom
| | - Paul Moran
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Duncan Stewart
- Mental Health and Addiction Research Group, University of York, United Kingdom
| |
Collapse
|
3
|
Abstract
OBJECTIVE Although risk assessment for suicide has been extensively studied, it is still an inexact process. The current study determined how busy emergency clinicians actually assessed and documented suicide risk, while also examining the differences between psychiatric and emergency medicine opinions on the importance of various suicide predictors. METHOD Phase 1 of the study involved the administration of a survey on the relative importance of various suicide predictors for the specialties of psychiatry and emergency medicine. In phase 2 of the study, a chart review of psychiatric emergency room patients was conducted to determine the actual documentation rates of the suicide predictors. RESULTS Several predictors that were deemed to be important, including suicidal plan, intent for suicide, having means available for suicide, and practicing suicide (taking different steps leading up to suicide but not actually attempting suicide), had low documentation rates. CONCLUSIONS Medical specialties have different opinions on the importance of various suicide predictors. Also, some predictors deemed important had low documentation rates. Educational interventions and simple assessment tools may help to increase documentation rates of several suicide predictors in busy clinical settings.
Collapse
|
4
|
Kumar N, Rajendra R, Majgi SM, Krishna M, Keenan P, Jones S. Attitudes of General Hospital Staff Toward Patients Who Self-harm in South India: A Cross-Sectional Study. Indian J Psychol Med 2016; 38:547-552. [PMID: 28031591 PMCID: PMC5178039 DOI: 10.4103/0253-7176.194920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND There is growing global interest into the attitudes and clinical management of persons who deliberately self-harm. People who self-harm experience many problems and typically have many needs related to management of their psychological wellbeing. A positive attitude amongst general hospital staff should prevail with people who self-harm. The principal purpose was to determine student staff attitudes towards patients who self-harmed from a professional and cultural perspective, which might influence patient treatment following hospital admission. The focus concentrated upon staff knowledge, attitudes and beliefs regarding self-harm. METHODS A cross sectional survey of the hospital staff using a validated questionnaire was carried out. This paper reports on interdisciplinary staff from two large general hospitals in Mysuru, South India (n=773). RESULTS Findings suggest that within a general hospital setting there is wide variation in staff attitudes and knowledge levels related to self-harm. Whilst there is attitudinal evidence for staff attitudes, this study investigates interprofessional differences in an attempt to progress treatment approaches to a vulnerable societal group. Very few staff had any training in assessment of self harm survivors. CONCLUSION There is an urgent need for training general hospital staff in self harm assessment and prevention in south India. The results allow a series of recommendations for educational and skills initiatives before progressing to patient assessment and treatment projects and opens potential for cross cultural comparison studies. In addition, interventions must focus on current resources and contexts to move the evidence base and approaches to patient care forward.
Collapse
Affiliation(s)
- Narendra Kumar
- Department of Psychiatry, Mysore Medical College and Research Institute, Mysuru, Karnataka, India
| | - Rajagopal Rajendra
- Department of Psychiatry, Mysore Medical College and Research Institute, Mysuru, Karnataka, India
| | - Sumanth Mallikarjuna Majgi
- Department of Preventive and Social Medicine, Mysore Medical College and Research Institute, Mysuru, Karnataka, India
| | - Murali Krishna
- Department of Psychiatry, Wellcome DBT Trust Research Fellow, Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysuru, Karnataka, India
| | - Paul Keenan
- Postgraduate Studies Centre, Faculty of Health and Social Care, Edge Hill University, Aintree Campus, Liverpool, United Kingdom
| | - Steve Jones
- Postgraduate Studies Centre, Faculty of Health and Social Care, Edge Hill University, Aintree Campus, Liverpool, United Kingdom
| |
Collapse
|
5
|
The Impact of Knowledge of Suicide Prevention and Work Experience among Clinical Staff on Attitudes towards Working with Suicidal Patients and Suicide Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:195. [PMID: 26861362 PMCID: PMC4772215 DOI: 10.3390/ijerph13020195] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/27/2016] [Accepted: 01/29/2016] [Indexed: 12/19/2022]
Abstract
