Cordet Smart

Attachment and coping of dementia care staff: The role of staff attachment style, geriatric nursing self-efficacy, and approaches to dementia in burnout

Past research suggests that dementia care staff are vulnerable to the development of burnout, which has implications for staff well-being and hence the quality of care for people with dementia. Studying personal vulnerability factors in burnout is important as it can guide staff training and support. Attachment theory suggests that adult attachment styles affect caregiving relationships and individuals’ responses to stress, providing a framework for understanding caregivers’ styles of coping. This cross-sectional survey study examined relationships between staff attachment styles, geriatric nursing self-efficacy, and approaches to dementia in burnout. Seventy-seven members of dementia care staff working on inpatient wards for older people completed self-report questionnaires. Insecure attachment, lower levels of self-efficacy, and more optimistic attitudes in staff were related to higher levels of burnout. Staff training on the role of attachment in dementia care is recommended. Further research is required to explore mediating factors between adult attachment styles and burnout.

An exploration of family dynamics and attachment strategies in a family with ADHD/conduct problems

This article reports the preliminary findings of a study of attachment patterns and relationship themes using the TAAI (Transition to Adulthood Attachment Interview), AAI (Adult Attachment Interview) and family interviews (based on the first of 15 families). Research data is presented on a young man aged 16 with a diagnosis of ADHD and his family. Individual interviews, attachment interviews, and family interviews were conducted in order to explore the link between family dynamics, ADHD and attachment strategies. In contrast to findings from existing research indicating pre-occupied patterns for young people diagnosed with ADHD, the young man displayed a complex ‘disoriented’ attachment pattern which primarily featured a dismissive strategy. However, this was combined with pre-occupied patterns triggered by intrusions from unresolved traumas and memories of his parents’ continuing unresolved conflicts. His sense of confusion and lack of a coherent strategy appeared to be closely related to his position of being triangulated into his parents’ conflicts. Trans-generational processes were also influential, in that the parents’ corrective intentions at more positive parenting were impeded by their own lack of experience of positive attachments in their own childhoods. The study emphasizes the need to consider the relationship between attachment patterns and problems within wider systemic process in the family, in particular triangulation and corrective scripts.

The Construction of ADHD: Family Dynamics, Conversations, and Attachment Patterns

The paper offers an analysis of the conversational and attachment processes in a family where an adolescent has been presenting with problems of ‘ADHD’ and self-harm. The research was with one family and utilised individual narrative- based attachment assessments and a semi-structured family interview. Conversational analysis was employed to focus on the processes of meaning construction between family members. Three attachment discourse themes appeared throughout the family interviews: Distress and problems as related to biology, Self–responsibility in regulating emotional problems and Problems related to family relational issues, conflicts, and triangulations. These were considered in terms of family beliefs systems/domains domains of functioning-attachment and discipline and their points of conflict and contradiction. The analysis focussed on how the conversational processes could serve to manage dilemmas regarding how actions were regarded and generated repertoires of actions. This included aspects of family dynamics, such as expressions of feelings, divided loyalties, and triangulation.

Making sense of dementia: Exploring the use of the Markers of Assimilation of Problematic Experiences in Dementia scale to understand how couples process a diagnosis of dementia

This qualitative study aimed to see whether the Markers of Assimilation of Problematic Experiences in Dementia (MAPED) scale could be applied to couples. It aimed to explore the interactions between couples and how this affected the levels of assimilation. Semi-structured interviews were conducted with four heterosexual couples. The results suggested that MAPED can be usefully applied to couples. It highlighted the oscillating process which couples undergo as they process a dementia diagnosis. This supports the notion that making sense of a dementia diagnosis is not static, but a fluctuating and ever changing process. The strategies couples employed either facilitated or prevented the expression and integration of the Problematic Voice. The study highlights the importance of supporting couples together during a dementia diagnosis.

“I Felt Like I Was Being Abused All Over Again”: How Survivors of Child Sexual Abuse Make Sense of the Perinatal Period Through Their Narratives

ABSTRACT Sequelae following child sexual abuse pervade the lives of adult survivors, significantly impacting on pregnancy and childbirth. Symptoms of this distress are recognized, but meanings for women are less understood. This research aimed to examine the meaning for women themselves of the impact of child sexual abuse on experiences of pregnancy, childbirth, and the postnatal period. Taking a critical feminist perspective, three open-ended interviews with three survivors enabled women’s narratives of pregnancy and childbirth to be heard, explored the structure of these narratives, including how experiences were connected, and identified key themes and how selves and others were positioned. Women themselves contributed to the analysis of their own narratives. The different struggles of each woman occurred within three domains of experience: identity, embodiment, and parenting. They were underpinned by a fluctuation between empowerment and disempowerment. These findings, although based on detailed analysis of the experiences of only three women, dovetail with, integrate, and extend the existent literature, offering a framework for understanding the complexity of meaning making for women. Further research might develop this. The framework may facilitate clinicians’ understandings of what it is like for some women having children who have experienced child sexual abuse.

What a discursive understanding of interprofessional team meetings might reveal: an exploration of intellectual (learning) disability managers’ performances

ABSTRACT Clinical and academic understandings of interprofessional working are focused mainly on individual factors such as knowledge about different professional roles, and organisational opportunities for interprofessional working (IPW). Less research has examined what happens between people at an interactional level, that is, how interprofessional working is conducted in everyday face-to-face interactions in clinical practice. The current paper proposes a discursive framework for understanding what constitutes IPW in interprofessional meetings at this interactional level. Clinical effectiveness meetings held in intellectual (learning) disability services were used as an example site for IPW. The analysis explored how agenda change points were negotiated, appropriate as agenda change points require collaboration (or agreement) between practitioners to progress to the next point The study found changes in agenda points were accomplished by practitioners conjointly through using discursive strategies including closing questions, and resources such as professional identity and laughter. The agenda provided a frame for the institutional order of the meetings, invoking a trajectory towards timely completion. However, this institutional order was at times subordinated to an ‘order of concern’, which seemed to enable challenges by managers to the meeting Chair and the agenda that demonstrated adherence not only to the procedural nature of the meetings, but also to the needs of service users and the services discussed. We suggest discursive strategies, resources, and both institutional orders, and order of concerns might provide a framework for developing future training and research, that is able to illuminate how IPW might be enacted in face-to-face team meetings.

Discovering Mental Ill Health: ‘Problem-Solving’ in an English Magistrates’ Court

In this chapter, we examine one particular approach to problem-solving in the English criminal justice system. The incorporation of problem-solving into Magistrates’ Courts for low-risk offenders has been called a ‘window of opportunity’ (Donoghue, 2014) insofar as it provides an opportunity to engage with ‘hard-to-reach’ social groups. It aims to identify any problems which are acting as barriers to a better life and signpost the person to services which can help address these problems. One of the aims of the project that we have been conducting on community justice is to examine how problem-solving works as a specific set of practices for those with mental ill health problems.