Attitudes of healthcare and social care professionals towards self-harm - Dissertation Example

?Attitudes of healthcare and social care professionals towards self-harm Mental patients may be more of a mystery today living among us, than they were hidden away in the asylum. We do not know them, because they are neither outside society in the world of exclusion, nor are they full citizens - individuals who are like the rest of us. Being neither self nor other, they are a new kind of social construction. Newell & Gournay, 2009, pp. 17 UK has one of the highest rates of self-harm in Europe: 400 per 100,000 populations Mental Health Statistics, 2012 Self-harm or deliberate self-harm, is a concept which is widely experienced in society in contemporary times, yet at the same time, is usually misunderstood. People involved in self-harm are known to suffer from social stigma and have experienced some degree of hostility in their lives. It is perceived and described by researchers as a means to cope with emotional distress. Self-harm is a manifestation of emotional distress – a desperate cry for help and care, experienced by individuals and indicates a disorder that needs immediate primary care to prevent fatal consequences (Dickenson, Huxtable and Parker, 2010). The rise in incidences of self-harm particularly among the youth is indicative of alarming trend and an issue of serious concern in our society. Deliberate self harm is one of the most commonly reported incidents in the UK requiring emergency care. The trend has assumed greater significance over the years due to the sheer rise in the number of cases reported each year, which has been on the rise during the past decade. The most vulnerable section of the population widely affected by this phenomenon includes young women and men over the age of 55 (Hawton et al., 2003; Gunnel et al., 2003). The first points of contact in case of emergency cases related to direct self harm are the emergency departments. Hence it is of utmost significance that the nurses / the staff directly responsible for handling such patients and providing emergency care must be adequately trained to cater to such patients. According to Happell et al., (2003) triage nurses who are given the key role of detecting direct self harm among patients and providing preventive care, are inadequately trained. Hence they lack the skill and expertise required to assess, diagnose and care for the patients suffering from any sort of mental distress. Such lack of ability to identify and provide effective treatment to their patients results in a serious loss of self-confidence among them, which leads to development of negative attitudes, which in turn is transferred to the patients (Happell et al., 2003; McDonough et al., 2003). Furthermore it has also been widely observed by researchers that in more often than not, the healthcare professionals are highly likely to feel indecisive with regard to providing effective care to patients who tend to self-harm (Holland & Plumb, 1973). They are often perceived to be bothersome by the nurses (Davidhizar, 1993). Also, their intention to self-harm might also be misinterpreted and dismissed by them, as attention seeking behaviour rather than emotional distress (Dower et al., 2000). Research suggests that the healthcare professionals may often fail to comprehend the fundamental factors influencing the patients to indulge in self-harm, which might be attributed to lack of proper training and/or skills required to diagnose such cases and offer appropriate treatment to such patients (Dower et al., 2000; Hopkins, 2002). It has also been observed by researchers that the nurses strongly believe that the patients who self-harm must be attended to by the mental health professionals and must be cared for by nurses who are trained to handle such cases, although the mental health professionals may be ill-equipped to do so. Historically, there has been overwhelming evidence indicating the negative attitudes of health care professionals towards patients who self-harm. According to Cotton et al., (1983) this could be attributed to the negative experiences of the nurses responsible for providing care with regard to such patients (Landeen, 1988). Furthermore in cases where the nurses are exposed to incidences of self-harm in the ward, such experience may lead to development of negative feelings towards such patients, such as guilt, lack of ability to offer emotional support, followed by grief, anger and shame (Midence et al., 1996; Flinn et al., 1978; Duffy, 1997). According to Sanders (2000) such negative attitudes or feelings among health care professionals or nurses towards patients who self-harm, may result in lowering the quality of care provided to such patients and change the perceptions of the nurses which may lead them to believe that their efforts are both time consuming as well as ‘not worth the effort’. The negative attitudes of health care professionals towards patients who self-harm are not only widely documented but also observed from the reactions of the patients themselves, according to various studies. For instance, in one study conducted in Brisbane, Australia to study the experiences of young people involved in self-harm towards the nursing staff responsible for their treatment, it was observed that one third of them were of the opinion that the healthcare professionals were of little or no use, and were generally described as unsupportive; while half of them described the staff as supportive and highly sympathetic towards them (Dower et al., 2000). In