Journeying to visibility:an autoethnography of self-harm scars in the therapy room

This autoethnography explores the experience of a therapist negotiating the visibility of their self‐harm scars in the therapy room. Its form takes the shape of the author's personal meaning‐making journey, beginning by exploring the construction of the therapist identity before going on to consider the wounded healer paradigm and the navigation of self‐disclosure. A thread throughout is finding ways to resist fear and shame as both a researcher and counsellor. The author concludes by recounting fragments of sessions from the first client she worked with while having her scars visible. While not every therapist will have self‐harm scars, all therapists have a body which plays “a significant part of his or her unique contribution to therapy” (Burka, 2013, p. 257). This paper is, therefore, potentially valuable to any therapist, at any stage of development, who seeks to reflect on the role of the body and use of the self

Personal notions of time travel:reflections on love, loss, and growth through autoethnography

Using the concept of time travel as a contextual and narrative tool, the author explores themes of love, loss and growth after trauma. Reflections relate primarily to the experience of conducting the qualitative research method of autoethnography. Opening with consideration of existing work (Yoga and Loss: An Autoethnographical Exploration of Grief, Mind, and Body), discussion moves on to academic thought on mental time travel, and personal transformation, culminating in the construction of a new memory combining past, present, and future

Student health professionals' attitudes and experience after watching 'Ida's diary', a first-person account of living with borderline personality disorder:mixed methods study

BACKGROUND: There is increasing interest in the use of commercial movies in nursing education, or 'cinenurducation'. There is a need for educational interventions which target mental health nurses' attitudes towards people with borderline personality disorder.OBJECTIVES: To investigate and evaluate the experience and effects of attendance at a screening of the movie Ida’s Diary, a first-person account of living with borderline personality disorder.DESIGN: Mixed methods design comprising a within-subjects AB longitudinal survey, and a qualitative analysis of participant-generated data and researcher field notes from a World Ca-fé discussion group.SETTINGS: One university in Scotland.PARTICIPANTS: N=66 undergraduate and postgraduate mental health nursing and coun-selling students.METHODS: Participants completed measures of cognitive and emotional attitudes towards, and knowledge about, people with borderline personality disorder before and after one of two film screenings. We conducted a World Café discussion group after the second screen-ing. Resulting data were subject to a qualitative thematic analysis.RESULTS: Quantitative analysis revealed a five-factor cognitive and a single-factor emo-tional attitude structure. Cognitive-attitudinal items related to treatment deservingness and value of mixed treatment approaches improved across iterations. Total knowledge score did not change, but one item about borderline personality disorder as a precursor to schizophrenia received considerably more incorrect endorsement post-screening. Qualitative analysis re-vealed five themes: Facilitation and inhibition of learning; promotion but not satiation of appe-tite for knowledge; challenging existing understanding; prompting creativity and anxiety; and initiating thinking about the bigger picture.CONCLUSIONS: Participants found the film thought provoking; it increased their appetite for knowledge. Findings suggest that screening should be delivered in conjunction with more didactic information about borderline personality disorder

Dangerous arms and everyday activism:a dialogue between two researchers with lived experience of self-harm

Using the format of dialogue, this paper is a collaborative exploration of navigating academia in self-harm scarred bodies. Prompted by the proposal of social media regulators to blur and ban self-harm scars, thus communicating such bodies as “dangerous,” our dialogue considers personal notions of activism, researcher identity, emotional labor, future potential, and the importance of finding and building communities for embodied solidarity. Structured as a single flowing discussion, the dialogue itself is (re)constituted from conversation, follow-up emails, and reviewer feedback. Explorations rely predominantly on personal experience and are supported in places by literature which has informed and shaped our ideas. In itself, this paper will be an “everyday act of defiance” in being seen, as well as advocating for spaces such as ECQI where meaningful connections can be instigated and maintained, and dialogues continued

Mixed methods evaluation of an educational intervention to change mental health nurses' attitudes to people diagnosed with borderline personality disorder

