Deliberate self-injury. Management in a psychiatric setting.

Self-injury is a significant clinical problem of psychiatric patients, although the prevalence of self-injury in specific disorders is unclear. Nurses can assess and intervene in the psychological causes and behavioral sequelae self-injury. Each patient's early history, dynamics, and motives for self-injury require evaluation. Behavioral techniques (eg, reinforcement) and psychodynamic techniques, such as exploring feelings and anxiety, can help patients understand their self-destructive tendencies. Patients can learn to anticipate anxiety-provoking situations, plan strategies to manage anxiety, cope with feelings, and reduce self-injury.     

Eating Disorders and Additional Psychopathology in Women

Eating disordered individuals are often found to exhibit additional psychopathology such as depression, anxiety, substance abuse, and "borderline symptoms" such as self-injury and suicidality. This pilot study examined 535 female subjects with eating disorders to determine the relationship between such additional psychopathology and a prior history of sexual abuse. While few differences were found on general psychiatric/psychological symptoms as measured by the SCL-90-R, subjects that reported a history of sexual abuse were found to have more prior suicide attempts and hospitalizations, and more frequent self-injury and alcohol problems. These findings suggest that symptoms seen in some eating disorder patients that are frequently described as "borderline" may be indicators for a history of sexual abuse.     

Predicting supportive behavior of parents and siblings to a family member with intellectual disability living in institutional care

This feasibility study examines whether the theory of planned behavior can predict supportive behavior provided by either parents to their offspring-or adult siblings to their brothers and sisters-with an intellectual disability living in 2 Israeli institutional care facilities. Participants were 67 parents and 63 siblings who were interviewed at baseline regarding their intentions to visit their offspring or sibling in the institutional care facility, to contact the caregiving staff, and to accept visits at home. Parents' and siblings' behavior regarding visitation and supportive behavior was examined after 6 months by caregiving staff. Core findings indicated that subjective norms in siblings and parents predicted frequency of home visits. Perceived behavioral control predicted frequency of contact between siblings and staff. Differences between parents and siblings regarding their supportive behaviors are discussed with respect to social work practice.     

The balancing act. Collaboration between frontline forensic staff and hospital administration

1. Flexibility, creativity, and consistency are critical characteristics for both frontline staff and administrators in the delivery of treatment and care for complex forensic patients who may be difficult to manage. 2. Through collaborative efforts and ongoing communication, plans can be identified and implemented that enhance patient and staff safety and facilitate positive behavioral and rehabilitation outcomes for patients. 3. Effective partnerships among frontline staff, administration, patients, their families, labor unions, and communities contribute significantly to the effective resolution of conflicts and dilemmas in the provision of holistic care to forensic patients.     

The prevailing cultures and staff dynamics in children's homes: implications for training

This paper is about training, and the learning needs of residential child care staff that training should address. It takes as its starting point research that focused on what happens in children's homes, as described by residential staff themselves. It depicts the tasks which staff carry out in relation to their overall goal of benefiting the children and young people in their care, and considers the ways in which staff work to develop and maintain viable and effective teams. Distinctive cultures emerge when working in staff teams, and the paper shows how these are related to the kinds of practice that can be achieved in residential settings. The knowledge base, practice skills, and personal qualities required to work within residential child care are detailed. The paper closes by addressing the implications which this research has for training residential staff to work effectively in group settings. It argues that fundamental to training competent residential staff is a commitment to developing an ongoing culture of learning in workplace settings.     

Cutting through the Silence: A Sociological Construction of Self-Injury

This project provides a sociological perspective on self-injury by assessing whether cutting is a learned behavior and whether practitioners use stigma management techniques. In-depth interviews via e-mail with self-reported self-injurers indicate cutting is learned from the self or from outside sources. Interviewees also discussed the stigma management techniques they use and whether they choose to disclose their behavior. The findings point to a potential increase in learned cutting from outside sources, and the potential for outside sources to help cutters maintain their behavior by providing each other with support.     

How to evacuate a psychiatric hospital: a Hurricane Katrina success story

This article describes the successful evacuation of an entire psychiatric hospital from New Orleans, Louisiana, to Memphis, Tennessee, on a weekend night. The destination site was 400 miles away and buses were used for transport. The evacuation occurred shortly before Hurricane Katrina struck New Orleans and included 73 adult, adolescent, and child acute psychiatric patients. Thirty-five staff members also participated in the evacuation with their families and pets. This report is significant because little is known about how to implement a disaster plan that involves the transport of an entire psychiatric hospital-patients, nurses, physicians, staff, and family members--to another city. The knowledge gained can also benefit psychiatric nurses and their organizations when establishing or modifying their disaster plans.     