Suicide-preventive training has shown to influence attitudes. This study aimed at investigating what impact other factors than knowledge might have on attitudes towards work with suicidal patients and suicide prevention. In 2007, 500 health-care staff working in a psychiatric clinic in Stockholm received a questionnaire with items concerning work with suicidal patients to which 358 (71.6%) responded. A set of attitude items were tested using structural equation modelling (LISREL). Three models were found to be satisfactory valid and reliable: Job clarity, Job confidence and Attitudes towards prevention. These were then used in regression analyses as dependent variables with predictors such as experience of work with suicidal patients, perceived sufficient training,age and gender. Perceived sufficient training was consistently the most important predictor for all three attitude concepts (p < 0.01, β = 0.559 for Job clarity; p < 0.01, β = 0.53 for Job confidence; p < 0.01, β = 0.191 for Attitudes towards prevention). Age was another significant predictor for Job clarity (p < 0.05, β = 0.134), as was experience of patient suicide for Job confidence (p < 0.05, β = 0.137). It is concluded that providing suicide preventive education is likely to improve attitudes towards the prevention of suicide, clarity and confidence regarding their role in the care for suicidal patients. These improvements may contribute to the prevention of suicide in health care settings.
Collapse
|
6
|
Loh C, Teo YW, Lim L. Deliberate self-harm in adolescent psychiatric outpatients in Singapore: prevalence and associated risk factors. Singapore Med J 2013; 54:491-5. [DOI: 10.11622/smedj.2013170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
7
|
Factors Influencing Perceived Effectiveness in Dealing with Self-harming Patients in a Sample of Emergency Department Staff. J Emerg Med 2012; 43:1084-90. [DOI: 10.1016/j.jemermed.2012.01.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 08/25/2011] [Accepted: 01/22/2012] [Indexed: 11/23/2022]
|
8
|
Adolescents who self-harm: professional staff knowledge, attitudes and training needs. J Adolesc 2012; 35:1307-14. [PMID: 22705150 DOI: 10.1016/j.adolescence.2012.05.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/01/2012] [Accepted: 05/07/2012] [Indexed: 11/21/2022]
Abstract
This study aimed to investigate professional staff attitudes and knowledge about adolescents who engage in self-harming behaviour and to identify training needs. Previous research has suggested that medical and health care staff perceptions may reinforce the stigma associated with such behaviour and therefore jeopardise the effectiveness of interventions. To date, no available research exists on the views of school teachers. Participants recruited for the study were 120 qualified professionals working within an Accident and Emergency Department (A&E), Child & Adolescent Mental Health Services (CAMHS) and a Secondary School, based within the West Midlands, United Kingdom. Results demonstrated statistically significant differences between the groups. CAMHS staff were more knowledgeable and felt more effective than either A&E staff or teachers, whereas A&E staff expressed more negative attitudes. 95% of all staff reported that they would benefit from further training. These findings are discussed in relation to practice issues.
Collapse
|
9
|
Dickinson T, Hurley M. Exploring the antipathy of nursing staff who work within secure healthcare facilities across the United Kingdom to young people who self-harm. J Adv Nurs 2011; 68:147-58. [DOI: 10.1111/j.1365-2648.2011.05745.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
10
|
Mackay N, Barrowclough C. Accident and emergency staff's perceptions of deliberate self-harm: Attributions, emotions and willingness to help. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 44:255-67. [PMID: 16004659 DOI: 10.1348/014466505x29620] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The study applied Weiner's (1980, 1986) attributional model of helping behaviour to Accident and Emergency (A&E) staff's care of patients presenting with deliberate self-harm. It was hypothesized that where staff attributed precipitants of the act of deliberate self-harm to controllable, internal, and stable patient factors, then staff would display greater negative affect, less optimism, and less willingness to help the patient. DESIGN Using four hypothetical scenarios in a two-factor between-subjects design, contextual factors describing a self-harm patient were manipulated. METHOD Participants were 89 A&E medical and nursing staff. They were asked to rate attributions for the cause of the deliberate self-harm and their emotional responses, optimism for change, and willingness to help change the behaviour. Their general attitudes towards deliberate self-harm patients and perceived needs for training in the care of these patients were also assessed. RESULTS The findings were consistent with Weiner's attributional model of helping. The greater attributions of controllability, the greater the negative affect of staff towards the person, and the less the propensity to help. The higher the ratings of stability of outcome, the less staff optimism for the success of their input. Male staff and medical staff had more negative attitudes, and medical staff saw less need for further training. CONCLUSION Formulating A&E staff's responses to deliberate self-harm using a cognitive-emotional model offers the possibility of working with staffs' beliefs, emotions, and behaviour to improve the care and treatment of deliberate self-harm patients.
