Hospital staff experiences of their relationships with adults who self-harm: a meta-synthesis

Purpose This review aimed to synthesize qualitative literature exploring inpatient hospital staff experiences of their relationships with people who self-harm. Methods Nine studies were identified from a systematic search of five research databases. Papers included the experiences of physical health and mental health staff working in inpatient settings. The studies employed various qualitative research methods and were appraised using an adapted quality assessment tool (Tong, Sainsbury, & Craig, 2007). A meta-synthesis was conducted using traditional qualitative analysis methods including coding and categorizing data into themes. Results Three main themes derived from the data. ‘The impact of the system’ influenced the extent to which staff were ‘Fearing the harm from self-harm’, or were ‘Working alongside the whole person’. A fear-based relationship occurred across mental health and physical health settings despite differences in training; however, ‘Working alongside the whole person’ primarily emerged from mental health staff experiences. Systemic factors provided either an inhibitory or facilitative influence on the relational process. Conclusions Staff experiences of their relationship with people who self-harm were highlighted to have an important impact on the delivery and outcome of care. Increasing support for staff with a focus on distress tolerance, managing relational issues, and developing self-awareness within the relationship may lead to a more mutually beneficial experience of care. Equally, structure, clarity, and support within inpatient systems may empower staff to feel more confident in utilizing their existing skills. Practitioner points •Working with people who self-harm can be emotionally challenging and how staff cope with this can significantly impact on the engagement of staff and patients. •Increasing the skills of staff in managing relational issues and tolerating distress, as well as providing support and reflective practice groups may be useful in managing emotional responses to working with people who self-harm. •Refining the supportive, procedural, and environmental structures surrounding the caregiving relationship may help enable better integration of physical and mental health care

A qualitative exploration of responses to self-compassion in a non-clinical sample

Research suggests that being self-compassionate can have myriad benefits, including life satisfaction, health-promoting behaviours and improved mental health. Given the possible advantages of being self-compassionate, it seems critical to explore how to promote this in the general population. This qualitative study aimed to understand responses to the idea of being compassionate to oneself within the general population. Semi-structured interviews were conducted in the North East of England between October 2014 and February 2015, they were analysed using thematic analysis. As part of an intervention study, non-clinical volunteers watched a psychoeducation video about the concept of self-compassion and then participated in one of four meditation exercises. Following this, participants were interviewed about their responses to the idea of being self-compassionate. Three themes were identified: Benefits of Self-Compassion; Being Self-Compassionate and Barriers to Self-Compassion. Participants believed that being self-compassionate would be beneficial, for both themselves and the world, but they believed that self-compassion would make them vulnerable and that others would judge them. Thus, participants were afraid to be the first ones to be self-compassionate and stated that, in order for self-compassion to be acceptable, we need to change the perspective of western culture. These findings underscore the importance of understanding society's role in a person's ability to be self-compassionate. In order to reap the benefits of self-compassion, we need to create a culture that accepts and encourages this. As practitioners, we are in a position to lead in self-compassion and to encourage other leaders to promote this as a preventative mental health strategy

Women’s experiences of commercial three-dimensional ultrasound scans

Ultrasound has become a routine part of UK maternity care and has a range of diagnostic and screening purposes. The last two decades have seen the development of three-dimensional (3D) scans, which use computer software to produce a seemingly 3D image of the foetus (Rankin et al 1993). Four-dimensional (4D) scans include the dimension of time, i.e. moving images of the foetus. This technology does currently have limited diagnostic use (Campbell 2002, Kurjak et al 2007) though it can be helpful in screening for facial anomalies. Over the last two decades 3D and 4D scans have become available to expectant parents (Roberts 2012) through commercial screening companies. They are generally marketed as ‘bonding scans’ or ‘reassurance scans’ (Wadephul 2013), in line with claims that the more ‘baby-like’ images enhance the parental relationship with the foetus and provide reassurance to expectant parents (Campbell 2002). This is not supported by research into the psychological impact of 3D and 4D scans, which suggests that while these scans may enhance parental recognition of the foetus , they do not increase ‘bonding’ or reassurance compared to conventional two-dimensional (2D) scans (Righetti et al 2005, Rustico et al 2005, Leung et al 2006, Sedgmen et al 2006, Lapaire et al 2007, de Jong-Pleij et al 2013). These studies offered 3D/4D scans as part of their research, rather than exploring women’s experiences of scans they had actively sought out and paid for. The case studies presented in this paper are part of a larger PhD study exploring discourses of 3D/4D scans and women’s experiences of having these scans (Wadephul 2013). The case studies aim to explore why individual women choose commercial 3D/4D scans, what their expectations and experiences are and how the scans affect their psychological experience and their maternal-foetal relationship

