Perception Of Nurses Regarding Self-Harming Patients - Literature review Example

? What are nurses attitude towards patients who self-harm? Contents Contents 2 3 Introduction 4 Literature Review 4 The Phenomena of Self-Harm and Nursing Practice 4 Perception of Nurses regarding Self-Harming Patients 5 Nursing Training to render Quality Care to Self-Harm Patients 7 Methodology 10 Process of Retrieving the Articles 10 Overview of the Research Articles 10 Findings 12 Discussion 16 Conclusions and Recommendations 16 References 18 Abstract The nursing and other support medical staffs are found to reflect a sense of wrong understanding and perception pertaining to the self-harming patients. This misunderstanding rather results in the nursing staffs to continually avoid taking proper care of such patients. The paper herein, focuses on type of wrong attitudes reflected by the nurses while endeavouring to treat such patients while also throwing light on the factors behind the same. Further the need and the use of training to change the perception and understanding level of nurses is reflected in the paper both theoretically and statistically. Effective recommendations are also rendered in places. Introduction Self-harming is taken up by individuals to seek the help of others in assisting them to counter the growing psychic and internal pain from which they are suffering from. It is also taken up by people in sense of utter desperation and frustration so as to affect the parties inferred by the person as the ones responsible for his or her present situation. The people that have self-harmed them are found to be devoid of the needed sympathy and care from the medical staffs and nurses on being admitted to the emergency units. Nurses tend to avoid them on account of wrong perceptions making them feel more desolate. This in turn again contributes in enhancing his or her self-farming behaviour which sometimes turns out to be fatal culminating to suicide (Cleaver, 2006, p.148-151). The paper would tend to use research based articles tends to focus on the attitudes and attributes of the nurses pertaining to the self-harming patients and also on the process of bring about attitudinal changes in the nurses involved. Further it would also endeavour in using specific statistical techniques relevant to the topic to help enhance the understanding and also cites recommendations pertaining to the issue taken. Literature Review The Phenomena of Self-Harm and Nursing Practice Cleaver (2006) observes that the act of self-harm constitutes such actions where the person, either a male or a female either tends to position, bruise or burn oneself. In that, the person focuses on injuring his or her own body as a mark of punishment rendered on oneself. This sense of punishment alleviates and culminates to the act of self-harm where the individual feels that such act would help him or her to regain their position in the society. More specifically, the people rendering self-harm tend to suffer from a huge burden of desperation. They, in order to evoke the sense of fear in the minds of others or to reinstate their position tend to act in such forceful manner. Observation shows, that this act of self-harm gains more prevalence pertaining to people in their teenage years and also in adults. Children, though quite rare become the silent victims of self-harm. Again, the phenomenon of self-harm is more noticeable regarding women folk than in men. Men are more prone to acts of suicide than ceasing to causing only self-harm like in women. Thus, owing to the variance reflected in the above cases the nurses working in the emergency units are required to act accordingly to render effective services. Herein, Cleaver (2006) states that some nursing staffs feel the zeal to take to such challenging assignments that includes a large amount of variations. Nursing staffs need to be trained in subjects pertaining to psychoanalytic and risk assessments to effectively function in such traumatic departments. The nurses and palliative care staffs need to understand the potency of the risk associated in dealing with such patients and thereby must effectively categorise or rate the risk involved with the action to be taken. Further nurses working for children suffering from such traumatised or self-harming conditions need to be well equipped in understanding the realms of child psychology. A well equipped and effective nurse would act as the best counsellor in helping the people regain confidence and thereby help them to gradually lose such fatal and injurious habits (Cleaver, 2006, p.148-151). Perception of Nurses regarding Self-Harming Patients McCann et al. (2007) observes that nurses working in traumatic departments in hospitals caring for patients suffering from acute depression and prone to self-injury generally feel hard to conduct their service. The nurses being devoid of proper training feel hard to work in such atmospheres where they have to deal with patients going to attempt suicide. Moreover the nurses also start feeling that caring for such patients tends to consume a larger amount of time and energy without rendering effective rewards. This fact disturbs the working zeal of the nurses meant to take effective care of patients prone to self injury. The nurses put to take care of such patients start feeling a lack of self-confidence which all the more enhances the distance between them and such suicidal prone patients. Nurses ill equipped and trained to counter such conditions fail to potentially understand the causes behind the patients going over to self harming practices. Thus, lack of proper training and psychoanalysis pertaining to the nurses working in such traumatic units causes the failure in development of proper attitude required in treating such patients. Lack of proper attitude in such nurses results them in rendering proper care to such patients and showing of needed emotions and mental and physical support and