Constructions of self-neglect: a multiple case study design

Patients who neglect personal hygiene, household cleanliness and their own health are familiar to most nurses. Despite this familiarity, self-neglect is a poorly conceptualized and little researched phenomenon. This multiple case study design uncovers the perceptions of self-neglect held by professionals, patients and relatives. The assumptions which underpin Orem's Theory of Self-Care and the medical model construction of self-neglect are explored and it will be suggested that there are limitations in understanding self-neglect using these theoretical frameworks.     

Sociological and psychological theories of self-neglect

BACKGROUND: Self-neglect can be defined as the failure to engage in those self-care actions necessary to maintain a socially acceptable standard of personal and household hygiene and/or a failure to adequately care for one's own health. It is generally acknowledged that research and practice in the area of self-neglect has been hampered by a lack of theoretical development. Socio-psychological theories, such as 'social constructivism' and 'negotiated interactionism' can contribute to a deeper understanding of the phenomenon and to the further development of self-neglect theory. AIMS: This paper seeks to apply social and psychological theories to understanding self-neglect. Self-neglect is an underconceptualized phenomenon, which requires to be studied within a broader theoretical context than is at present the case. IMPLICATIONS: Sociological and psychological theories offer radically different ways of looking at self-neglect, as opposed to the medical model, as they seek to explain and understand, rather than simply classify it as a medical disorder caused by some form of underlying psychopathology. These theories emphasize the dynamic and interpretative nature of self-neglect and illustrate the arbitrary way in which this label is applied.     

社区老年人自我忽视与衰弱的相关性分析

【摘要】目的 了解社区老年人衰弱与自我忽视的现状,探讨二者之间的关系。方法 采用一般情况问卷、老年人自我忽视问卷、中文版Tilburg衰弱评估量表（TFI）对995名社区老年人进行横断面调查。结果 社区老年人自我忽视总分为（7.51±4.01）分,衰弱总分为（4.86±3.09）分,衰弱发生率为47.14%;自我忽视总分与衰弱总分呈正相关（r=0.639,P＜0.001）;多因素分析显示自我忽视、合并慢性病数量、婚姻状况、性别、文化水平为衰弱的主要影响因素。结论 社区老年人衰弱发生率较高,老年衰弱与自我忽视有关,医护人员应重视老年人心理健康状态,改善老年人自我忽视以延缓老年人的衰弱进程。     

A survey of self-neglect in patients living in the community

Self-neglect is a familiar concept to all community nurses. Nevertheless there have been few empirical studies undertaken in this area over the last 30 years. The study of self-neglect has been hampered by inadequate conceptualization and a lack of theoretical frameworks. This article reports a study of patients who did and did not self-neglect, drawn from district nursing caseloads. Patients with self-neglect had lower levels of operable self-care agency than patients in a comparison group. Only self-neglecting patients had the nursing diagnoses 'ineffective management of therapy' and 'non-compliance'.     

Developing self-neglect theory: analysis of related and atypical cases of people identified as self-neglecting

Self-neglect is a complex, relatively common and as yet not fully understood phenomenon. People who self-neglect often do not undertake those activities which are judged necessary to maintain a socially accepted standard of personal and household hygiene or to maintain their health status. This may be explained by a variety of factors of which psychopathology, culture, social class and poverty all play a role in the construction of this phenomenon. The self-neglect literature overwhelmingly presents professional views and focuses on the most severe cases. This paper explores some core issues in relation to self-neglect theory through in-depth interviews with atypical (related) cases. These cases allow the boundaries of what is and is not self-neglect to be tested. Analysis of these cases suggests that self-neglect remains a useful concept but contains a far wide range of presentations than previously reported.     

A framework for good practice in interagency interventions with cases of self-neglect

Self-neglect is probably more common than has generally been thought and gives rise to a number of difficult conceptual, identification and intervention problems for health and social care workers. These patient management issues are compounded by the lack of any evidence-base for practice which nurses can draw on when faced with managing people who self-neglect. Nurses working with self-neglecters operate in an interdisciplinary context which includes professional groups, such as environmental health officers, who do not normally figure within health and social care teams. In the absence of such an evidence-base, a pragmatic solution in the form of a framework for interagency practice has been proposed. The background underpinning this framework, including a research study of housing in self-neglect and interagency responses, is briefly outlined in this paper.     

Factors influencing nurses' judgements about self-neglect cases

From the perspective of the practising nurse self‐neglect may best be understood in terms of a set of complex and often poorly defined clinical problems in which two key clinical issues are ‘how do I judge whether this person has the capacity make decisions about their lifestyle?’ and ‘do we need to treat this person using mental health legislation?’ These are taxing questions as judging if a patient has the capacity to make decisions about their lifestyle choices is difficult for even the most experienced clinicians. Such determinations require nurses to form a judgement as to mental capacity of the patient. We do not know what patient characteristics and in what combination nurses use these when making these judgements. This factorial survey aimed to identify which patient characteristics influenced Registered Nurses’ judgements on decision‐making capacity and decisions on the use of interventions which require statutory interventions in cases of self‐neglect. Judgements on decision‐making capacity were overwhelmingly predicted by information of the patients’ mental health status. Nurses place patients in one of three broad categories of no mental illness, minor mental illness and severe mental illness. This categorization appears to operate as a fast and frugal heuristic indicating that nurses may use mental status as a cognitive screen to work from in judging self‐neglect. Although there is a correlation between the severity of mental illness and the capacity for making decisions they are not the same. This study shows the continued work that needs done in educating nurses not only about self‐neglect but also about the role a patient’s mental status may have in assessment of problems.     

