The Attitudes and Perceptions of Healthcare and Social Care Professionals To People Who Self-Harm - Dissertation Example

?What are the current attitudes, knowledge and perceptions of healthcare and social care professionals towards people who self- harm? Introduction Statistics for attempted suicides rates in recent times are showing a sudden increase. This is also evident from the number of deliberate self harming patients being admitted daily in the accident and emergency departments of hospital. More than mere medical treatment and emergency care it is more important to identify the needs of these self harming persons and the reasons behind doing so (Ouzouni and Nakakis, 2009). Care and moral support is more important for such patients than medical treatment. This however depends on the behavior and attitude of the staff and nurses working in accident and emergency (A&E) departments. The care and management of the patients rests entirely on whether the nursing staff develops a positive or negative attitude towards those patients who harm themselves either through cuts or burns in the skin or through other harmful methods such as self poisoning (Friedman, Newton, Hooley, Patel and Mitchell, 2006). In recent times these patients have often complained about insufficient care in the A&E department of hospitals. This is because in most cases the nursing staff exhibits anger or frustration while dealing with self harming patients (McAllister, Creedy, Moyle and Farrugia, 2002). Research studies have been undertaken by eminent psychologists to understand the attitude of nurses and doctors encountering such self harming patients to develop measurement tools and frame developmental policies accordingly. The essay intends to present a critical review of the methodologies adopted and finding obtained during such research studies to identify the current attitudes, knowledge and perceptions of social and health care professionals dealing with self harming patients. Before getting into interpretation of results performing thematic analysis and critical review of the given articles on behavior of health care professionals towards self harming patients it is important to identify the theme underlying each article which is essential for our analysis. The article themes have been identified and presented in a hypothetical format below: Table 1: Thematic Analysis for different articles (attached) on self harming behavior Author Name of Paper Theme Terence McCann Eileen Clark Susan McConnachie Isabel Harvey Accident and Emergency nurses’ attitude towards people who self harm Whether the attitude of nurses working in accident and emergency department is positive or negative towards self- harming patients Trevor Friedman Charles Newton Christine Coggan Samantha Hooley Rekha Patel Matthew Pickard Alex J. Mitchell Predictors of A&E staff attitudes to self-harm patients who use self-laceration: Influence of previous training and experience Whether the attitude of staff working in accident and emergency (A&E) department is positive or negative towards patients who harm themselves through cut or injuries in the skin and assessment of role of age, experience and education of nurses influencing such behavior Terence McCann Eileen Clark Susan McConnachie Isabel Harvey Deliberate self-harm: emergency department nurses’ attitudes, triage and care intentions The study is to get an idea of the attitude and care decisions of nurses working in A&E department towards patients who harm themselves deliberately Nadine Mackay Christine Barrowclough Accident and emergency staff’s perceptions of deliberate self-harm: Attributions, emotions and willingness to help The study of the helping behavior of A&E department staffs who harm themselves deliberately Andrew R. Thompson Jane Powis Angela Carradice Community psychiatric nurses’ experience of working with people who engage in deliberate self-harm The study intends to present a report on the experience of those nurses working for psychiatric patients who harm themselves deliberately Nick Huband Digby Tantam Attitudes to self-injury within a group of mental health staff Identification and description of factors that influence professional attitude towards self injury K.I. Perseius A Kaver S Ekdahl M Asberg Stress and burnout in psychiatric professionals when starting to use dialectical behavioral therapy in the work with young self-harming women showing borderline personality symptoms The study showing effect on occupational stress and professional burnout of psychiatric professionals when using dialectic behavioral therapy among young self-harming women with slight personality disorder P. Patterson R. Whittington J. Bogg Measuring nurse attitudes towards deliberate self-harm: the Self-Harm Antipathy Scale (SHAS) The study aims to develop an effective instrument that will help to measure the mental health nurses’ attitude in the area of self harm antipathy Andy McKinlay Maggie Couston Sue Cowan Nurses' behavioral intentions towards self-poisoning patients: a theory of reasoned action, comparison of attitudes and subjective norms as predictive variables The study aims to know the attitude of the nursing staff towards self poisoning patients in the setting of general hospital Alastair McElroy Gerry Sheppard The assessment and management of self harming patients in an Accident and Emergency department: An action research project The paper aims to frame developmental policies for management of self harming patients through assessment of self harming patient management within Accident and Emergency department Debra Creedy Wendy Moyle Charles Farrugia Nurses’ attitudes towards clients