Concept analysis of self‐mutilation

Title. Concept analysis of self‐mutilation. Aim. This paper is a report of a concept analysis to define and describe self‐mutilation. Background. Although there has been an increased interest in self‐mutilation, as evidenced by recent publication of opinion literature, anecdotal reports and a few clinical studies, the concept has not been well developed to guide nursing research and interventions. Method. Definitions and uses of self‐mutilation were obtained in a comprehensive review of the health, psychology and education literature up to April 2007 to identify the defining attributes, antecedents and consequences. Walker and Avant’s concept analysis strategy was the organizing framework. Findings. Self‐mutilation is the intentional act of tissue destruction with the purpose of shifting overwhelming emotional pain to a more acceptable physical pain. Antecedents of self‐mutilation are impaired coping skills and an unhealthy response to situations that cause unbearable emotional stress. Limited research suggests that risk factors for self‐mutilation may be White race, adolescent age, female sex and history of sexual abuse as a child. Although self‐mutilation allows the individual to gain control over emotions and provides a diversion from emotional pain, a release of endorphins after the physical damage that contributes to the feeling of relief supports an addictive maladaptive coping cycle of pain, relief, shame and self‐hate. Conclusion. The theoretical definition of the concept of self‐mutilation offers the basis for nurses to develop interventions to provide competent care when discovering injuries that are self‐inflicted.     

Self‐harm in young people: Prevalence,associated factors,and help‐seeking in school‐going adolescents

Adolescent self‐harm is recognized as a serious public health problem; however, there is little reliable comparative data on its prevalence or characteristics, or on the extent of help‐seeking for self‐harm. The aims of the present study were to determine the prevalence and associated factors of adolescent self‐harm in an urban region in Ireland, and to investigate help‐seeking behaviours for self‐harm. This was a cross‐sectional study of 856 school‐going adolescents, employing an anonymous self‐report questionnaire. A lifetime history of self‐harm was reported by 12.1% of adolescents. Factors independently associated with self‐harm included exposure to self‐harm of a friend/family member. Professional help‐seeking was uncommon prior to (9%) and after (12%) self‐harm. Furthermore, only 6.9% of adolescents presented to hospital as a result of their last self‐harm act. These findings indicate that self‐harm is common in adolescents; however, seeking professional help is not a common phenomenon, and those who present to hospital represent the ‘tip of the iceberg’ of adolescent self‐harm. Identifying the prevalence of self‐harm and associated factors, in addition to help‐seeking behaviours, in young people is important to determine the preventative programmes to target ‘at‐risk’ groups. Mental health nurses have an important and increasing role to play in such school‐based initiatives.     

Concept analysis: confidence/self-confidence

BACKGROUND. Confidence and self‐confidence are crucial practice elements in nursing education and practice. Nurse educators should have an understanding of the concept of confidence in order to assist in the accomplishment of nursing students and their learning of technical and nontechnical skills. With the aim of facilitating trusted care of patients in the healthcare setting, nursing professionals must exhibit confidence, and, as such, clarification and analysis of its meaning is necessary. PURPOSE. The purpose of this analysis is to provide clarity to the meaning of the concept confidence/self‐confidence, while gaining a more comprehensive understanding of its attributes, antecedents, and consequences. METHOD. Walker and Avant's eight‐step method of concept analysis was utilized for the framework of the analysis process with model, contrary, borderline, and related cases presented along with attributes, antecedents, consequences, and empirical referents identified. CONCLUSION. Understanding both the individualized development of confidence among prelicensure nursing students and the role of the nurse educator in the development of confident nursing practice, nurse educators can assist students in the development of confidence and competency. Future research surrounding the nature and development of confidence/self‐confidence in the prelicensure nursing student experiencing human patient simulation sessions would assist to help educators further promote the development of confidence.     