What is traumatic birth? A concept analysis and literature review

Background: A number of women experience childbirth as traumatic. This experience can have enduring and potentially lifelong effects on both mental and physical health, and have implications for the woman's relationship with her baby, partner and family. It can also have implications for future decisions about pregnancy and birth. However, the meaning of the term ‘traumatic birth’ remains poorly defined. Clear understanding of the concept is critical to better underpin understanding and effectively evaluate women's experiences. Objective: To review the literature pertaining to ‘traumatic birth’ and produce a definition of the concept. Methods: The concept analysis framework of Walker and Avant (2011) was used. Electronic bibliographic databases CINAHL, Medline, PsycINFO and Cochrane were searched to find papers written in English and dated 1998–2015. From a narrative literature review, the defining attributes were ascertained, and model, borderline, related, contrary, invented and illegitimate cases were constructed. The antecedents and consequences were then identified and empirical referents determined. Findings: The apparent attributes of ‘traumatic birth’ are that a baby has emerged from the body of its mother at a gestation where survival was possible. This birth has involved events and/or care that have caused deep distress or disturbance to the mother, and the distress has outlived the immediate experience. Conclusions: ‘Traumatic birth’ is a complex concept which is used to describe a series of related experiences of, and negative psychological responses to, childbirth. Physical trauma in the form of injury to the baby or mother may be involved, but is not a necessary condition

Food choice by people with intellectual disabilities at day centres: A qualitative study

People with intellectual disabilities experience a range of health inequalities. It is important to investigate possible contributory factors that may lead to these inequalities. This qualitative study identified some difficulties for healthy eating in day centres. (1) Service users and their family carers were aware of healthy food choices but framed these as diets for weight loss rather than as everyday eating. (2) Paid carers and managers regarded the principle of service user autonomy and choice as paramount, which meant that they felt limited in their capacity to influence food choices, which they attributed to the home environment. (3) Carers used food as a treat, a reward and for social bonding with service users. (4) Service users’ food choices modelled other service users’ and carers’ choices at the time. It is suggested that healthy eating should be made more of a priority in day care, with a view to promoting exemplarily behaviour that might influence food choice at home

Exploring changes in health visitors' knowledge, confidence and decision-making for women with perinatal mental health difficulties following a brief training package

Rationale and objective: Perinatal Mental Health (PMH) is an issue that spans the spectrum of pregnancy and childbirth and is now acknowledged to be significant on a global level. Health visitors (HVs) are increasingly expected to extend their knowledge and to understand and identify PMH in the antenatal period and across the spectrum from mild/moderate to severe. While training has been shown to enable HVs to identify post-natal depression (PND) effectively and reduce the proportion of women at risk, the mechanisms underpinning this success are unclear. This paper reports on the findings of a mixed methods study aimed at examining the impact of a single half day training session on perinatal mental health problems (PMHP) on HVs knowledge, confidence and empowerment in relation to managing PMH. Methods: Findings from data gathered by Likert Scales and focus group discussions are presented. Results: Training can empower HVs to identify PMHP beyond PND and plays a vital role in promoting confidence. Conclusions: This research highlights the potential that training of this type has on service provision and delivery. In a resource-limited service, the feasibility of a brief training package has demonstrated positive results for health visitors, childbearing women and their families

