Eleanor Yurkovich

A Literature Review of Deliberate Self‐Harm

PURPOSE Despite agreement across disciplines regarding the significance of deliberate self-harm (DSH), there continues to be a lack of consensus regarding what DSH is and is not. The purpose of this literature review was to determine the current state of understanding of this complex phenomenon. CONCLUSIONS There remains a problem of definitional ambiguity regarding DSH, and a definition derived from the literature is offered. Using Rodgers framework for the evolutionary approach to concept analysis, the attributes, antecedents, and consequences of DSH are developed. PRACTICE IMPLICATIONS Therapeutic approaches that are based on open-minded, non-judgmental listening and on harm minimization rather than abstinence may be more effective than current treatment approaches that forbid any form of DSH.

Defining health and unhealthiness: Perceptions held by Native American Indians with persistent mental illness1

Discrepancies in definitions of health exist. These discrepancies, if not acknowledged, create major communication gaps between health-care professionals and their clients, which interferes with the provision of culturally responsive care. The purpose of this study was to understand how Native American Indians experiencing persistent mental illness (PMI) define/describe being healthy and being unhealthy. Grounded theory design was used in conducting data gathering (semistructured interviews) and analysis (constant comparative) because the study focuses on generating social/psychological phenomena or process. Forty-four audiotaped interviews were conducted and transcribed. Symbolic interactionism is this studys framework. During data analysis, health emerged as being in balance/equilibrium, having a sense of harmony, and not being out of control of spiritual, cognitive, emotional, and physical domains. Furthermore, as this study reflects, the modified Circle of Wellness model emerges as a better fit for Native American Indians with PMI than the traditional Medicine Wheel because it more effectively presents the social nature/needs and the centrality of spiritualism of this population. Clearly, deficits in healthy social environments and relationships affect the ability of a Native American Indian with PMI to maintain health. To provide culturally competent care, professionals and native healers need to work the integration of spirituality into treatment processes, and advocate the creation and maintenance of healthy environments for improved social opportunities. 1The opinions expressed in this manuscript are those of the authors and do not necessarily reflect the views of Indian Health Services. The following presentation was reviewed and approved by four Tribal Councils and five Service Unit Directors in either a passive understood agreement manner or by a signature of agreement.

A grounded theory exploration of deliberate self‐harm in incarcerated women

Abstract The purpose of this study was to explicate a definition of deliberate self‐harm (DSH) and present a model that illustrates the DSH process as experienced by incarcerated women. Grounded theory was used to guide the collection and analysis of data. A circular process of DSH emerged. For the incarcerated women in this study anxiety caused a visceral build‐up of tension that reached a critical level necessitating a need to act in some way to gain relief. DSH supplied the mechanism by which overwhelming tension was released. The temporary relief, however, was soon supplanted by the negative consequences of disciplinary detention imposed as a means of punishment that in turn, lead to more anxiety and anger. Implications: Nurses practicing in corrections need to work towards “decriminalizing” DSH and to develop a prison protocol that gives nurses permission to “just listen” and incarcerated women permission to “just talk” without fear of reprisal.

“Chaotic soup of politics:” a Native American Indian mental health perspective

Through a grounded theory process, tribal politics emerged as a core theme from interviews with mental health providers (MHPs) and Native American Indian people experiencing persistent mental illness (PMI). Interviews were conducted over a four-year period with 13 Indian MHPs and administrators, and 18 persons experiencing PMI. Symbolic Interactionism was the informing framework. Findings indicate that reservation life promotes a high immersion in Eurocentric politics, which negatively affects the person with PMI in their maintenance of a healthy spirit balance. To be effective, MHPs need immersion in; the oneness of culture, spirituality, and politics of the community; knowledge of the tribal history; and communication with elders/spiritual leaders. This personal growth could facilitate provision of culturally responsive care needed for a clients navigation of intergovernmental regulations. MHPs should work for adequate funding policies of human service centers while supporting the establishment of indigenous governing practices through tribal sovereignty.