Self-care in diabetes: model of factors affecting self-care

Aims and objectives. The aim of this paper is to explore self‐care in diabetes and to present a model of factors that affect self‐care according to reviewed literature. Background. Self‐care in diabetes is crucial to keep the disease under control. Self‐care consists at least four aspects: (i) self‐monitoring of blood glucose, (ii) variation of nutrition to daily needs, (iii) insulin dose adjustments to actual needs and (iv) taking exercise regularly. It is known that diverse factors influence self‐care such as knowledge, physical skills and emotional aspects and self‐efficacy which have been listed as being of high importance. Methods. The searched databases were ProQuest, PsycINFO and Medline from 1995 to 2002. The search terms were ‘self‐care’ or ‘self‐management’ coexisting with diabetes and ‘self‐efficacy’. The search was limited to English and adults with type 1 diabetes. Results. The main components of the model clarify how knowledge, physical skills and emotional factors as well as self‐efficacy influence self‐care which again affects metabolic control. Flexible self‐care indicates high level of self‐care when patients are able to care for and manage the disease in a responsible and flexible way that does not affect their life extensively, resulting in adequate glycosylated haemoglobin value. Self‐efficacy is a strong predictor of flexible self‐care and affects metabolic control through increased perceived ability to conduct self‐care. Conclusions. The review illuminated that benefits of self‐care should be emphasized and knowledge of the Diabetes Complication and Control Trial results can contribute to better self‐care. However, factors affecting flexible self‐care still require better identification. Relevance to clinical practice. The review emphasizes and adds to the topic, that in daily practice health care practitioners must assess diabetes‐related knowledge, physical skills and emotional factors in combination with self‐efficacy and the four self‐care areas. The effects of self‐monitoring of blood glucose needs better clarifications as it is now regarded the cornerstone of flexible self‐care.     

The butterfly effect of caring – clinical nursing teachers’ understanding of self‐compassion as a source to compassionate care

Scand J Caring Sci; 2013; 27; 175–183 The butterfly effect of caring – clinical nursing teachers’ understanding of self‐compassion as a source to compassionate care This study has its roots in a clinical application project, focusing on the development of a teaching–learning model enabling participants to understand compassion. During that project four clinical nursing teachers met for a total of 12 hours of experiential and reflective work. This study aimed at exploring participants’ understanding of self‐compassion as a source to compassionate care. It was carried out as a phenomenological and hermeneutic interpretation of participants’ written and oral reflections on the topic. Data were interpreted in the light of Watson’s Theory of Human Caring. Five themes were identified: Being there, with self and others; respect for human vulnerability; being nonjudgmental; giving voice to things needed to be said and heard; and being able to accept the gift of compassion from others. A main metaphorical theme, ‘the Butterfly effect of Caring’, was identified, addressing interdependency and the ethics of the face and hand when caring for Other – the ethical stance where the Other’s vulnerable face elicits a call for compassionate actions. The findings reveal that the development of a compassionate self and the ability to be sensitive, nonjudgmental and respectful towards oneself contributes to a compassionate approach towards others. It is concluded that compassionate care is not only something the caregiver does, nor is compassion reduced to a way of being with another person or a feeling. Rather, it is a way of becoming and belonging together with another person where both are mutually engaged and where the caregiver compassionately is able to acknowledge both self and Other’s vulnerability and dignity.     

A concept analysis of suicidal behavior

Suicidal behavior is a significant global public health problem. Despite this, many health care professionals remain unaware of the distinction among suicidal behavior, self‐mutilation, and deliberate self‐harm. The aim of this study was to conduct a concept analysis of suicidal behavior. Method: Walker and Avant's 8‐step method of concept analysis was used to examine the concept of suicidal behavior. Sources for analysis were identified using a systematic search of Medline, CINAHL, ProQuest Nursing & Allied Health Source, and the reference lists of related journal articles. Results: Suicidal behavior was found to be associated with a constellation of external hazards and internal crises, lack of coping mechanisms and social support structures, and degree of suicidal intent, which, in the worst‐case scenario, results in successful suicide. The antecedents of suicidal behavior are vulnerability characteristics that make painful events seem unbearable, and the consequences are death or failed suicide. In cases of failure, the medical consequences may be serious and long lasting. Conclusions: Defining the concept of suicidal behavior provides a basis for public health nurses to better understand suicidal behavior, thus improving their ability to care for suicidal patients during home visits.     