who self-harm The study aims to test a scale for identifying the relevant dimensions of the attitude of nurses working in emergency department towards the patients who harm themselves Christina Ouzouni Konstantinos Nakakis Attitudes towards attempted suicide: the development of a measurement tool The research study aims to develop a tool for measuring the attitudes of nurses and doctors towards patients who attempt suicide From the table it is found that for many of the papers the themes identified happens to portray more or less the same phenomenon. In short the themes for some of the paper happen to be overlapping. The commons themes can be categorized and grouped under broad heads as shown in the hypothetical below: Name of Group Name of paper Common themes Attitude of nurses 1. Accident and Emergency nurses’ attitude towards people who self harm 2. Deliberate self-harm: emergency department nurses’ attitudes, triage and care intentions 3. Community psychiatric nurses’ experience of working with people deliberate self-harm 4. Nurses' behavioral intentions towards self-poisoning patients: a theory of reasoned action, comparison of attitudes and subjective norms as predictive variables Here the identified common theme among the papers is to study the attitude and behavior of nurses working in A&E department towards those self harming patients harming themselves in various ways Attitude of emergency staff and psychiatric professionals 1. Accident and emergency staff’s perceptions of deliberate self-harm: Attributions, emotions and willingness to help 2. Predictors of A&E staff attitudes to self-harm patients who use self-laceration: Influence of previous training and experience 3. Attitudes to self-injury within a group of mental health staff Stress and burnout in psychiatric professionals when starting to use dialectical behavioral therapy in the work with young self-harming women showing borderline personality symptoms Here the identified common theme among the papers is to study the attitude and behavior of staffs and psychiatric therapists working in A&E department under occupational stress towards those self harming patients harming themselves in various ways Development of measurement tools and effective policies 1. Measuring nurse attitudes towards deliberate self-harm: the Self-Harm Antipathy Scale (SHAS) 2. The assessment and management of self harming patients in an Accident and Emergency department: An action research project 3. Nurses’ attitudes towards clients who self-harm 4. Attitudes towards attempted suicide: the development of a measurement tool Here the identified common theme among the papers is to develop a tool for measuring the intensity of nurses and staffs negative behavior and attitude towards self harming patients and develop effective policies accordingly for proper management of this patients From the table above the common themes from the given papers could be identified. These common themes have been classified into four broad groups which are related to: attitude of nurses working in A&E department attitude of emergency staff Development of the measurement tools for accessing the emergency nurses and staffs and psychiatric professionals’ behavior and framing developmental policies accordingly for efficient management of such self harming patients. The critical review for the given papers has performed by grouping them under the broad headings which contains common themes for the given papers. Critical Review Attitude of nurses working in A&E department To get an idea of the nurses’ attitude towards self harming patients the background of the nursing staff was considered. A research study was conducted through questionnaire method asking for opinions on suicidal persons. Primary data was collected from 43 nurses who had medical registration. Questions regarding their age, experience in the sector and educational qualification were also asked. The survey revealed that most of them did not have academic knowledge of dealing with self harming patients. Only 8 respondents have claimed to have attended DSH based in-service education. Moreover no guidelines were issued from 20% of the hospitals for treatment of such patients. Thus the survey has been effective in revealing a major flaw of such health care clinics in treating self harming patients(McCann, Clark, McConnachie, Harvey, 2005). However a modifiedSuicide Opinion Questionnaire was prepared later containing only non probability samples. This was done to focus more and get more relevant outcomes regarding the ill behavior and negative attitude of nurses towards self-harming patients (McCann, Clark, McConnachie, Harvey, 2007). The inclusion of information on nurses’ educational qualification, age and experience is considered worthy because it has been proved in the research that such factors do influence the behavior of nurses towards self harming patients. The responses showed mixed opinions and the attitude towards self harming patients were found to vary with the nurses’ age, experience and education. The older nurses were found to be more confident about their responses and opinions about self harming behavior. Their long experience in dealing with such suicidal patients has obviously boosted their level of confidence. Unlike the younger nurses, older ones did not believe that suicide attempts by such patients are solely for sympathy. The experienced nurses also disagreed on high chances of survivors for attempting suicides again in future to which the less experienced ones agreed. Hence information on age, experience and educational qualification are deemed necessary to get an access of attitudes of nurses