Collapse
|
11
|
Dickinson T, Wright KM, Harrison J. The attitudes of nursing staff in secure environments to young people who self-harm. J Psychiatr Ment Health Nurs 2009; 16:947-51. [PMID: 19930370 DOI: 10.1111/j.1365-2850.2009.01510.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T Dickinson
- University of Central Lancashire, Preston, Lancashire, UK
| | | | | |
Collapse
|
12
|
Walker T. ‘Seeing beyond the battled body’ – An insight into selfhood and identity from women's accounts who self-harm with a diagnosis of borderline personality disorder. COUNSELLING & PSYCHOTHERAPY RESEARCH 2009. [DOI: 10.1080/14733140902909174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
13
|
Commons Treloar AJ, Lewis AJ. Targeted clinical education for staff attitudes towards deliberate self-harm in borderline personality disorder: randomized controlled trial. Aust N Z J Psychiatry 2008; 42:981-8. [PMID: 18941964 DOI: 10.1080/00048670802415392] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of the present study was to assess the impact of attending targeted clinical education on borderline personality disorder on the attitudes of health clinicians towards working with deliberate self-harm behaviours commonly exhibited by patients diagnosed with this complex disorder. Comparisons of clinicians across service settings, occupational fields, and other demographic areas were also made. METHOD A purpose-designed demographic questionnaire and the Attitudes Towards Deliberate Self-Harm Questionnaire were used to collect the demographic information and assess the attitudes of 99 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service, both before and after education attendance. RESULTS Statistically significant improvements in attitude ratings were found for both emergency medicine clinicians and mental health clinicians in working with deliberate self-harm behaviours in borderline personality disorder, following attendance at the education program with a medium affect size (t(32)=-3.45, p=0.002, d=0.43 and t(65)=-5.12, p=0.000, d=0.42, respectively). Clinicians across occupational areas of nursing, allied health, and medical fields demonstrated equivocal levels of improvement in their attitude ratings. CONCLUSIONS Results are discussed in terms of the necessity of providing regular access to targeted clinical education for health professionals working with patients diagnosed with borderline personality disorder.
Collapse
Affiliation(s)
- Amanda J Commons Treloar
- School of Psychological Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | | |
Collapse
|
14
|
Commons Treloar AJ, Lewis AJ. Professional attitudes towards deliberate self-harm in patients with borderline personality disorder. Aust N Z J Psychiatry 2008; 42:578-84. [PMID: 18612861 DOI: 10.1080/00048670802119796] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of the present study was to assess the attitudes of mental health and emergency medicine clinicians towards patients diagnosed with borderline personality disorder. The clinician gender, primary occupation and service setting, level of university training and years of experience, frequency of clinical contact, and completion of specific training in borderline personality disorder were expected to influence the attitudes of health professionals towards working with borderline patients that engage in self-harm. METHOD A purpose-designed questionnaire and an assessment tool to quantify attitudinal levels were used to collect demographic information and assess the attitudes of 140 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service. RESULTS Statistically and clinically significant differences were found between emergency medical staff and mental health clinicians in their attitudes towards working with borderline personality disorder. The strongest predictor of attitudes was whether the clinician worked in emergency medicine or mental health. This was followed by years of experience and specific training in personality disorders as significant predictors of attitudes to self-harm. CONCLUSIONS The implications of these findings for the professional training of clinicians in the management and treatment of borderline personality disorder patients are discussed.