Clinical tools for the assessment of pain in sedated critically ill adults

Aim: This paper aims to review the evidence regarding pain assessment tools for sedated patients and to establish whether the use of a tool can be recommended in practice. Background: Pain assessment is a challenging area of critical care nursing practice, particularly among sedated patients. Tools to aid in assessing pain among this patient group have been developed and tested recently. Search strategy: In this systematic review five papers that tested pain assessment tools for sedated patients are discussed. These papers were identified via the CINAHL and MEDLINE databases using the search terms: ‘pain assessment’ and ‘sedated’ or ‘unconscious’ or ‘critically ill’ or ‘critical illness’ or ‘critical care’. Conclusions: The Behavioural Pain Scale (BPS) has been tested among the broadest range of patients and was found to be a reliable and valid tool in three studies. Research is needed to further demonstrate the reliability and validity of the Critical‐Care Pain Observation Tool (CPOT), as the paper of Gelinas et al. did not test its internal consistency and domain structure. The CPOT also needs testing among different critical care populations. The design of Odhner et al. study did not allow adequate testing of the Non‐verbal Pain Scale (NVPS). Implications for practice: The implementation of the BPS can be recommended in intensive care units and may improve the management of pain among sedated patients by providing a systematic and consistent approach to pain assessment to guide interventions. The CPOT may also prove useful in assessing pain among sedated patients, but first requires further validation. Also, further research is needed into the effects of pain assessment tools on pain management practices and patient outcomes.     

Concerns relating to the application of frameworks to promote person‐centredness in nursing with older people

There is an increasing need to develop a multi‐dimensional discussion and critique around the concept of ‘person‐centred’ in the context of the delivery of nursing care for older people. As the context of nursing being considered here, it is primarily nurses who should be leading with this discourse, although drawing on a broad range of ideas from outside of nursing. The person‐centred movement, commonly believed to originate in the care of those with dementia in the UK, is growing, especially in the UK and Australia, with signs of it moving across parts of Western Europe and North America. Person‐centredness has a big emotional appeal to many nurses working with older people, perhaps because it ‘has the right feel’ for them and nurses believe it ‘feels right’ for older people. It has grabbed the attention of many practising nurses in the UK in a way that humanistic nursing theory and the various associated nursing models from previous decades, seemed to have missed. This paper contributes to the discussion by suggesting that there are conceptual frameworks that nurses can draw on to help them understand and enhance their practice. However, it is suggested that these frameworks are either in their infancy or incomplete and they still need to convince nurses of their utility for day to day practice. It is also pointed out that the underpinning concept of ‘personhood’ has not yet been fully clarified by nursing.     

Stigmatization and self‐determination of preregistration nurses: A path analysis

The concept of stigma and the stigmatizing behaviours of health‐care professionals can have a profound influence on people with mental illness. A key construct that has been identified as influencing our behaviours is self‐determination. As such, in the present study, we attempted to examine the connection and influence of motivational measures on the stigmatization of preregistration nurses. Data were collected once using three surveys that measured the motivational responses and stigmatizing behaviours of preregistration nurses after an approved mental health clinical placement. Using a path analysis, the results indicated that psychological needs significantly influenced preregistration nurses’ self‐determination towards work. In addition, self‐determination was a significant influence on the stigmatization behaviours of preregistration nurses. The results of the present study provide initial empirical evidence that supports the importance of professional self‐determination and the potential connection of quality care, as illustrated with the low stigmatizing behaviours of preregistration nurses who are more self‐determined towards their work/career. Because of the significant results of the present study, it is recommended that future research is needed that uses self‐determination theory as a lens to understand the application and importance within the field of nurse education.     

Describing Self‐Care Self‐Efficacy: Definition,Measurement, Outcomes,and Implications

PURPOSE

The pragmatic utility method of concept analysis was used to explore the usefulness of the concept self‐care self‐efficacy.

DATA SOURCES

Empirical studies across disciplines published between 1996 and 2015 were used as data.

DATA SYNTHESIS

A data matrix was developed. Analytical questions and responses were derived from the data to understand patterns, develop new knowledge and achieve synthesis.

CONCLUSION

Usefulness of the concept is contingent on how it is defined and measured. Self‐care self‐efficacy is associated with performance of self‐care activities and positive health outcomes in diverse populations.

IMPLICATIONS

Research can guide development of targeted interventions to increase patients' self‐care self‐efficacy, thus reducing costs, and assisting people to achieve optimal health.     

