An examination of the attitudes of Accident & Emergency clinicians toward children who deliberately self-harm
Recent years have seen an increase in self-harm behaviours amongst children and young people. In tandem, the amount of research on the phenomenon has also grown. However, despite the evident importance of care staff attitudes in the treatment of those who self-harm, an examination of the literature indicated a limited number of studies on how clinicians view such behaviour in the young. The aim of this thesis was to examine the attitudes of health care staff toward child self-harm. Within the study, it is argued that factors pertaining to both patients (age, gender and rate of admission) and care staff (role and clinical experience), will influence how an incidence of child self-harm is viewed. To answer the question, both quantitative and qualitative methods were employed. Within the former, a questionnaire was developed that contained hypothetical case vignettes of child self-harm. Once constructed, the instrument was distributed to the care staff of four Accident and Emergency departments, each of which treated self-harming children. Examination of the completed questionnaires (n = 152), showed significant differences in both staff and patient variables, confirming that attitudes toward child self-harm should not be viewed as a single entity but rather as constituent parts of a whole phenomena, each worthy of examination in its own right. In order to explore these issues in more detail, a series of focus groups were undertaken amongst care staff. Use was made of a Foucauldian discourse analysis framework devised by Kendall and Wickham (1999). This revealed intrinsic differences in the way clinicians view self-harm in children and the constituent parts therein. Comparison of both experienced and inexperienced nurses and physicians produceda raft of reasonsw hy child self-harm elicited responsesp articular to each group, ranging from personal experiences to the use of medical jargon. In conclusion, this thesis has explored a particular aspect of the self-harm spectrum, touching on topics that appear to have been neglected by the literature. The dissemination of its results to a wider audience, it is hoped, will generate debate aroundt his sensitiveto pic andt husi ncreasea n understandinogf the needso f those clinicians who deal with such vulnerable patients.