towards self harm patients (McCann, Clark, McConnachie, Harvey, 2005). The group focused method of data collection can also be of help to collect information and opinions from group discussions of particular targeted population. The experience of a group of psychiatric nurses has also been utilized to know the problems faced by these nurses while dealing with self-harm patients. Most of the nurses have shared their experience of dealing with anger of these patients. Such a research with experienced nurses has been effective because they are able to trace out common behavior exhibited by these self harming patients. Suicide has been described as their effort to transfer emotional pain into physical one (Thompson, Powis and Carradice, 2008). Hence from the outcomes of the research study the essay interprets that most self harming suicidal patients are suffering from emotional stress and they need emotional support more than any medical treatment to enable them to live. Moreover comparing the articles it can be claimed that experience of nurses should be taken into account in the research of attitude of nurses towards self harm patients. The negative attitude of nurses has been termed as harmful for DSH patients because in that case the nurse will not perform her duties with full responsibilities. Moreover in absence of clear guidelines for managing such patients makes the nurse feel less confident about her work and this confusion of patient management leads to frustration. Sometimes nurses are helpless in tackling such DSH patients and this in turn contributes to the negative behavior of nurses towards patients. In some cases nurses fail to understand the patients and their annoying behavior. Professional boundaries may obstacles to proper understanding of patients (Thompson, Powis and Carradice, 2008). Nurses emphasize more on healing physical injuries rather than giving emotional support to these patients. But in most cases the patient’s condition demands better understanding and moral support rather than healing up of physical injuries. Without such understanding of patients even in a long time the staff fails to realize this need of the patient (Patterson, Whittington and Bogg, 2007). Hence the paper advocates in favor of better understanding in the nurse patient relationship that in turn will promote better care for the DSH patients and help them recover faster. Attitude of Emergency staff and Health Care professionals In order to deliver care and emotional support to self harming persons it is also important to know the cause of such harmful attempts. With such an instance the research study performed by Mackay and Barrowclough can be claimed as superior because the questionnaire also contained questions regarding the reason behind suicidal attempts of the patients. However it is unlikely that patients will provide accurate information to the emergency staff (Mackay and Barrowclough, 2005). Such information, if provided, will definitely help in better psychological care of the self harming patients. For another such research project for knowing the attitudes of emergency staff using the same focused group methodology moderate responses of 53.8% were obtained. Responses of staffs working in emergency department were collected. However even such responses helped to reveal the undesirable and unhelpful behavior of emergency staff for such self harming patients (Friedman, Newton, Hooley, Patel and Mitchell, 2006). In this case the research methodology could not be considered to be much suitable because of low and moderate responses. It might be that the questions framed in the questionnaire were not framed according to the research objective. It may also be that staffs were reluctant to response to some topics and questions. The number of deliberate self harm patients has been increasing with each passing day. A research study has shown an annual admission of about 10,000 deliberate self harm (DSH) cases in hospital comprising mostly young people. The emerging statistics have nullified the view that deliberate self harm is entirely a female activity. Apart from young people old age and senior citizens are deliberately self harm themselves mainly with the feelings of hopelessness. Previous mental illnesses like depression can also be cited as a reason for DSH (McCann, Clark, McConnachie, Harvey, 2007). Some researches have also figured out 150,000 such cases in the emergency department of UK (Mackay and Barrowclough, 2005). Such high numbers of cases are really difficult to handle for emergency staffs. This work burden fills them with frustration and anger and this is culminated in disrespectful behavior towards the self harming patients (McCann, Clark, McConnachie, Harvey, 2007). In other research studies it has also been revealed that certain other factors like age and sex of the patient may influence staff behavior. The severe DSH patients definitely receive a special treatment (Mackay and Barrowclough, 2005). However in another research study where factor analysis was performed gender was not proved to be much influential factor for staff behavior (Huband and Tantam, 2000). Self harm or self wounding has been cited clinically as an outcome of powerful emotions which lead the patient to harm himself physically. It is quite different from other accident cases involving psychological disorder. Apart from self poisoning many patients try to harm themselves through cuts, burning. Some even attempt to hang themselves. Such self wounding cases are estimated to be about 2200 in a year (Friedman, Newton, Hooley, Patel and Mitchell, 2006). The clinical management needs to be efficient enough to