Collapse
Affiliation(s)
- Amanda J Commons Treloar
- School of Psychological Medicine, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | | |
Collapse
|
15
|
Thompson AR, Powis J, Carradice A. Community psychiatric nurses' experience of working with people who engage in deliberate self-harm. Int J Ment Health Nurs 2008; 17:153-61. [PMID: 18460076 DOI: 10.1111/j.1447-0349.2008.00533.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This paper reports on a study that explored community psychiatric nurses' experiences of working with people who self-harm. Interpretative Phenomenological Analysis was used with eight experienced community psychiatric nurses who participated in semi-structured interviews. Established quality control procedures were utilized including audit of the analysis process and validating the results with participants. The participants described struggling to conceptualize self-harm behaviour and generally reported finding working with people who self-harm stressful particularly in terms of managing the emotional impact upon themselves and the boundaries of their professional responsibilities in relation to managing risk. The therapeutic relationship was viewed as crucial and a variety of coping methods to manage the impact of the work, which had largely developed through 'on the job', experience were described. The results highlight the potential difficulties faced by community staff and can be translated into clear recommendations for training and support.
Collapse
Affiliation(s)
- Andrew R Thompson
- Clinical Psychology Unit, Department of Psychology, University Of Sheffield, Sheffield, UK.
| | | | | |
Collapse
|
16
|
Patterson P, Whittington R, Bogg J. Measuring nurse attitudes towards deliberate self-harm: the Self-Harm Antipathy Scale (SHAS). J Psychiatr Ment Health Nurs 2007; 14:438-45. [PMID: 17635251 DOI: 10.1111/j.1365-2850.2007.01102.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Most mental health nurses engage at some point with clients who harm themselves and these nurses often experience strong negative emotional reactions. Prolonged engagement with relapsing clients can lead to antipathy, and 'malignant alienation'. The study reported here has the aim of developing a brief, robust instrument for assessing nurse attitudes in this area. The Self-Harm Antipathy Scale, developed here on a sample of 153 healthcare professionals, has 30 attitudinal items with six factors. It has acceptable face validity, good internal consistency and some evidence of good test-retest reliability. It discriminates effectively between criterion groups. Overall this is evidence for the complexity of nurses' responses to this client group but such complex attitudes can still be assessed using a relatively brief structured instrument.
Collapse
Affiliation(s)
- P Patterson
- School of Healthcare Sciences, University of Wales Bangor, Bangor, UK.
| | | | | |
Collapse
|
17
|
Anderson M, Standen PJ. Attitudes towards suicide among nurses and doctors working with children and young people who self-harm. J Psychiatr Ment Health Nurs 2007; 14:470-7. [PMID: 17635255 DOI: 10.1111/j.1365-2850.2007.01106.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This paper presents a study investigating the attitudes towards suicide in nurses and doctors who work with children and young people who self-harm. The effect of basic demographic factors on attitudes towards suicide in the staff group is explored. The Suicide Opinion Questionnaire was implemented to collect data on attitudes towards suicide. A 5-point Likert Scale was used to score responses and attitudes were measured on eight clinical scales. Participants were 179 nurses and doctors working in three clinical areas: accident and emergency; paediatric medicine and adolescent inpatient mental health services. Nurses and doctors indicated agreement on the Mental Illness, Cry for Help, Right to Die, Impulsivity, Normality and Aggression scales, and less agreement on the Religion and Moral Evil scale. Only the scores for Mental Illness were statistically different in relation to professional group. There were no other significant differences on the other clinical scales in relation to gender, age clinical speciality and length of experience in current post. It is argued that complex attitudes need to be taken into account in training for healthcare professionals and in the development of contemporary suicide prevention policy.