An education for life: The process of learning the Alexander technique

The Alexander technique is an educational self-development self-management method with therapeutic benefits. The primary focus of the technique is learning about the self, conceptualized as a mind-body unity. Skills in the technique are gained experientially, including through hands-on and spoken guidance from a certified Alexander teacher, often using everyday movement such as walking and standing. In this article the authors summarize key evidence for the effectiveness of learning the Alexander technique and describe how the method was developed. They attempt to convey a sense of the unique all-encompassing and fundamental nature of the technique by exploring the perspectives of those engaged in teaching and learning it and conclude by bringing together elements of this account with relevant strands of qualitative research to view this lived experience in a broader context

’I am teaching them and they are teaching me’: Experiences of teaching Alexander Technique to people with dementia

Introduction: To enable people with dementia to live well we must support the person as a whole. The Alexander Technique (AT) offers an approach which addresses both physical and psychological issues which may be suitable to help people with dementia. In this new area of research, this study aimed to establish whether the AT is currently taught to people with dementia and if so to bring together the experiences of AT teachers in relation to the perceived benefits and suitability of the AT for this group.Methods: This qualitative study included data from responses to survey questions, interview transcripts and published articles.Results : A total of 84 AT teachers took part in an international survey of whom 18 (21%) had taught one or more people with dementia. Thematic analysis generated the following superordinate themes: ‘The AT can help people with dementia’, ‘How change comes about’, and ‘Adapting the AT for people with dementia’.Conclusions : AT teachers described perceiving improvements in movement, pain and flexibility; increased calm, sociability and environmental awareness. They highlighted the reciprocal nature of the relationship between teacher and student and highly valued this. Touch was seen as a key means of communication, helping people with dementia to feel safe. It seems that the AT does not require major adaptation to work with this group although the challenges of working in a care setting were discussed. The AT offers the potential to be a valuable intervention for people with dementia and further research is warranted

Conceptualising women's perinatal well-being: a systematic review of theoretical discussions

Background: Perinatal well-being has increasingly become the focus of research, clinical practice and policy. However, attention has mostly been on a reductionist understanding of well-being based on a mind-body duality. Conceptual clarity around what constitutes well-being beyond this is lacking. Aim: To systematically review theoretical discussions of perinatal well-being in the academic literature.Design and methods: A search of online databases identified papers which discussed perinatal well-being theoretically, taking a multi-dimensional approach to well-being. Thematic synthesis was used to identify and synthesize relevant elements within the included papers.Findings: Eight papers were identified for inclusion in this review. All contributed a number of elements towards a theoretical discussion of perinatal well-being. Three themes were developed: (1) the importance of a number of general domains of women’s lives and domains specific to the perinatal period, (2) well-being as a subjective and individual experience with physical/embodied, affective, and psychological/cognitive aspects, and (3) the dynamic nature of well-being. Conclusions and implications for practice: Perinatal well-being is a complex, multi-dimensional construct. Current theoretical discussions in the academic literature do not provide a comprehensive model or conceptualisation covering all aspects of well-being during the perinatal period. Further theoretical work is required, particularly with regards to theorising well-being during labour and birth, the perinatal period as a continuum, and the role played by women’s expectations. The themes identified in this review contribute to a tentative model of perinatal well-being, taking note particularly of the dynamic nature of well-being. This model should be refined and validated through empirical work and can then be used to underpin further research and the development of a multi-dimensional measure of perinatal well-being

The psychological impact of overactive bladder: a systematic review

This review aimed to provide an overview of the current research on the psychological impact of overactive bladder. A systematic search yielded 32 papers. It was found that people with overactive bladder tended to have greater levels of depression, anxiety and embarrassment/shame; difficulties with social life; impact on sleep and sexual relationships; and a lower quality of life than people without overactive bladder. A psychological impact on family members was also found. Psychological health should be considered an important aspect of managing overactive bladder and further research is required to determine how best to provide psychological care and support in this area