‘I do like the subtle touch’: interactions between people with learning difficulties and their personal assistants

Disabled people have often been denied choice and control in their lives. Although direct payments promise to deliver autonomy for disabled people, much depends on the way direct payments employers and personal assistants handle their interactions. These matters are particularly important for people with learning difficulties, who have routinely been restricted and controlled by their support staff. This paper presents an analysis, based on video material, of interactions between people with learning difficulties and personal assistants. The paper examines how difficult tasks, such as giving advice, can be accomplished in ways that people with learning difficulties find acceptable. Successful interactions are built on sensitivity to the wishes of the person, on a moment by moment basis. It is important that both parties coordinate their body language, humour and timing to demonstrate a close and friendly relationship, which is both professional and on the terms of the direct payments employer.     

State sponsored health care in rural Uttar Pradesh: grassroots encounters of a survey researcher

This paper reports on impressions gained by the author while gathering data for a baseline survey on the delivery and quality of health and family planning (FP) services in rural Uttar Pradesh in India. Data were collected from FP staff and acceptors. The author found that the public health service staff were often derelict in their duties and failed to maintain proper records. Staff positions were secured and kept through the payment of bribes. Bribes are also used to secure or prevent transfers to other districts. Staff morale was further demoralized by harassment in the form of delaying payment of salaries or travel allowances and by the creation of factions loyal to the Medical Officer-in-Charge and the immediately subordinate Medical Officer. In order to reform this system, it must be held accountable to the people it serves and must regain their confidence. The presence of a privately-operated clinic in the area indicates that affordable services can be delivered. FP staff also require a means of transportation, such as mopeds, to allow them to increase their effectiveness. Despite this climate of derelict service provision, it must be noted that some personnel were performing an exemplary service to their districts.     

Record keeping practices: Consequences of accounting demands in a public clinic

This observational study explores the tensions and negative consequences of record construction for patients and front-line staff in a public clinic providing services to poor women and children. For emphasis, it is possible to say that the routine of the clinic is record driven, not service driven. More is accomplished in clinic work than producing records; patients certainly do receive needed health care. However, tight regulations filtered through heavy paperwork requirements stifle the effective delivery of comprehensive, flexible services especially needed by disadvantaged families. Clinic staff may be motivated to attend to individual patient concerns, but accounting demands generally circumscribe their work and create barriers for patients. The record has a life of its own as a socially constructed artifact in the process of caregiving in bureaucratic settings, where actual services often respond not to the client, but to the countable, accountable mandates of management.     

Assessing Attentional Bias Toward Nonsuicidal Self-Injury Cues in Young Adults with Histories of Engaging in Self-Harm

Child and Adolescent Social Work Journal - Nonsuicidal self-injury (NSSI) is a prevalent behavior among young people maintained by complex transdiagnostic processes. This study sought to...     

Prevalence and correlates of self-injury among university students

OBJECTIVE: The authors' purpose in this research was to establish estimates of the prevalence and correlates of nonsuicidal self-injury among university students. PARTICIPANTS: The authors recruited participants (N = 2,843) from a random sample of 5,021 undergraduate and graduate students attending a large midwestern public university. METHODS: Using an Internet-based survey, the authors measured the prevalence of self-injury and potential risk factors, including depression, anxiety, eating disorders, suicidal thoughts, and negative health behaviors. RESULTS: Seven percent of students reported any self-injury over the previous 4 weeks. Factors associated with a significantly higher likelihood (p <.05) of self-injury included cigarette smoking, concurrent depressive and anxiety disorders, and for men, growing up in a family of low socioeconomic status and having symptoms of eating disorders. Only 26% of those who reported self-injury received mental health therapy or medication in the previous year. CONCLUSIONS: Students who harm themselves experience high anxiety and distress, yet are unlikely to seek help.     

SOFTWARE REVIEWS

ABSTRACT

This report outlines the components of wiki technology and its possible applications in the human services. Wikis have the potential to manage the detailed internal and external information and knowledge that is ubiquitous in the human services. For example, a wiki would be an ideal tool to store the knowledge of how things actually work in agencies with high staff turnover or many retiring of baby boomers. Wikis offer the opportunity for veteran staff to disseminate their expertise by hyperlinking knowledge about a certain operation to other operations or procedures. Furthermore, since wikis can be updated by all users, the knowledge can be easily and instantly updated as the human services environment changes. Wikis also offer the capacity to track and manage user changes. The report describes a specific external wiki application for capturing and disseminating community referral information.     