care. Patients feel that the nurses are tending to avoid them or are suffering from fear of their actions. Hence, proper and on-the-job training are required to be rendered to such nurses to help them feel free and earn confidence in rendering effective care to such patients (McCann et al., 2007, p.1705-1706). Emerson (2010) further notes that self-harm patients fail to obtain needed care from nursing and palliative care staffs owing to growing misconceptions adhered to such practices. It is thus observed that people that people who get admitted into hospitals and nursing homes time and again owing to such self-harming practices fails to get due attention after the first admission. Nursing staffs not properly equipped with the knowledge of rendering psychiatric assistance to such people often earmark such self-harming intentions and practices as a mode to earn and enhance attention. Thus, being marked as attention seekers the feelings of desperation and inner pain that has remained locked gets embedded further in such patients. Hence, in a number of cases, Emerson (2010) reflects that people who had been previously admitted to hospitals owing to self-harming actions eventually meet death by committing suicide. The act of self-harm is also conducted by people in situations where other modes to free oneself from the imminent danger become absent. In such hours, the person is compelled to break free through conducting actions that render self-harm. Thus, the nursing staffs need to have an open ear in endeavouring to understand the reasons as to why the persons have pursued such self-harming actions. They in turn rather than reflecting a feeling of hate should try to actively counsel such people and thereby should work in rendering solutions to the problems. In some other cases, it is observed that nurses were quite eager to help the people get rid of such self-harming habits and to provide assistance to their mental and physical suffering. However, owing to lack of proper knowledge about the manner or conduct of providing the requisite help the nursing staffs generally start refraining from visiting such quarters where such patients get admitted (Emerson, 2010, p.840-842). Nursing Training to render Quality Care to Self-Harm Patients Wright and Wright (2011) states that effective training is needed to be provided to nurses to hone their skills and attitudes in treating patients suffering from self-harming actions. Firstly, it is required for the nursing staffs to honour the suffering of the patients admitted in the hospitals on account of such self-harming conducts. In that, the nursing staffs should try to render all possible assistance to such patients suffering both physical and psychic trauma as applicable to other patients. Secondly, it is recommended that the nursing activities are rendered to such patients on a one-to-one basis. Such process would help the nursing staff involved in gaining an enhanced understanding of the reasons that led the person to commit such self-harm. Thirdly, the nursing staffs pertaining to the medical intervention needed must endeavour to act like fellow companions to such patients and in that should always try to make the patient feel important. Fourthly, effective training must be rendered to nurses to provide dressing and other physical aids to help them revive from the pains of cuts and bruises rendered. Fifthly, the nursing staffs should be trained not to put pressure on the patients and neither to avoid them on account of their habitual intentions of self-harming. Both putting pressure and denial would tend to enhance the intention of the self-harmers in not quitting such habits but rather would enhance its repetition. Wright and Wright (2011) further reflect the above needed nursing interventions through the presentation of case studies of female self-harmers. The case of Sarah given reflects how she felt the urgency of a proper assistant to help her reduce the level of frustration and anguish she was suffering from internally. The case also reflected a change of attitude of health and support medical workers pertaining to such self-harming conducts and the need to further refine such. Again, the case of Julie shows that how the medical and support workers should behave in rendering potential assistance both physically by dressing up wounds and cuts and mentally by providing relevant mental assistance and reducing the pressure and burden involved (Wright and Wright, 2011, p.379-382). McAllister et al. (2009) state a formal training workshop formulation pertaining to the nursing staffs working to provide assistance to self-harming patients. The training workshop would consist generally of three parts. In the first part, the nurses would be introduced to the concepts of self-harming and the reasons or factors such gain practice among the people. This part would help the nursing staffs get rid of the misconceptions raised pertaining to the practice of self-harming. In the second part of the workshop, the nurses need to be introduced to the several physical and psychological mechanisms involved in providing effective palliative and nursing care to the people involved. Finally, the third part of the workshop would potentially highlight on special technique aimed at providing effective nursing solutions in rendering quality nursing service to the self-harming patients. In the realm of discussing the concept of ‘Solution Focused Nursing’, McAllister et al. (2009) state that such nursing practice needs to be taken in three different stages. The first stage, basically aims at joining the minds of the patients involved with the nursing staffs. Herein, the nursing groups need to effectively assess the potential strengths and weaknesses of the people involved so as to come out with effective coping strategies to be accepted by them. The nursing staffs should herein endeavour to understand the behaviours that in turn would make the people more vulnerable