“Close-Knit” Defines a Healthy Native American Indian Family:

In the United States, the most significant health disparities occur among members of the American Indian and Alaskan Native populations. Because their health beliefs, values, and cultural practices are learned within a family system, this study used a focused ethnography to explore American Indians’ perceptions of a healthy family. Seventeen interviews were performed with 21 adults residing on a reservation on the Northern Plains of the United States. Participant observation was conducted during 100 hr of fieldwork. All informants identified a healthy family as being “close-knit,” indicating that the major defining feature of these families is the degree of connectedness among members, immediate and extended. In this paper, we present adult tribal members’ descriptions of a healthy family. It is evident that culturally appropriate programs, which consider American Indians’ values/beliefs and build on community assets, are urgently needed to reduce health disparities.

Health-seeking behaviors of Native American Indians with persistent mental illness: completing the circle.

Nationally, disparity exists in the delivery of mental health services to minority groups, and an imperative exists that expects culturally responsive care. The purpose of this grounded theory study was to discover health-seeking practices used by Native American Indians (NAIs) with persistent mental illness (PMI). Eighteen interviews were examined using constant comparative analysis. Health-seeking practices emerged as two central categories: health engagement strategy and avoidant strategy. This research assists mental health caregivers in approaching the NAI with PMI in a culturally responsive manner by providing a NAIs perception of health and knowledge of their health-seeking behaviors/practices.

Satisfaction with and benefits of a psych-social club: development of a mixed method evaluation instrument.

There are no instruments for validation or evaluation of a members satisfaction of and benefits with psych-social clubs. This article reports on the development and testing of the mixed-method instrument entitled Benefits and Satisfaction Tool for Members of a Psych-social Club (B&ST-MPC), which evolved from findings of a qualitative research study. The alpha reliability coefficient was .92. The Kaiser-Meyer-Olkin Test yielded a value of .812. The items loaded on 3 factors. Utilization of B&ST-MPC supports development of services for rural communities through feedback from consumers. Further testing of the B&ST-MPC in settings with diverse populations is recommended.

Work Re-Entry of RNs After Substance Use Disorder Treatment A Grounded Theory Study

An estimated 10% of the 2.6 million registered nurses (RN) in the United States may meet diagnostic criteria for a substance use disorder (SUD), negatively impacting patient safety as well as the health and career of the nurse. There is a paucity of studies that explore workplace re-entry of this population. This study fills that gap by studying the topic from the personal experience of the nurse. The purpose of this qualitative, grounded theory study was to explicate a theoretical model describing the basic social processes operating when a RN reenters the workplace following completion of SUD treatment. Research questions were as follows: (a) What helped the RN re-enter the workplace after completion of SUD treatment? (b) What acted as barriers to the RN’s re-entry to the workplace after completion of SUD treatment? The theoretical frameworks of symbolic interactionism and pragmatism guided the study with the premise that people find meaning and experience change as a result of interactions with others in the environment. Semi-structured face-to-face or telephone interviews were used with a purposive sample of 22 participants from different regions of the United States who had re-entered the nursing practice workplace after SUD treatment. “Self-redefinition” emerged as the core variable of the theoretical model for successful work re-entry. It was characterized by acceptance and internalization of self as a person and a nurse with SUD. Recovery support, healthy self-care, compliance with regulatory mandates, and honesty about SUD status contributed to work re-entry success. Strong professional nursing identity also helped sustain participants through regulatory monitoring and job searches after SUD treatment. Conclusions reached were that nurses who return to work successfully do so with supportive strategies in place related to self-care and recovery. Stigma and deficits in knowledge and education about SUDs amplify the complexities for RNs who re-enter work after SUD treatment. Study results have implications for changes to nursing regulation, policy, and education, and suggest that additional research is needed about this topic.