Managing the process of change in residential child care: A consultancy approach

This article explores the impact of a consultancy undertaken with groups of residential child care staff within a large local authority who were experiencing considerable changes in their working environment as a result of a review of residential care structures. The authors were invited to engage directly with staff on an individual and group basis to help them work through the barriers they perceived to changing their approach to practice. The theoretical underpinning for the work was Charles Handy's [1993, Understanding Organisations (Harmondsworth, Penguin)] belief that change is more likely to have a positive outcome when staff have an investment in and contribution to the change processes. The model of change utilised within the sessions with staff was Kurt Lewin's three stages of 'unfreezing', 'change' and 'refreezing'. The consultancy raised a number of issues about the process of change and how this can be achieved within the residential child care context. In particular, it highlighted the problems of assuming that change is a linear process which can be directly controlled and managed in the flux and uncertainty which characterises this sector.     

Therapeutic Recreation for the Institutionalized Elderly:

This study examined the perceptions of recreation therapists, administrators and residents from six nursing homes in Alberta, Canada regarding participation in recreation programs. The processes by which the residents were allowed to make decisions were analyzed within a potential staff conflict-abuse model. The results demonstrated that the residents' behaviors were being externally controlled and their needs to have self-determination, control, and autonomy regarding program participation were undermined. The loss of these basic rights is postulated to promote increasing dependence on the staff, thereby enhancing the potential for conflict and further abuse.     

Further notes on record taking and making in maternity care: The case of South Asian descent women

This paper draws on data from a small-scale ethnographic study of the delivery of maternity care to South Asian descent women in a hospital in Southern England during 1988. Stereotyped views of these women which related to their customs and culture as well as their typification as patients were commonly expressed by staff, particularly midwives. The paper examines the role of medical records and record making in stereotyping Asian women: the ways in which stereotyped views of women may affect the record making process; and how that process itself may reinforce and create stereotypes. The utility of records for ‘rate production’ purposes is also discussed. The focus of the paper is the creation of a woman's maternity records which occurs in the antenatal clinic. The transformation of stigmatised views of a client into ‘facts’ about a client is common among bureaucrats, in this setting health service staff. This process affects the client's future encounters with the bureaucracy. In medical settings records (ie the case notes) help to create, transmit and reify negative stereotypes of health service users. These stereotypes can affect the kind of care given to individual patients.     

Transforming the culture of caring

Direct care staff struggle with the decision of when to physically intervene with patients. There is a widely held belief that they are expected to place themselves in danger of harm to prevent patients from hurting themselves or others. In this acute mental health care setting, an educational program was developed, using principles of adult and transformational learning, to dispel the idea that getting hurt is part of the job. The Staying Safe program strongly discourages staff from physically intervening alone and promotes staff getting enough help and having a plan. Staff are encouraged to interact with patients in helpful ways and to respond to patient requests in ways that do not increase frustration or evoke anger. There has been a positive response to the training program, evidenced by changes in the way staff think about their jobs and a reduction in the number of assaults and injuries to staff.     

The impact of funding sources and board representation on consumer control of service delivery in organizations serving low-income communities

This article examines the influence of funding sources and board members on the degree to which an organization enhances consumer control of the organization or limits access to services for some groups of clients. Based on a study of decision making in organizations serving three low-income communities, a limited degree of board influence on an organization's choice of service strategies can be traced to both the power of donors to demand service strategies that reflect their interests and the efforts of staff members to limit the ability of the board to engage in policy-making. The high degree of dependence of low-income communities on external funding restricts the development of boards as decision-making bodies that effectively reflect community interests.     

Slaps,Punches, Pinches—But not Violence: Boundary‐Work in Nursing Homes for the Elderly

This article presents an analysis of boundary work in the context of care for the elderly, where violence appears to be widespread but is still relatively unacknowledged. Talk about aggressive patients was formulated in a particular way among workers in a nursing home. Nursing home staff described how the elderly residents sometimes slapped, pinched, or hit them. Although staff members could describe these acts as intentional, although they could hold patients responsible, and although this violence could end in injuries, demarcations were made such that aggressive acts were constructed as somehow not really “violence.” As “violent” is an inherently exclusionary label, this downplaying can be seen as an effort to avoid pushing persons outside the boundary of normalcy and of continued acceptance. Placing the elderly's violence outside the boundaries of violence means that the elderly remain “care takers,” the staff “caregivers,” and the nursing home a “caring context.”