in their self-harming actions. The second stage, of the solution focused nursing strategy aims at cultivation and enhancement of relationships with the patients. Relationship building approach helps the nursing staffs to jointly work with the patients in formulating collaborative designs aimed at rendering potential solutions to the problem concerned. Finally, the third part of the solution providing mechanism would focus on the extension of the benefit of the solution rendered to the patients to other people suffering from such self-harming practices. Herein, the patients being cured can extend the benefits in curing others facing the same trouble. Such training methodology and process is found to bring about transformation in the attitudes in the nurses reflecting a rise of positivism and self-confidence in their conduct of treating such patients (McAllister et al., 2009, p. 2839-2840). Methodology Process of Retrieving the Articles The research is conducted based on mainly five primary research articles based on nursing practice involved with generating quality care to the patients suffering from self-harming actions. Databases from which the research articles were gained mainly constitute of CINAHL, MEDLINE and Health Source Nursing. These databases were largely used for gaining access to potential journals from which five were selected. Such articles selected bear adequate relation to the research question under review. The first article focusing on enhancing the understandability of the concept of self-harm and the nursing practice related to such was retrieved from MEDLINE. Again, the second and third article that mainly reflects on the perception level of the nurses regarding the self-harm patients was gained from databases pertaining to CINAHL AND MEDLINE. Finally, the fourth and fifth articles focusing on the training pursuits that need to be taken in changing the attitudes of the nurses and palliative care staffs to render quality support services to the self-harming people are retrieved from both MEDLINE and Health Source Nursing. Overview of the Research Articles The first article written by Karen Cleaver in the British Journal of Nursing during 2007 is retrieved from the MEDLINE Database. In this article, Cleaver effectively reflected on the understanding of the phenomenon of self-harming emerging as a striking event in some people. The writer in that sought the reader’s attention to some of the factors or causes behind the growth of such menace. However, though the writer effectively indicated in some of the implications that are required to be taken by the nurses pertaining to attending self-harming patients yet failed to bring about variations pertaining to the attitudinal factor of the nurses. The second article written by Terence V McCann and others in the Journal of Clinical Nursing during 2007 is also retrieved from the MEDLINE Database. McCann et al, in this article endeavours to uncover the erroneous perception level of the nurses regarding the self-harming patients and the growth of common misunderstandings thereby obstructing the delivery of needed quality care. McCann et al reflected that self-harming as a practice is commonly observed by the nurses as an attention seeking mechanism and thus is often disregarded. However, the writer failed to highlight potential solutions to help bring about a change in the attitudes of the nurses by breaking the misconceptions and myths involved. The third article written by Amy-Laura Emerson in the British Journal of Nursing in 2010 is retrieved from the CINAHL Database. Emerson, in this article effectively underpinned the factors that lead to the misunderstanding or faulty inferring of the causes relating to self-harming events rendering in disruption in the perception levels of the nurses. Thus, owing to wrong perceptions the nurses fail to reflect needed emotions or to thereby sympathise with the self-harming patients. However, herein also the writer failed to effectively hint on the areas pertaining to nursing training and development to help them bring about changes in their attitudes. The fourth article written by Karen M Wright and Caraline E Wright in the British Journal of Healthcare Assistants during 2011 is retrieved from the CINAHL Database. Herein, the writers briefly focused on the phenomenon of self-harming as a growing menace and indicated on the different nursing attitudes pertaining to such patients. Further, the writers also focused on the medical and psychological interventions that are needed to be rendered by the nurses caring for such patients through the use of two case studies. The article however only focuses on the benefits received by the self-harming patients in the course of significant changes in the attitudes and intervention patterns of the nurses. It does not heavily reflect on the training processes involved in changing the attitudes of the nurses and also in bringing about cases of nurses showing attitude changes after having gone through the training imparted. The fifth and the final article were written by Margaret McAllister and others in the Journal of Clinical Nursing during 2009. Herein, McAllister et al focused on the different training methodologies both at the classroom level and at the practical level to help the nurses bring about attitudinal changes while treating for the self-harming patients. The writers also showed that how the training methods helped the nurses gain self-confidence and draw in a positive nature in taking care of self-harming patients through interviews conducted. However, the writers failed to put forward effective recommendations for future courses of action pertaining to infrastructural and procedural assistance to help in sustaining the transformed and positive attitudes. Findings In the ambit of findings as to the impact of the attitudes of nurses on the patients that tend to render self-harm and again the change in impact owing to a