tackle such cases and disorders. A research article has also advised training for emergency staffs and awareness programs which would help to overcome such psychological disorder of patients of causing harm to themselves. Behavior of some female patients cannot be termed as a complete psychological case. In such an instance thinking of health care professionals and their attitudes do matter a lot (Huband and Tantam, 2000). A research has shown more negative attitude of staff towards these self harming patients than any other cases. Their behavior has often been judged as non tolerable. Under these circumstances the training of emergency staff has been deemed as necessary. But majority of staffs believe that such training cannot be termed as highly important. This is evident as only 9% were found to be professionally trained to handle such DSH patients (Friedman, Newton, Hooley, Patel and Mitchell, 2006). This means that training has been neglected by most of the working staffs and most of them do not even know how to deal with such DSH patients. The essay suggests better professional training to the emergency staffs to change their undesirable behavior towards DSH patients. Thus training also can be claimed as a comparatively more important factor influencing emergency staff behavior towards DSH patients than factors such as patient’s age and gender. Burden of work and the resulting stress contributes positively to the negative attitude of the nurses and staffs towards these self harming patients. Professional burnout leads to exhaustion of an individual’s emotional feelings. Such emotional stress is normally encountered by health care professionals who are associated with dialectic behavioral therapies (DBT) to young women encountering slight disorders in personality. A research study performed to access the occupational stress of professionals treated this therapists like patients. Such is the occupational stress under DBT that it leads to huge number of dropouts (Perseius, Kaver, Ekdahl and Asberg, 2007). This is mainly because working with psychologically ill person is much more strenuous and brain storming than a usual eight hour job. It has been seen that junior staffs and nurses in medical institutions show more negative attitudes towards self harming patients particularly for self poisoning individuals. Such a negative behavior is less reflected in case of senior staff members. However at the same time health care professionals are found to have sympathy for such patients. Thus it can be said that normative beliefs of these professional result in their behavior towards the patients (McKinlay, Couston and Cowan, 2000). Thus the essay claims that work load and stress is an important factor influencing negative attitude towards DSH patients. This negative attitude is more for people new to this burden. Once they get familiar to handling such accident pressures their negativity diminishes. Development of Measurement Tools and Effective Management Policies The questionnaire method for data collection on research has also been found useful in other research studies that were conducted on doctors and other staffs to develop tools for measuring attitude of heath care professionals towards self harming patients. The number of responses was also considered sufficient because out of the sample size of 102 respondents, responses were received from 80 people. The results were found to be significant and consistent at 0.96 under Cronbach’s alpha for selected factors like positiveness, acceptability, mental illness and discrimination. The Attitude Towards Attempted Suicide Questionnaire (ATAS-Q) was also judged as a reliable measure after significant re-tests (Ouzouni and Nakakis, 2009). In questionnaire methodology adopted by Patterson and Bogg, responses of social workers and other general nurses has also been collected rather than just focusing on emergency staffs. Such a mixed population as sample wills surely to compare the responses and opinions between the generalized and self –harm groups. The measurement tool for accessing the scale of nurses’ negative attitude towards the self harming patients has been constructed using the scale of antipathy. It is useful for measuring the levels of tolerance which varies among the different health care professional (Patterson, Whittington and Bogg, 2007). This is an effective methodology because it helps to know mass opinion besides opinions of emergency staff. The current mass opinion will help to access of the position of such patients in society and their social care..A research conducted to identify specific dimensions of nurses’ behavior towards suicidal patients using the focused group methodology and the Attitude towards Deliberate Self-Harm Questionnaire (ADSHQ). Identification of relevant items were found out from the literature review of works of other well known psychiatrists as well as opinions arising from the group discussion of a particular group of nurses working in emergency department. However in this case responses were found to be as low as 35%. Only four factors related to nursing skill and abilities could be identified as relevant factors for research (McAllister, Creedy, Moyle and Farrugia, 2002). The methodologies for Action Research Projects can be considering time saving and very much directed towards significant output because it is concerned with through study and research of only those relevant factors that are important in context of research. Unlike a traditional method it takes actions and decisions based on a problem solving cycle. Such an action research undertaken to reform existing policies and frame developmental