a similar study conducted in UK, it was observed that there were mixed opinions among the patients who self-harm towards the health care professionals, thus indicating a shift in the perception of nurses’ attitudes towards such patients, as compared to historical data (Clarke & Whittaker, 1998; Harris, 2000). The change in perception towards attitudes of nurses by the patients who self-harm may be attributed to various factors such as the age, skills, experience etc., of the nursing staff responsible for providing care. According to a study conducted by McLaughlin (1994) to study the attitudes of healthcare professionals towards patients who self-harm, in Northern Ireland, it was observed that the age of the nurses positively affects the treatment and care provided to such patients. The older and experienced nurses were generally observed to be more sympathetic towards the patients who self-harm as opposed to the younger and less experienced ones. Similar observations were made by Anderson (1997) who stated that the experienced nurses are more likely to react positively to patients with suicidal tendencies as compared to their younger and less-experienced colleagues. However, no conclusive evidence could be found regarding the impact of age and experience of nurses and healthcare professionals on the treatment and quality of care provided to patients who self harm, due to a general absence of common consensus among researchers. This can be observed from a study conducted by McAllister et al., (2002) involving nurses of an emergency department in Queensland, Australia, which concluded that there is no substantial evidence which successfully establishes the relationship between age and experience of nurses and healthcare professionals on the quality of treatment provided to patients who self harm. Thus, it can be safely concluded on the basis of the above discussions, that the relationship between attitudes of nurses towards such patients and their clinical experience is highly complex and multidimensional in nature. In this study the researchers observed the attitudes of nurses working in two major departments in Queensland's largest hospital which served a population of almost 400,000 people. The nursing staff was huge as well comprising of about 90 shift workers. The sheer size of the sample population warranties higher accuracy in terms of results since it affords greater scope for analysis. The results so derived from this study can hence be considered as credible. According to Doheny-Farina (1988) a large population size offers the researcher the ability to choose from a non-homogenous selection, which may greatly affect the interpretation of results. Furthermore one of the key benefits of a large population size is the ability to generalize the results which is otherwise not available in case of a smaller population sample. The issue of deliberate self harm is critical to public health and needs effective health care policies that help the nurses and the staff involved in improving the treatment and quality of care provided to patients who self harm. The fact that issues concerning self harm poses a major challenge to the healthcare department, and particularly so to the A&E (Accidents and Emergency) department has been largely established by various researchers (Holdsworth, Belshaw & Murray, 2001). According to a survey conducted by Warm, Murray & Fox (2002) the respondents (patients with a history of self-harm) were asked to mention the people they consulted for help, as well as indicate their satisfaction levels with regard to the services received from the medical staff. It was observed that most of the respondents responded negatively to the questions regarding the support offered by the healthcare professionals, indicating their displeasure at the services received with some of them describing it as highly unsatisfactory. Similar observations were made by other researchers in their studies, whereby it was indicated that the patients of self-harm have often described the attitudes of health care professionals as lacklustre, and unsupportive in nature (McAllister, 2001). There is a wide amount of literature which includes studies conducted by various researchers to assess the key factors responsible for the widely prevalent negative attitudes among the healthcare professionals towards the patients who self-harm. Salkovskis et al., (1990) suggest that the negative attitudes of health care professionals towards patients who self harm are largely on account of psychological issues along with the lack of awareness and/ or support by the psychiatric department (Cooper & Appleby, 1998). Studies involving assessing the factors responsible for the lack of effort and co-operation on the part of healthcare professionals to help the patients who self harm are scarce. Although on the basis of available literature, the general consensus indicates that negative attitudes of the nursing staff is largely on account of the perception of such patients by the medical staff (Roman, Bancroft & Skrimshire, 1975; Creed & Pfeffer, 1981; Platt & Salter, 1987; Alston & Robinson, 1992). The concept of self harm includes self wounding such as self inflicted injuries caused by burning, slashing or cutting. Such behaviour, as mentioned previously, is often a result of emotional distress and social exclusion faced by the patients, a condition which is either generally unnoticed or largely misunderstood by the caregivers, thus making it difficult to provide much needed care. It has been observed by various