refinement in the attitudes through effective training a finding technique is formulated. Such technique would involve a sample size of 15 nurses chosen on a basis of stratified random sampling method. Herein, the nurses chosen all work for the emergency units rendering care to patients having caused self-harm to them and thus reflect an equal or uniform chance to get selected for the sample constructed. These sample size of 21 nurses would be subjected to a score of 1 to 6 where 1 is the lowest and 6 is the highest score rendered. Evaluation of the nurses is conducted based on such scores in two phases before and after the training rendered to bring about a change in their attitudes towards the self-harming people. Further, a hypothesis is constructed pertaining to the analysis to be conducted. H0: The attitude of the nurses remains the same pertaining to the self-harming people after participating in the training program. H1: There has been considerable change in the attitudes of the nurses pertaining to rendering quality care to the self-harming people after attending the relevant training program and workshop. The statistical analysis is conducted using both t-tests for Paired Two Sample. Herein, two pairs are taken for a population of 21 nurses where the first pair constitutes of nurses before the training program while the latter pair consists of them subjected to training in changing their attitudes to self-harm patients. Scores set from 1 to 3 hold for the first set of nurses reflecting erroneous perceptions and attitudes towards the patients while the latter set is rendered score from 4 to 6 reflecting emergence of positive attitude after needed training is rendered. Figure 1 (Source: Author’s Creation) The results of the T-test as reflected in figure 2 shows that the t-statistic or the absolute value is farther from zero than that of the values obtained in T Critical one and two tailed tests. This signifies that the null hypothesis stands rejected. Again, the P Value for the test as obtained from the ANOVA Single Factor Test reflected in figure 3 shows that it is much lesser than the Alpha Value of 0.05 percent. Thus, the P value being lesser than the value of Alpha the test stands to be statistically and scientifically significant at a confidence interval level of 95 percent. Single Factor ANOVA Test is carried out for the attitudes of the nurses towards the self-harming patients are rated based on changes before and after the training program. Figure 2 (Source: Author’s Creation) Figure 3 (Source: Author’s Creation) Discussion The above findings reflect that there are significant variations in the value of mean for the two sets of nurses’ attitudes before and after the training program. Thus based on the results and inferences drawn on the T-Test conducted the null hypothesis stands rejected. Rejecting the Null Hypothesis at the statistical test conducted on a 95 percent confidence level steadily implies that the attitudes of the nurses towards the self-harming patients counters significant change after having participated in the training program. The training program pertaining to solution based programs or such endeavouring to create an interest among them in rendering quality care services to the self-harm patients as they render to normal patients thus stands promising enough in creating positive attitude in the nurses. Thus through effective training the nurses involved in the emergency and traumatic units looking after self-harming patients would gain the potential in bringing about positive solutions rather than abstaining from taking care of such people. The training also helps in drawing the attention of the nurses to the level of physical and mental main that those self-harming people do suffer from. Thereby, the nurses gradually learn to empathise and show their emotions in their endeavour to effectively take care of the patients and bring them back to normal life. Conclusions and Recommendations People who tend to self-harm are considered mostly insane by the society. They when admitted to hospitals and nursing homes in the need of getting adequate treatment fail to draw needed attention of the health and nursing staffs. Nurses often tend to avoid such patients owing to certain misunderstandings and distortion in the perception levels. Herein, the paper researches to understand the different wrong attitudes shown by the nurses in taking care of such self-harming patients and the factors leading to such. It also shows that how an effective training program can bring about needed attitudinal changes in the nurses both through qualitative and quantitative research techniques. The paper can be further enhanced through rendering research on the procedural and infrastructural changes that are required to be brought about to help the nurses sustain their positive and confident attitudes in treating self-harming people. References Cleaver, K 2006, ‘Characteristics and trends of self-harming behaviour in young people’, British Journal of Nursing, Vol. 16, No.3, pp. 148-152, viewed 30 June, 2012, MEDLINE. McCann, TV et al 2007. ‘Deliberate self-harm: emergency department nurses’ attitudes, triage and care intentions’, Journal of Clinical Nursing, Volume 16, pp. 1704-1711, viewed 30 June, 2012, MEDLINE. Emerson, A 2010, ‘A brief insight into how nurses perceive patients who self-harm’, British Journal of Nursing, Vol. 19, No.13, pp. 840-843, viewed 30 June, 2012, CINAHL Plus with Full Text. Wright, KM, and Wright CE 2011. ‘Self-harm, suicidal feelings and compassionate care’, British Journal of Healthcare Assistants, Volume 5, No.8, viewed 30 June, 2012, CINAHL Plus with Full Text. McAllister, M et al 2009. ‘I can actually talk to them now’: qualitative results of an educational intervention for emergency nurses caring for clients who self-injure’, Journal of Clinical Nursing, Volume 18, pp. 2838–2845, viewed 30 June, Health Source Nursing Academic Edition. Read More