Aims and objectives: To evaluate and explore mental health nurses’ responses to and experience of an educational intervention to improve attitudes towards people with a diagnosis of Borderline Personality Disorder. Report findings are concordant with relevant EQUATOR guidelines (STROBE and COREQ).Background: Attitudes towards people with a diagnosis of Borderline Personality Disorder are poorer than for people with other diagnoses. There is limited evidence about what might improve this situation. One intervention with reportedly good effect uses an underlying biosocial model of borderline personality disorder. No previous intervention has been co-produced with an expert-by-experience. We developed and delivered a 1-day intervention comprising these elements.Design: A mixed-methods design was used comprising prospective uncontrolled cohort intervention and qualitative elements. Participants were mental health nursing staff working in inpatient and community settings in one NHS Board in Scotland, UK.Methods: Measurement of cognitive and emotional attitudes to people with a borderline personality diagnosis at pre- and post- intervention (N =28) and at 4-month follow-up. Focus groups were used to explore participants’ experiences of the intervention (N =11).Results: Quantitative evaluation revealed some sustained changes consistent with expected attitudinal gains in relation to the perceived treatment characteristics of this group, the perception of their suicidal tendencies, and negative attitudes in general. Qualitative findings revealed some hostility towards the underpinning biosocial model and positive appreciation for the involvement of an expert-by-experience. Conclusions: Sustained benefits of an educational intervention for people working with people diagnosed with BPD in some but not all areas. Participants provided contrasting messages about what they think will be useful.Relevance to clinical practice: The study provides further evidence for incorporation of a biosocial model into staff training as well as the benefits of expert-by-experience co-production. Mental health nurses, however, believe that more well-resourced services are the key to improving care. <br/

Receiving thank you letters in inpatient child and adolescent mental health services (CAMHS):a qualitative study of nurse’s experiences

Introduction: Previous research has found that nurses in inpatient CAMHS can struggle to define their role and contribution to patient care. While gratitude has received increased attention in relation to subjective well‐being in healthcare settings, the receipt of gratitude in the form of thank you letters is currently unexplored in the CAMHS context.Aim/Question: To gain an understanding of how inpatient CAMHS nursing staff experience receiving expressions of gratitude from patients.Method: Adopting an exploratory qualitative approach, two focus group interviews were conducted. Participants completed a brief online follow‐up questionnaire. Data were examined using thematic analysis. Results: Reflecting on expressions of gratitude improved understanding of professional identity, enhanced reflexivity, enhanced team cohesion and increased professional and personal confidence and motivation.Discussion: Expressions of gratitude appear to offer meaningful sources of feedback for nurses and support a greater sense of personal accomplishment, professional role and the relational impact of care for patients. When nurses share and discuss expressions of gratitude with colleagues this brings benefits additional to the initial receipt. Implications for Mental Health Nursing: Nurses should be supported to engage in discussing and reflecting upon receiving thank you letters and other tokens of gratitude although care should be taken to support those who might experience unease or increased self‐doubt

Improving response rates using a monetary incentive for patient completion of questionnaires: an observational study

Background: Poor response rates to postal questionnaires can introduce bias and reduce the statistical power of a study. To improve response rates in our trial in primary care we tested the effect of introducing an unconditional direct payment of 5 pound for the completion of postal questionnaires. Methods: We recruited patients in general practice with knee problems from sites across the United Kingdom. An evidence-based strategy was used to follow-up patients at twelve months with postal questionnaires. This included an unconditional direct payment of 5 pound to patients for the completion and return of questionnaires. The first 105 patients did not receive the 5 pound incentive, but the subsequent 442 patients did. We used logistic regression to analyse the effect of introducing a monetary incentive to increase the response to postal questionnaires. Results: The response rate following reminders for the historical controls was 78.1% ( 82 of 105) compared with 88.0% ( 389 of 442) for those patients who received the 5 pound payment (diff = 9.9%, 95% CI 2.3% to 19.1%). Direct payments significantly increased the odds of response ( adjusted odds ratio = 2.2, 95% CI 1.2 to 4.0, P = 0.009) with only 12 of 442 patients declining the payment. The incentive did not save costs to the trial - the extra cost per additional respondent was almost 50 pound. Conclusion: The direct payment of 5 pound significantly increased the completion of postal questionnaires at negligible increase in cost for an adequately powered study

