People committing self-injurious behaviour are often perceived as difficult patients; confronted with unhelpful reactions from nurses, the patients find themselves left alone in their distress. A connection between self-injurious behaviour and feelings of alienation is suggested in the literature. Alienation is described as a state in which the self is perceived as strange, machinelike and not in contact with its emotional and physical needs. On one hand, complex neuro-biological processes are seen as responsible for this; on the other hand, alienation is seen as a means of self-protection when one is exposed to a threatening or traumatic situation. Nursing interventions focus on the nurse-patient relationship and on the handling of self-injuries, but they tend to ignore the client's previous experience. Proceeding from the assumption that patients committing self-injurious behaviour are the experts on their own harm, the purpose of the present study is to get insight into their 'lived experience' and to contribute to the understanding of this vulnerable group. Adopting a hermeneutic phenomenological research perspective, methods of participant observation and qualitative interviewing were chosen to generate data. The database consists of 99 observational sequences, five interviews and a set of email texts written by a self-injuring woman. A thematic analysis as described by Van Manen was done. The main findings are that alienation is experienced in several stages, that nurses can detect early signs of an impending loss of control, and that self-injurious behaviour is an effective strategy to end a painful experience of alienation. Self-injurious behaviour is appropriately understood as a form of 'self-care'.
This paper examines the perception of moral issues in nursing as presented in the literature and in themes of meetings, discussions and study days devoted to the subject. It offers an account of moral issues perceived by nursing students and qualified nurses as being relevant to discussions of moral aspects in nursing. The second part of this paper presents a closer examination of the problems related to professional truth telling and deception as an illustration of an ‘everyday’ moral issue in nursing and in health care generally.
On political consciousness in nurses The argument presented in this paper centres around the proposition that all nurses need to develop their critical abilities in the understanding and analysis of the socio‐economic and political background to the services of which they are a part as a potentially powerful group of health care workers.
The topics under examination in this paper, The Welfare State, Social Thought and Social Planning and Politics of Health Care, are used as examples to demonstrate the kind of critical understanding which nurses need to acquire in order to deal with some of the fundamental assumptions that influence their work either directly or indirectly.
From the argument follows the conclusion that it is an illusion, and possibly a dangerous one, if nurses continue to believe in the unpolitical nature of nursing as a professional activity.
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