Collapse
Affiliation(s)
- M Anderson
- School of Nursing, Faculty of Medicine and Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
| | | |
Collapse
|
18
|
Pompili M, Girardi P, Ruberto A, Kotzalidis GD, Tatarelli R. Emergency staff reactions to suicidal and self-harming patients. Eur J Emerg Med 2005; 12:169-78. [PMID: 16034262 DOI: 10.1097/00063110-200508000-00005] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Staff in the emergency departments of hospitals are reported as being negative or ambivalent toward suicidal or self-harming individuals. According to the literature, these patients are subjected to stigmatization and lack of empathy. This phenomenon has been linked to a decreased quality of care offered to these individuals and to missing an important opportunity to prevent further suicidal behavior or repetition of deliberate self-harm. Also, protocols, proper guidelines and education for the emergency staff call for a revision and an implementation. In this paper, evidence suggesting staff attitudes toward suicidal and self-harming patients is reviewed. An overview of related issues such as clinical judgment, the use of scales and nurses' role is also included in this report.
Collapse
Affiliation(s)
- Maurizio Pompili
- Department of Psychiatry, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy.
| | | | | | | | | |
Collapse
|
19
|
Lindgren BM, Wilstrand C, Gilje F, Olofsson B. Struggling for hopefulness: a qualitative study of Swedish women who self-harm. J Psychiatr Ment Health Nurs 2004; 11:284-91. [PMID: 15149375 DOI: 10.1111/j.1365-2850.2004.00712.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There has been an increase in the number of Swedish psychiatric patients who self-harm, yet self-harm is seldom described in published research. The aim of this study was to describe how people who self-harm experience received care and their desired care. Nine participants, all Swedish women who had been treated for inpatient or outpatient psychiatric care, narrated their experiences of care for self-harm. Using qualitative content analysis, two themes were formulated: 'Expecting to be confirmed while being confirmed fosters hopefulness'; and, 'Expecting to be confirmed while not being confirmed stifles hopefulness'. Each of these themes emerged from five subthemes that clustered around positive and negative aspects of being seen-not being seen, being valued-being stigmatized, being connected-disconnected, being believed-doubted, and being understood-not being understood. Of significance is for nurses to view persons who self-harm as human beings and to grasp the importance of being confirmed by staff that can foster hopefulness in persons who self-harm, yet realize the possibility of the paradoxical nature of hopefulness and being confirmed.
Collapse
Affiliation(s)
- B-M Lindgren
- Department of Nursing, Umeå University, Umea, Sweden.
| | | | | | | |
Collapse
|
20
|
Anderson M, Standen P, Noon J. Nurses' and doctors' perceptions of young people who engage in suicidal behaviour: a contemporary grounded theory analysis. Int J Nurs Stud 2003; 40:587-97. [PMID: 12834924 DOI: 10.1016/s0020-7489(03)00054-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Over the past 25 years, suicidal behaviour in young people has continued to be a major concern for health services around the world. Self-harm in individuals aged 13-18 is common and represents a significant reason for admission to accident and emergency departments, paediatric medical services and child and adolescent mental health services. Nurses' and doctors' working in these areas are the first point of contact for young people following an episode of self-harm. This paper presents a study exploring nurses and doctors perceptions of young people who engage in suicidal behaviour. The data presented form part of larger project conducted using both quantitative and qualitative methods, and a contemporary grounded theory approach to analysis. The findings revealed two main categories and associated subcategories: Experiences of frustration in practice (subcategories: non-therapeutic situations, insubstantiality of interventions and value of life) and strategies for relating to young people (sub-categories: specialist skills in care and reflections on own experience). The meanings of these categories highlight barriers in the relationship nurses and doctors have with young people who engage in suicidal behaviour. If suicide prevention policies around the world are to succeed the phenomena impacting on the communication between these professionals and young people needs to be addressed in research, education and in the development of practice.