Incentives as connectors : insights into a breastfeeding incentive intervention in a disadvantaged area of North-West England

PMID: 22458841 [PubMed - indexed for MEDLINE] PMCID: PMC3414740 Free PMC ArticlePeer reviewedPublisher PD

Understanding communication pathways to foster community engagement for health improvement in North West Pakistan

Background: This paper describes the community engagement process undertaken to ascertain the focus, development and implementation of an intervention to improve iodised salt consumption in rural communities in North West Pakistan. The Jirga is a traditional informal structure, which gathers men respected within their community and acts in a governing and decision making capacity in the Pukhtoon culture. The Jirga system had a dual purpose for the study; to access men from the community to discuss the importance of iodised salt, and as an engagement process for the intervention. Methods: A number of qualitative data collection activities were undertaken, with Jirga members and their wives, male and female outreach workers and two groups of women, under and over forty years old. The aim of these were to highlight the communication channels and levers of influence on health behaviour, which were multiple and complex and all needed to be taken into consideration in order to ensure successful and locally sensitive community engagement. Results: Communication channels are described within local families and the communities around them. The key influential role of the Jirga is highlighted as linked both to the standing of its members and the community cohesion ethos that it embodies. Engaging Jirga members in discussions about iodised salt was key in designing an intervention that would activate the most influential levers to decision making in the community. Gendered decision making-processes within the household have been highlighted as restricting women’s autonomy. Whilst in one respect our data confirm this, a more complex hierarchy of decisional power has been highlighted, whereby the concept of ‘wisdom’, an amalgamation of age, experience and education, presents important possibilities. Community members with the least autonomy are the youngest uneducated females, who rely on a web of socially and culturally determined ways to influence decision-making. Conclusions: The major lines of communication and influence in the local community described are placed within the wider literature on community engagement in health improvement. The process of maximisation of local cultural knowledge as part of a community engagement effort is one that has application well beyond the particular setting of this study

Perceptions and experiences of using a nipple shield among parents and staff - an ethnographic study in neonatal units

Background: Preterm infants have an immature sucking behavior and the capacity to be exclusively breastfed may be reduced for a period of weeks or months, depending on gestational age. Nipple shields have been used, not only as a device to help mothers with sore nipples, but also to facilitate the infant’s latch on to the breast. However, the benefits of using nipple shields have been debated. The aim of this study was to explore perceptions and experiences of using a nipple shield among parents and staff in neonatal units in Sweden and England. Methods: An ethnographic study was undertaken where observations and interviews were conducted in four neonatal units in Sweden and England. The data were analyzed using a thematic networks analysis. Result: The global theme was developed and named, ‘Nipple shield in a liminal time’. This comprised of two organizing themes: ‘Relational breastfeeding’ and ‘Progression’. ‘Relational breastfeeding’ was underpinned by the basic themes, ‘good enough breast’, ‘something in between’ and ‘tranquil moment’. ‘Progression’ was underpinned by the basic themes, ‘learning quicker’, ‘short-term solution’ and ‘rescue remedy’. Although breastfeeding was seen primarily as a nutritive transaction, the relational aspects of breastfeeding were of crucial importance. These two organizing themes show the tension between acknowledging the relational aspects of breastfeeding and yet facilitating or supporting the progression of breastfeeding in the period from tube feeding or cup feeding to breastfeeding. It is a liminal time as mothers and their infants are “in between” phases and the outcome, in terms of breastfeeding, is yet to be realized. Conclusion: This study demonstrates parents’ and staffs’ perceptions of the nipple shield as a short term solution to help initiation of breastfeeding but also as a barrier between the mother and infant. It is important that the mother and baby’s own particular needs are taken into account, in a person-centred way and on an ongoing basis. Furthermore, we need to emphasise the importance of the ‘relational’ whilst understanding the need for ‘progression’. Holding these in balance may be the key to appropriate use of the nipple shield