Schoppmann S, Schröck R, Schnepp W, Büscher A
Institute of Nursing Science, Private University of Witten/Herdecke, Germany.
J Psychiatr Ment Health Nurs. 2007 Sep;14(6):587-97. doi: 10.1111/j.1365-2850.2007.01150.x.
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'.
有自我伤害行为的人常常被视为难缠的患者;面对护士无益的反应,患者在痛苦中倍感孤立。文献中指出自我伤害行为与疏离感之间存在联系。疏离感被描述为一种自我被视为陌生、机械且与自身情感和身体需求脱节的状态。一方面,复杂的神经生物学过程被认为对此负有责任;另一方面,当一个人面临威胁或创伤性情境时,疏离感被视为一种自我保护手段。护理干预侧重于护患关系以及自我伤害行为的处理,但往往忽视了患者以往的经历。基于有自我伤害行为的患者是自身伤害问题专家这一假设,本研究的目的是深入了解他们的“生活体验”,并有助于增进对这一弱势群体的理解。采用诠释现象学研究视角,选择参与观察法和定性访谈法来收集数据。数据库由99个观察序列、5次访谈以及一位有自我伤害行为的女性撰写的一组电子邮件文本组成。按照范曼恩所描述的方法进行了主题分析。主要研究结果是,疏离感在几个阶段中都有体现,护士能够察觉到即将失去控制的早期迹象,并且自我伤害行为是结束痛苦疏离体验的一种有效策略。自我伤害行为可恰当地理解为一种“自我护理”形式。