Collapse
Affiliation(s)
- Martin Anderson
- School of Nursing, Faculty of Medicine and Health Sciences, University of Nottingham, University Park Room B50, Queen's Medical Centre, Nottingham NG7 2UH, UK.
| | | | | |
Collapse
|
21
|
O'Neill K, Horowitz LM, Smith MF, Levin C, Klavon S. Recognizing suicide risk in a pediatric emergency department: a change in nursing care. Pediatr Emerg Care 2001; 17:306-9. [PMID: 11493838 DOI: 10.1097/00006565-200108000-00022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K O'Neill
- Department of Psychiatry, Children's Hospital/Harvard Medical School, Boston, Massachusetts 02115, USA.
| | | | | | | | | |
Collapse
|
22
|
Anderson M, Standen P, Nazir S, Noon JP. Nurses' and doctors' attitudes towards suicidal behaviour in young people. Int J Nurs Stud 2000; 37:1-11. [PMID: 10687805 DOI: 10.1016/s0020-7489(99)00057-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper presents an exploratory study performed to identify the attitudes towards suicidal behaviour in young people, amongst nurses (and nursing lecturers), and doctors working in in-patient medical and mental health care settings. The Suicide Opinion Questionnaire (SOQ) was administered to 59 participants. Responses were scored using eight clinical scales, and tested by using a Kruskal-Wallis one way analysis of variance. An Independent Sample t-test was used to analyse gender differences. Qualitative interviews were conducted in a sample of respondents. SOQ findings revealed no overall significant differences in the relevant groups of nurses and doctors, with the exception of gender and the clinical scale relating to a 'Cry for Help'. The focused interviews generated five categories relating to suicidal behaviour and young people. Nurses and doctors working in these areas possess a range of influential perceptions of suicidal behaviour and need to be considered in the contexts of care and treatment of young people.
Collapse
Affiliation(s)
- M Anderson
- School of Nursing, Faculty of Medicine and Health Sciences, University of Nottingham, Medical School, Queen's Medical Centre, UK.
| | | | | | | |
Collapse
|
23
|
Anderson M. Nurses' attitudes towards suicidal behaviour--a comparative study of community mental health nurses and nurses working in an accidents and emergency department. J Adv Nurs 1997; 25:1283-91. [PMID: 9181428 DOI: 10.1046/j.1365-2648.1997.19970251283.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to explore and compare the attitudes towards suicidal behaviour of community mental health nurses (CMHNs) and registered nurses working in an accidents and emergency (A&E) department. The sample consisted of 80 nurses working in the same locality. An instrument was designed using statements from Domino's 'Suicide Opinion Questionnaire' (SOQ) and new statements based on a comprehensive survey of research in this area. The instrument contained four attitudinal categories consisting of; acceptability; morality and mental illness; professional role, work and care; and communication and attention. Results reveal that both groups of nurses held generally positive attitudes towards suicidal behaviour, contrasting with previous studies where more negative attitudes amongst nurses were found. A t-test showed no statistically significant differences between the two groups of nurses in any of the four attitudinal categories. Attitudes were significantly different in accordance with nurses' length of experience and age within both groups. Further research is needed in this area if nurses are to develop their role alongside other professionals working towards the objectives of suicide prevention policies.
Collapse
Affiliation(s)
- M Anderson
- Department of Nursing and Midwifery Studies, Faculty of Medicine, University of Nottingham, England
| |
Collapse
|
24
|
Long A, Reid W. An exploration of nurses' attitudes to the nursing care of the suicidal patient in an acute psychiatric ward. J Psychiatr Ment Health Nurs 1996; 3:29-37. [PMID: 8696794 DOI: 10.1111/j.1365-2850.1996.tb00189.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Suicidal patients admitted to hospital following a suicidal attempt or expressing suicidal ideation present a real challenge to health professionals with regard to their therapeutic care. This study was undertaken to explore the attitudes of psychiatric nurses caring for such patients. Results reveal that psychiatric nurses do hold positive views on caring for potentially suicidal patients, contradicting previous studies where more negative feeling were expressed by nurses, especially those with initial contact. Findings also show that some nurses experience an element of distress, and the length of experience within such a working environment does not affect the nurses' level of satisfaction gained on caring for the suicidal patient. This study also identifies an expression of need for further education and practice in interpersonal skills and therapeutic modalities to enhance and develop a more effective delivery of care for this group of patients.
