The meaning of caring as described by nurses caring for a person who acts provokingly: an interview study

Abstract

Nurses working with people with learning disabilities are sometimes exposed to provoking behaviour such as unpredictable and violent actions, spitting and sexual harassment. Eight nurses at a group dwelling in Sweden were interviewed about their experiences when caring for a person who acts provokingly. Narrative interviews were conducted and interpreted using a method inspired by Ricoeur. Three themes were formulated which describe nurses' feelings of being tormented, disrupted and helpless. Nurses describe themselves as being deeply humiliated by physical violence, spittle, sexual invective and actions on the part of the patient. They respond more to being spat on and the sexual invective than to the patient's physical violence. The frequent humiliations could be seen as a symbolic language connected to defilement and 'evil' and therefore as having a deep symbolic meaning for the nurses. These results were interpreted and reflected on in the light of a theoretical framework from an affliction perspective in order to achieve a deeper understanding of the text. This paper shows that an affliction perspective is important when searching for the meaning of caring for a patient who acts provokingly. The study indicates that the goal in a provoking care situation must be to see the provoking patient, as he appears to the nurses in order to glimpse the goodness concealed behind the provoking facade.

Challenging behaviour in the elderly—monitoring violent incidents

“…Being spat at is not by itself inherently dangerous. The fact that this behaviour receives such a high severity score may reflect the humiliation felt by the staff being subjected to this kind of behaviour, as suggested by Hellzen et al (2004). This should certainly be taken into account both for training of staff as well as for debriefing procedures.…”

“…We were surprised to find that spitting, which occurred in 15.6% of the cases, received the second highest severity score, and was rated as more severe than being kicked or hit. In a recent study of nurses working with people with learning disabilities, Hellzen et al (2004) found that nurses responded more to being spat on than to the patient's physical violence. Being spat at is not by itself inherently dangerous.…”

Contradictions between Ideals and Reality: Swedish Registered Nurses’ Experiences of Dialogues with Inpatients in Psychiatric Care

“…They also saw that a silenced conscience, for example, in carers and nurses neglecting their own perceptions of good care to carry out the work, is strongly related to burnout. Hellzén et al (2004) point out the need to support carers to help prevent them from having feelings of insufficiency and a loss of control.…”

“…Such distance led to feelings of guilt and incompetence for the nurse. In Hellzén, Asplund, Sandman, and Norberg (2004), carers of a very disorderly patient, described feelings of being tortured, helpless, and aggravated. With a lack of support comes a feeling of insufficiency that may lead to a loss of control.…”

Staff's Collaborative Work Process with an Adolescent Boy with Autism and Intellectual Disability in Community-based Sheltered Housing

“…Caring for individuals with autism spectrum disorders (ASD) is an even more demanding task because of those individuals' social deficits and communicative difficulties (Bryson 1996) such as stereotypes, violence and self-injurious behaviour (Peters & Gillberg 1999), as well as hyperactivity and changes in state of mood (Schopler & Mesibov 1984). Provocative care situations involving behaviour such as unpredictable and violent actions frequently occur and are also demanding for the caregivers because the meaning of the behaviour is often unclear and sometimes impossible to understand (Hellzen, Asplund, Sandman & Norberg, 2004). Hellzen and Asplund (2002) stated that staff caring for a person with a severe autism spectrum disorder described themselves as being in a chaotic world because they perceived their work situation as fragmented and isolated.…”