researchers that self harm caused by various means, has a serious impact on the caregivers, since it evokes emotional responses among them, which range from shock and displeasure to fear and disdain for such acts (Novotny, 1972; Simpson, 1980). The complexity of self harm caused by the patients, tends to give rise to mixed emotions among the nursing / medical staff, resulting in strong and often negative attitudes towards such patients, ultimately affecting the treatment provided by them (Allen, 1995). Patients of self harm have been known to be critical and apprehensive of receiving treatment, due to the negative attitudes of the clinical staff towards them, and their highly critical perceptions about them (Arnold, 1995). In a study carried out by Huband & Tantam (2000) to study the attitudes of a group of mental health staff towards patients of self injury, it was observed that the perception and attitudes of the staff depended highly on their professional qualifications and knowledge. The study was conducted via a questionnaire which was circulated among the clinical staff comprising of about 386 people in all at the Directorate of General Psychiatry. The respondents were required to respond to two frequently cited descriptions of patients of self-harm. Of the total 386 questionnaires 214 responded. According to Carter & Thomas (1997) the questionnaire method is most appropriate in the field of nursing research where the key aim is to analyze and measure the characteristic traits and /or collection opinions and attitudes of the respondents towards a given phenomenon. However, despite this being a quick method of gathering responses, this may not be apt for a research involving a large number of respondents since receiving straight forward and precise answers from them is a tedious task. In such cases the most recommended form of methodology would be personal interviews which might be a little time consuming but ensure better outcomes in terms of honest and accurate responses from the participants. The increasing evidence that point towards the overall negative attitudes of health care professionals towards patients of self harm has raised awareness regarding the issue resulting in an increased awareness to change their attitudes for the better, through improved training and education of the concerned staff. It has also attracted various policy initiatives, in the UK, whereby health care professionals are now required to follow appropriate guidelines while dealing with such sensitive issues and are entitled to exhibit genuine care, patience and support while interacting with or treating such patients. According to Gournay (2000) negative attitudes of health care professionals towards patients of self harm, can be attributed to the lack of training of the practitioners in UK. The medical staffs lacks adequate training to deal with distress caused due to emotional distress, thus making them ill equipped to offer appropriate care services to the patients. In order to improve their attitudes towards them and to enhance the quality of care services offered, the healthcare professionals must be exposed to effective training in providing clinical and psychology services. The relationship between training and quality of care is discussed below: Effect of training: Training of staff is widely documented to have result in wide ranging positive health outcomes for the patients of self harm. According to Grant et al., (2004), the introduction of sophisticated training approaches such as the RCT (Randomized Controlled Trials) in psychotherapy is likely to improve the existing knowledge among the medical staff and significantly improve their ability to respond positively to the patients. Evidence based medicine ensures better assessment of psychological issues and detection of emotional distress faced by the patients, thus providing an opportunity for the clinical staff to accurately examine, assess and offer support to the patients concerned. Furthermore, a systematic training approach ensures identification of patients with chronic psychological illnesses such as schizophrenia or other severe mental illness, causing the patients to indulge in self-harm; and differentiating between those requiring urgent medical assistance and critical care than the regular patients (Grant et al., 2004). It is commonly observed, on the basis of literature review and other evidence based research that a medical staff which is well qualified and specially trained in counselling, or those with formal training in psychotherapy, differ significantly in their approach to treating patients as compared to their less knowledgeable counterparts. The training of medical staff ensures an improvement in their ability to contain the anxiety and stress levels of the patients, by way of therapy and counselling. It also prepares them to contain their own anxiety levels, since according to available literature, dealing with self harming patients often tends to cause stress to those dealing with them. Effective training of the staff, prepares them to deal with their own fear, insecurities and concerns while interacting with or treating the self harm patients, improve their reactions to the treatment offered (Feldman, 1988). It has been observed that more often than not, the clinical staff tends to shift the blame, of inadequate care on their part, to the patients, citing non-cooperation from the patients. Professional training helps them in overcoming such setbacks and prepares them to rise up to the challenge and derive better outcomes in