Collapse
|
25
|
Abstract
The increase in adolescent suicides has prompted the World Health Organization to set targets to reduce the incidence of deaths by the year 2000. In order to achieve this target further investigation into the perceptions of adolescent parasuicidal individuals is required to reduce the number of suicide attempts. Statistical evidence shows that parasuicidal individuals are commonly females who attempt suicide by taking an overdose. In the majority of cases help has been sought within the month prior to the attempt. Following an attempt many individuals feel isolated or ignored by health professionals. It appears that communication difficulties and negative attitudes by health professionals often reinforce the stigma associated with suicide. Nurses can contribute to the prevention of parasuicide/suicide by actively providing therapeutic care and counselling parasuicidal individuals to help them deal with major life events.
Collapse
|
26
|
Pederson C. Promoting nursing students' positive attitudes toward providing care for suicidal patients. Issues Ment Health Nurs 1993; 14:67-84. [PMID: 8454465 DOI: 10.3109/01612849309006891] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Nurses may encounter patients who are suicidal in most clinical settings, yet many nurses report a negative attitude toward providing care for these patients. Nursing programs, in which students learn about suicide and develop skills in assessing and intervening with patients who are suicidal, are opportune settings for promoting a positive attitude toward providing care for suicide attempters. An experimental study compared the effectiveness of an interactive teaching strategy known as "structured controversy" with a lecture on promoting a positive attitude. A questionnaire based on Ajzen and Fishbein's (1980) theory of reasoned action was used to measure attitude, and was completed by 51 senior nursing students following a suicide class session. Students who had participated in structured controversy on suicide were significantly more positive on the stress/frustration factor extracted from a scale of attitude items. Students who had listened to the suicide lecture held significantly more positive beliefs about providing care for suicidal patients. Implications for education and practice are discussed.
Collapse
|
27
|
Abstract
A questionnaire examining attitudes to patients with eating disorders was completed by 352 medical and nursing staff in a general hospital. Patients with eating disorders were less liked than patients with schizophrenia and were seen as responsible for their illness almost to the same degree as recurrent overdose takers. Factor analysis showed a first factor in which patients with eating disorders were construed as vulnerable to external pressures (from others, the media) while also self-inducing their illness, and this was associated with treatment recommendations for education, urging the patient to take self-control and psychotherapy. The professions differed significantly in attitudes.
Collapse
Affiliation(s)
- J Fleming
- Department of Psychiatry, Royal Melbourne Hospital, Parkville, Victoria
| | | |
Collapse
|
28
|
Abstract
This study examines the knowledge, beliefs, attitudes, intentions and experiences of nurses at various stages of their careers with regard to patients who have made suicide attempts. It focuses particularly on the relationship of traditional Shona beliefs about suicide and considers how they interact with western medical beliefs. A detailed questionnaire covering these elements was administered to three groups of nurses. They were sampled at either the beginning or end of their training or after approximately ten years experience. Knowledge of suicide was found to be poor and attitudes towards parasuicide were negative. Traditional beliefs were held strongly by all groups of nurses; western beliefs were strongest amongst experienced nurses. Practical implications of these attitudes and beliefs for training are considered.
Collapse
Affiliation(s)
- E Elliot
- Staffordshire University, Stoke-on-Trent, UK
| | | | | |
Collapse
|
29
|
Waterhouse J, Platt S. General hospital admission in the management of parasuicide. A randomised controlled trial. Br J Psychiatry 1990; 156:236-42. [PMID: 2180527 DOI: 10.1192/bjp.156.2.236] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Suitably trained junior doctors selected parasuicides with no immediate medical or psychiatric treatment needs on initial assessment in a casualty department. This group was then randomly allocated to hospital admission (38 cases) or discharge home (39 cases). One week later there were no significant differences between groups on diverse outcome measures, including repetition rate, psychological symptoms, and social functioning. A second follow-up using the same measures at 16 weeks also failed to demonstrate any differences between groups, both of which showed considerable overall improvement. A parasuicide management policy consisting of assessment in a casualty department and selective discharge was appropriate for 15% of a hospital-referred population. This lends support to recent government recommendations, but caution should be exercised before such a result is generalised.
Collapse
Affiliation(s)
- J Waterhouse
- Institute of Research in Social Sciences, University of York
| | | |
Collapse
|