Health care professional's relationships with those who self harm have been found to be failing, characterised by negative staff attitudes leading to a phenomenon termed 'terminal malignant alienation' prior to client suicide (Morgan, 1979). Greater understanding of attitude and care experience is vital to enhancing care process and its outcomes. A mixed method approach was required to examine both meanings given to care experience and attitudes of a large group of qualified nurses attending post qualification courses. The phenomenology of the care experience of six participants, carer, clients and their nurses is the focus of Study 1. Four essential themes (van Mannen 1990) were derived; Trying Hard Getting No where (Past relating) Time Strain and Apprehension, Incongruent Relating and Acceptant Engagement. A transition in ways of relating is emergent in these themes and sub themes which is marked by movement from nurse/carer focus on control of self harm and the repeated experience of strain apprehension, avoidance and disempowerment, to greater acceptance of client experience. Shared responsibility and more authentic relationships are accompanied by diminished belief that self harm is a direct reflection of carer effort and competence. Study 2 describes both the development of a thirty item Self Harm Antipathy Scale (SHAS) and six attitude dimensions derived using exploratory factor analysis and a survey of attitudes to self harm (n=153). Between groups analysis using the Mann-Whitney test showed that; previous study of self harm and contact with self harming clients was associated with more positive attitudes (p<.05) and general nurses held more negative attitudes than participants with mental health qualifications. Gender and years of experience and age were not found to be related to attitudes to self harm (p>.05). Qualitative content analysis of written responses in the questionnaire informed by Carper (1978), revealed three main themes describing attitudes and perspectives on care; 'Need for knowledge understanding and skill; 'Care Strain; reactions and feelings '; 'Therapeutic Approach and Treatability '. Analysis revealed tension and contrast between awareness of professional care values, perceived competence and personal feelings. Study 3 investigated the effect on attitude of a post qualification course on self harm. In a quasi-experimental design utilising an intervention and comparison group, participant's attitudes were measured immediately on course commencement and twice following course completion. Analysis using within groups Wilcoxon test on post course scores (n=65) revealed less antipathy in the intervention group; scores were significantly lower on both the SHAS scale and 4 attitudes dimensions derived from factor analysis (p<.05); Care Futility; Client Intent; Rights and Responsibilities; Needs Function. The intervention group demonstrated more belief in the value of care, less critical motivational attributions and more recognition of client responsibility and need. In a comparison group (N=22), (no teaching on self harm), no significant difference was found between pre and post test SHAS on 5 of the 6 attitude dimensions (p>.05). It was concluded that attitude, perceived competence can be positively influenced by the educational intervention and optimise the potential to restore caring and therapeutic qualities to alienated relationships. Clinical supervision is recommended as a resource for enhancing practice and a means of promoting learning for those who cannot access formal courses on self harm.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:399214 |
| Date | January 2003 |
| Creators | Patterson, William Paul |
| Publisher | University of Liverpool |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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