terms of patient health, through autonomy and self competence (Breeze & Repper, 1998). The defensive attitudes of the medical staff, which is largely responsible for their negative attitudes towards the self harm patients can be completely eradicated through training, which enables them to assume control of the situations they are faced with, and preparing them to assume greater responsibilities (Fincham & Emery, 1998). Training of staff involves a comprehensive study of various issues faced by the healthcare professionals while dealing with self harm patients, and provides them with adequate experience, insight and knowledge to address the issues encountered by them during treatment, at the same time providing them an opportunity for self growth. A well- trained medical workforce, has greater authority and competence and can guide the others to deal with their defensive responses and approach the care process with a positive attitude, thus drastically increasing the odds of better and favourable health outcomes. It is of utmost significance for the clinical staff entrusted with the responsibility of dealing with patients of self harm, to be emotionally strong. Training offers them the opportunity to assess their own emotional distress and overcome their shortcomings, prior to assessing and addressing the emotional needs of their patients. Effective psychological functioning of the healthcare professionals is extremely crucial for providing better assistance to the patients. Theoretical Perspective: Attribution Theory Attribution theory offers a critical framework for psychologists to study the manner in which individuals cope with, adjust to and manage the stressful situations encountered by them. It is often applied to assess the attitudes of individuals i.e., patients as well as clinical staff with regard to dealing with chronic illness. According to Fiske et al., (2010) various theories are developed by individuals to describe and cope with chronic illnesses which include stress, physical injury etc. among others. The patients of self harm are often subjected to critical perceptions on the part of the clinical staff. The healthcare professionals or caregivers often judge the self harm patients with certain pre-conceived notions which make them react to the patients in an inconsiderate manner, since such patients are perceived to have brought the harm to themselves by their own choice, thus evoking little or no sympathy by the staff. With regard to patients of self harm, this theory suggests that the clinical staff must take care to ensure that their interpretation and observation with regard to their patients must be interpreted appropriately. They must consider the involvement and role of external social factors in the situation faced by the patients, and attribute their behaviour to cause self injury to psychological or situational factors rather than consider it as a personality trait. The clinical staff must refrain from making assumptions about the patients who have indulged in self harm, particularly those who are homeless, or drug addicts, since there is often a valid and much greater explanation behind such a drastic step taken by them. Furthermore, this theory ensures that the health care professionals refrain from making impulsive judgements about the patients and stresses on approaching them with greater concern and care, by taking effective steps to understand their behaviour and the cause that prompted them to take such a drastic step (Walsh and Kent, 2001). Implications: On the basis of the above discussion it can be safely stated that in order to ensure better health outcomes for the patients of self-harm, it is of utmost significance to improve and enhance the attitudes and skills of the medical staff, towards such patients. Training and self improvement are almost widely acknowledged as effective measures in bringing about such improvement. Such changes can be brought about through governmental measures and policies implemented by them on the basis of professional recommendations. Some of the key implications of attitudes of health care and social care professionals towards patients of self harm are discussed below: Improving clinical practice and taking steps to ensure an overall improvement in the quality of service provided through training and development of the staff. This includes increasing access to medical and emergency services particularly for patients of self-harm, and ensuring their long term good health, by designing and implementing an after care plan to ensure their health and well being. The clinical staff involved in providing care to the patients of self harm must make active efforts in establishing a good rapport with such patients in order to foster health patient doctor relationship and to eradicate any fear and / or anxiety on the part of the patients. Most of such patients suffer from insecurity and feelings of abandonment and social exclusion. The establishment of a good rapport with the medical staff may encourage them to share their grievances and in turn help the clinical staff to help them in a better manner. Maximization of therapeutic benefits must be key goal of the clinical staff, and they should strictly adhere to the policies framed by the policy makers and government, in order to ensure positive health outcomes. 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Self-mutilation. Philadelphia : Temple University Press. Walsh, M., Kent, A., (2001). Accident and emergency nursing, Elseiver Health Sciences Publication, pp. 11-14 Read More