policies found the research process quite complex in presence of interacting factors. Only a few variables could be termed as manipulative. Other by such a research process had to be assumed as constants (McElroy and Sheppard, 1999). The process could not be termed as convenient because a controlled experiment is out of purview of the research scenario. Moreover holding a number of variables as constants which may be varying raises questions on the outcome obtained from such a research process. As per the policies the government has suggested active interventions from health authorities to reduce suicidal attempts for each district. But better services for such patients are required in general hospitals. Staffs need to find out the determination of each patient to commit suicide (McElroy and Sheppard, 1999). The notion of antipathy is effective in measuring the different tolerance levels of nurses and staffs. However the relevant study of nursing behavior as well as staffs and other health care professionals reveals that an effective training is required to improve management of such patients. This is required in order to understand the clients much better and share their problems. The services offered for such patients have not been found to be satisfactory. They need better care. Under such circumstances suggestion of a different group for these patients is obviously an appreciating one. The mass opinion has helped to get an idea about the position of these self harming people in society. This will help policy makers to frame effective policies for betterment of these self harming people keeping in mind the mass thinking. Conclusion Suicidal attempts and deliberate self harming patients are rising in due course of time. From being confined to just female activity it is now common for males and even old age. Different studies have been undertaken to know the current attitude and knowledge of health care professionals towards these self harming patients. The results obtained by different articles vary mainly due to adoption of different research methodologies adopted. Among them the questionnaire methodology has shown wide usage and is considered to be a reliable one for the current topic. However problems may be encountered due to low responses and hesitation in responding. The results obtained for nurses’ attitude vary with respect to their age, experience and educational qualification. Among the factors experience has been termed as most important for knowing their attitudes towards patients since experienced ones realize better the patient’s needs and patients. A better understanding between nurse and patient is also important from the patient’s perspective. The emergency staffs are also advised better training to change their attitude towards DSH patients. The paper also emphasizes on the need to try and reduce the work pressures of health care professionals dealing with DSH patients to help them develop a positive attitude towards these patients. References: 1. Friedman, T, Newton, C, Coggan, C, Hooley, S, Patel, R and Mitchell, AJ. (2006). Predictors of A&E staff attitudes to self-harm patients who use self-laceration: Influence of previous training and experience. Journal of Psychosomatic Research, Vol 60, pp.273-277 2. Huband, N and Tantam, D. (2000). Attitudes to self-injury within a group of mental health staff. British Journal of Medical Psychology, Vol 73, pp. 495-504 3. Mackay, N and Barrowclough, C. (2005). Accident and emergency staff’s perceptions of deliberate self-harm: Attributions, emotions and willingness to help, British Journal of Clinical Psychology, Vol 44, pp. 255-267 4. McAllister, M, Creedy, D, Moyle, W and Farrugia, C. (2002). Nurses’ Attitudes Towards Clients Who Self Harm. Journal of Advanced Nursing, Vol 40, No 5, pp. 578-586 5. McCann, T Clark, E, McConnachie, S and Harvey, I. (2005). Deliberate self-harm: emergency department nurses’ attitudes, triage and care intentions.Journal of Clinical Nursing, Vol 16, pp.1704-1711 6. McCann, T Clark, E, McConnachie, S and Harvey, I. (2007). Accident and emergency nurses’ attitudes towards patients who self-harm. Accident and Emergency Nursing, Vol 14, pp.4-10 7. McElroy, A and Sheppard, G. (1999). The Assessment and Management of self Haring patients in an Accident and Emergency Department: An action research project. Journal of Clinical Nursing, Vol 8, pp. 66-72 8. McKinlay, A, Couston, M and Cowan, S. (2000). Nurses' behavioral intentions towards self-poisoning patients: a theory of reasoned action, comparison of attitudes and subjective norms as predictive variables. Journal of Advanced Nursing, Vol 34, No 1, pp.107-116 9. Ouzouni, C and Nakakis, K. (2009). Attitudes towards attempted suicide: the development of a measurement tool. Health Science Journal, Vol 3, No 4, available at: http://www.hsj.gr/volume3/issue4/345.pdf (Accessed on December 27 2011) 10. Patterson, P, Whittington, R and Bogg, J. (2007). Measuring nurse attitudes towards deliberate self-harm: the Self-Harm Antipathy Scale (SHAS). Journal of Psychiatric and Mental Health Nursing, Vol 14, pp. 438-445 11. Perseius, KI, Kaver, A, Ekdahl, S, Samuelson, M and Asberg, M. (2007). Stress and burnout in psychiatric professionals when starting to use dialectical behavioral therapy in the work with young self-harming women showing borderline personality symptoms. Journal of Psychiatric and Mental Health Nursing, Vol 14, pp. 635-643 12. Thompson, A, Powis, J and Carradice, A. (2008). Community psychiatric nurses’ experience of working with people who engage in deliberate self-harm. International Journal of Mental Health Nursing, Vol 17, pp. 153-161 . Read More