Deliberate self-harm: emergency department nurses' attitudes, triage and care intentions

Aim and objectives. This exploratory study investigates emergency department nurses’ attitudes towards patients who engage in deliberate self‐harm. It examines their attitudes towards, and triage and care decisions with, patients who self‐harm. Background. Emergency department nurses sometimes show unsympathetic attitudes towards patients who present with self‐harm and these can contribute to difficulties in assessing and providing appropriate care. Design. A modified version of the Suicide Opinion Questionnaire was used. A non‐probability sample of 43 emergency department nurses from a large Australian hospital participated in the study. Data were analysed using SPSS. Results. Most nurses had received no educational preparation to care for patients with self‐harm; over 20% claimed that the department either had no practice guidelines for deliberate self‐harm or they did not know of their existence and one‐third who knew of them had not read them. Overall, nurses had sympathetic attitudes towards patients who self‐harm, including both professional and lay conceptualizations of deliberate self‐harm. They did not discriminate against this group of patients in their triage and care decisions. Conclusions. The findings of this exploratory study are important because attitudes can affect care decisions. Recommendations are made for improving the educational preparation of emergency department nurses, for improving awareness and implementation of practice guidelines, and for improving attitudes towards patients with deliberate self‐harm. Further research is needed to confirm these results.     

SCHOLARLY PAPER: Defining the fundamentals of care

Kitson A, Conroy T, Wengstrom Y, Profetto‐McGrath J, Robertson‐Malt S. International Journal of Nursing Practice 2010; 16 : 423–434
Defining the fundamentals of care A three‐stage process is being undertaken to investigate the fundamentals of care. Stage One (reported here) involves the use of a met a‐narrative review methodology to undertake a thematic analysis, categorization and synthesis of selected contents extracted from seminal texts relating to nursing practice. Stage Two will involve a search for evidence to inform the fundamentals of care and a refinement of the review method. Stage Three will extend the reviews of the elements defined as fundamentals of care. This introductory paper covers the following aspects: the conceptual basis upon which nursing care is delivered; how the fundamentals of care have been defined in the literature and in practice; an argument that physiological aspects of care, self‐care elements and aspects of the environment of care are central to the conceptual refinement of the term fundamentals of care; and that efforts to systematize such information will enhance overall care delivery through improvements in patient safety and quality initiatives in health systems.     

Mental health nurses' perspectives of people who self‐harm

Self‐harm is a significant health issue, a leading cause of serious injury and is an indicator of psychological distress. Nurses play an important role in providing therapeutic care to people who self‐harm. The aim of this study was to explore mental health nurses’ (MHNs) experience of working with people who self‐harm. Data were collected using semi‐structured interviews and transcribed verbatim from 14 MHNs across Australia. Elo and Kyngäs’ inductive content analysis was used to extract meaning from the data which is reported in accordance with the consolidated criteria for qualitative research guidelines (COREQ). Two categories were identified which captured the MHNs’ experiences of working with people who self‐harm: (i) Nurses’ level of preparedness to work with people who self‐harm; and (ii) The healthcare system. Several sub‐categories were identified. Attitudes, knowledge, skills, and support from others influenced their experience of working with people who self‐harm. Clinical and life experience, undergraduate programme preparation and ongoing education all contributed towards developing therapeutic care with this group of patients. Nurses are vital in the care of people who self‐harm and an accurate understanding of the functions of self‐harm focuses therapeutic interactions to manage psychological distress and reduce further self‐harm and lessen the risk of suicide.     