The utility of self-care theory as a theoretical basis for self-neglect

AIM: This paper sets out to explore the utility of self-care theory in understanding self-neglect. Further theoretical development of both self-care and self-neglect theory and attending core concepts is an important objective. BACKGROUND: The notions of self-neglect and self-care are frequently linked in the literature. The relationship between self-neglect and self-care is not clear and the strengths and limitations in using self-care theory to facilitate a greater understanding of self-neglect will be addressed. Specifically the issues of self-care agency, self-care requisites, objectivity, class and culture, and lifestyle choice will be critically evaluated in the context of self-neglect theory. CONCLUSION: Self-care theory has a useful role to play in furthering our understanding of self-neglect. Self-care theory is able to explain some aspects of self-neglect but not others, although this may be a reflection of the relatively underdeveloped state of self-care theories or alternatively may reflect a more fundamental limitation in our ability to fully explain human behaviour.     

Risk assessment and management of patients with self-neglect: a 'grey area' for mental health workers

This study explores the perceptions and experiences of community mental health workers who assess and manage the risk of self-neglect and severe self-neglect in people with serious mental health problems. The initial literature review demonstrated a lack of material on this specific subject. Semi-structured interviews were undertaken with seven community mental health workers who met the criteria of being knowledgeable, skilled and credible practitioners. Data analysis was completed using thematic content analysis. Findings suggest that community mental health workers are operating in a number of areas where there is a distinct lack of clarity--'The Grey Areas'. The most important of these were the tolerance of workers to situations of self-neglect/severe self-neglect, policies, procedures and legislation, and definitions of self-neglect/severe self-neglect. The workers dealt with this lack of clarity by completing a detailed risk assessment, which then enabled them to manage the risk. However, the need to balance the safety needs of clients against their need to be treated as autonomous individuals presented a major dilemma for workers.     

Nurses' perceptions of gross self-neglect amongst older people living in the community

Self-neglect in older people has an established medical literature but receives surprisingly little attention in the nursing literature. Hospital and community nurses were interviewed using a semistructured questionnaire. All the nurses were able to identify patients who had shown features of 'gross self-neglect'. Poor nutrition was a prominent feature: links with the literature are explored.     

护理模式与医学模式的比较研究

[目的]探讨现在的护理模式是否体现了护理的特色和价值,为护理模式的完善提供参考依据。[方法]应用文献资料法、历史法和比较研究法,从历史的角度将不同阶段的护理模式与医学模式进行比较。[结果]两者构建发展的出发点和终结点、包含内容形式、影响其形成及实践的宏观因素相同,在模式形成时间、产生的背景、产生及转变的动因、模式实践程度、意义和影响方面不同。[结论]护理模式体现了护理的特色,但未充分显现其价值,可借鉴美国的护理发展模式探索出适合我国国情的护理发展之路。     

新医学模式下的心理干预发展现状

生物心理社会医学模式认为人体是由生物因素、心理因素、社会因素三者共同构成的一个统一整体,生物因素、心理因素、社会因素三者共同制约着人的健康和疾病,有时其中某个因素起主导作用,但三者总是相互影响的。然而,目前我国综合医院服务对象基本上都是躯体疾病,心理因素所引起的精神疾患基本被忽视。根据这种现状,我们初步制定相应的对策。     

审视医学模式的发展 拓展现代护理服务内涵

介绍了医学模式发展过程中存在的主要问题以及现代护理模式与医学模式的关系。认为应将健康教育、人文关怀、循证护理作为现代护理服务重点，更好地促进整体护理的发展。     

审视医学模式的发展拓展现代护理服务内涵

介绍了医学模式发展过程中存在的主要问题以及现代护理模式与医学模式的关系.认为应将健康教育、人文关怀、循证护理作为现代护理服务重点,更好地促进整体护理的发展.     

工作室教育模式对中医护理教育的启示

综述了工作室教育模式的概念、理论基础、内容,提出工作室教育模式对中医护理教育的启示。     

医护人员对分级护理决策主体的态度调查

目的确定分级护理合理的决策主体,探讨护士能否参与分级护理的决策及参与方式。方法应用自拟的两种分级护理决策主体的认同情况调查表,对259名护士和239名医生进行调查,了解他们对决策主体的认同及意愿情况。结果 92.12%的医生和67.23%的护士认为护士参与分级护理决策的方式是医护合作。结论医护合作共同确定护理等级是相对合理的决策方式。     

工作室教育模式对中医护理教育的启示

综述了工作室教育模式的概念、理论基础、内容,提出工作室教育模式对中医护理教育的启示。     

医护合作型责任制护理模式在妇科病区的实践

目的探讨医护合作型责任制护理模式对医疗护理质量和病区相关满意度的影响。方法选取该院妇科2014年1月~6月收治的患者为对照组（实施医护合作型责任制护理模式前）,2014年7月~12月收治的患者为实验组。对照组采用传统的查房模式,实验组采用医护合作型责任制护理模式,比较医护合作型责任制护理模式实施前后医疗护理质量和病区相关满意度的情况。结果实施医护合作型责任制护理模式后, 患者的住院天数、甲级病历病案率、患者满意度均优于实施前（P < 0.01）。结论医护合作型责任制护理模式改善了医护患沟通,提高了工作效率,改进医疗护理质量,有利于深化优质护理服务,强化专科护理内涵。