Brief admission for patients with emotional instability and self‐harm: A qualitative analysis of patients’ experiences during crisis

Previous studies report that individuals diagnosed with borderline personality disorder have been met by negative attitudes from healthcare professionals and their care needs have often been neglected during hospitalizations. When symptoms of emotional instability are combined with self‐harm, the resulting crisis often becomes difficult to handle for patients and healthcare professionals. To meet their care needs during these crises, an intervention called ‘brief admission’ (BA) has been developed. The purpose of BA is to provide a timeout, in situations of increased stress and threat, in order to foster self‐management in a safe environment. In the present study, we explored the following research questions: What are patients’ experiences with BA? What do patients consider to be the key components of BA? What improvements are considered relevant by patients? A qualitative design was employed, and 15 patients (13 females, 2 males; mean age 38.5 ± 12.9, range 20–67 years) were interviewed using a semi‐structured interview guide. Thematic analyses were performed, which yielded four themes related to the patients’ experiences: ‘a timeout when life is tough’, ‘it is comforting to know that help exists’, ‘encouraged to take personal responsibility’, and ‘it is helpful to see the problems from a different perspective’. Four themes also described the key components: ‘a clear treatment plan’, ‘a smooth admission procedure’, ‘a friendly and welcoming approach from the staff’, and ‘daily conversations’. Lastly, three themes described areas for improvements: ‘feeling guilty about seeking BA’, ‘room occupancy issues’, and ‘differences in staff’s competence’. Collectively, the findings indicate that BA constructively supports patients with emotional instability and self‐harm during a period of crisis.     

Older women nurses: health, ageing concerns and self-care strategies

Title. Older women nurses: health, ageing concerns and self‐care strategies Aim. This paper is a report of a study of the health and ageing concerns and self‐care strategies of older female Registered Nurses currently working in direct care‐giving roles in acute public hospitals and community facilities. Background. Nursing is a rapidly ageing, and female‐dominated workforce. However, despite the ageing of the nursing workforce, little is known about the needs and health concerns of older nurses. Method. A feminist perspective was used and 12 female Registered Nurses aged 40–60 years, employed in various acute hospital and community health settings in Australia took part in qualitative interviews in late 2004. Narratives were audio taped, transcribed and analysed thematically. Findings. Two major themes were identified. The first theme –Aches and pains of ageing– had four subthemes: Neglecting self: ‘You don't think of yourself first’; Physical changes: ‘The body is wearing out’; Living with pain: ‘You just work around it’; and Tiredness: ‘I’m just tired all the time’. The second theme –Evolving lifestyles: works in progress – had three subthemes: The power of exercise: ‘I feel great…and I’m enjoying life’; Healthy eating: ‘Low fat, lots of fruit and veg, little processed food’; and Adapting to ageing: ‘I think it’s quite a good time of life’. Conclusion. Further research is needed to explore the need for protective work practices and promoting healthy lifestyle practices for ageing nurses. Managers need to recognize the changing health needs of older clinical nurses and offer, for example, flexible rostering and tailored exercise programmes to promote their health.     

Patient perceptions of epinephrine auto‐injectors: exploring barriers to use

Scand J Caring Sci; 2013; 27; 335–344 Patient perceptions of epinephrine auto‐injectors: exploring barriers to use Background: In recent years, government initiatives have proposed that patient self‐care should serve as a key resource in response to the anticipated increase in global demand for health care. However, if patients are to be empowered as self‐carers, barriers to engagement must be identified and overcome. Anaphylaxis is an increasingly common life‐threatening allergic reaction. Patients at risk of anaphylaxis are prescribed epinephrine auto‐injectors and play a crucial role in delivering their own care and management of this condition. One key recommendation is that patients routinely carry an epinephrine auto‐injector with them and deploy the device when needed. However, only a small proportion of patients that require epinephrine actually receive it. Objective: To explore the reasons why patients who have been prescribed epinephrine auto‐injectors fail to adhere to self‐care and management recommendations. Methods: In‐depth interviews with 15 adults who have been prescribed epinephrine auto‐injectors were carried out to explore the barriers that exist in the provision of effective self‐care and management of anaphylaxis. Results: Inconsistent health professional advice, perceived stigma of carrying a ‘weapon‐like’ device, poor device design and limited patient training were identified as barriers to carriage or use. Patients were reluctant to carry devices in public because of perceived and observed stigma and suspicion. They were happy to ignore expiry dates, and some participants were confident that the emergency services would provide them with the appropriate care they needed, and therefore, did not carry the device in urban areas. Conclusions and clinical implications: Improved training of patients, the public and health professionals around both the carriage and use of auto‐injectors are areas for urgent attention if improved levels of self‐care are to be attained. The design of epinephrine auto‐injectors should also receive attention as patients often fail to carry them owing to size and aesthetics.