Responding to self-harm in borderline personality disorder : from clinician frustration to therapeutic enquiry

Pessimistic attitudes and reactive behavioural management strategies act as a major barrier to effective service provision for patients with borderline personality disorder. This paper reviews research on countertransference reactions (negative professional attitudes) towards these patients and the professional response to the common presentation of self harm in this particular client group. The psychotherapeutic treatment of patients with borderline personality disorder is complex and both professionally and personally demanding. A clinical framework is proposed that enables clinicians to develop a more nuanced and empathic understanding of self harm within the context of personality disorder in order to facilitate enhanced therapeutic engagement with these challenging patients. A clinical case study illustrates the use of this framework and the potential for enhanced therapeutic management in conjunction with the recognition and reduction of clinician indifference and rejection, thus improving patient outcomes. (editor abstract)Pessimistic attitudes and reactive behavioural management strategies act as a major barrier to effective service provision for patients with borderline personality disorder. This paper reviews research on countertransference reactions (negative professional attitudes) towards these patients and the professional response to the common presentation of self harm in this particular client group. The psychotherapeutic treatment of patients with borderline personality disorder is complex and both professionally and personally demanding. A clinical framework is proposed that enables clinicians to develop a more nuanced and empathic understanding of self harm within the context of personality disorder in order to facilitate enhanced therapeutic engagement with these challenging patients. A clinical case study illustrates the use of this framework and the potential for enhanced therapeutic management in conjunction with the recognition and reduction of clinician indifference and rejection, thus improving patient outcomes.

Saving human rights from its friends : a critique of the imaginary justice of Costas Douzinas

Costas Douzinas has argued that human rights arise from a universal but unconscious need for recognition of oneself by others as unique and whole. According to Douzinas, humans' activities and interrelationships are determined by their desires and human rights are a manifestation of those same deep characteristics. Because the basic desires are by their nature incapable of being satisfied, the aspiration for human rights is likewise doomed to frustration. Douzinas' analysis of human nature is derived from a reading of Jacques Lacan's theory of psychoanalysis in which an imaginary and a symbolic realm of experience are defined. Douzinas attempts a synthesis between the Lacanian imaginary and the ethical arguments of Emmanuel Levinas. It will be argued here that the synthesis proposed by Douzinas is itself doomed to failure and that Douzinas' negative approach to human rights and to justice should be rejected in favour of a positive approach.

The need to vent and dissatisfactory self-service technology encounters

Reports of customer dissatisfaction with self-service technologies (SSTs) are becoming increasingly common. The SST context is characterised by customer participation in service production and delivery, independently of service personnel. With no opportunity for humanto- human interaction, feelings of customer irritation and frustration can have a tendency to build-up in dissatisfactory SST encounters. If SSTs do not perform as promised, customers can become angry and frustrated, and do not have the security or reassurance of human service personnel. With this in mind, it is argued that customers’ “need to vent” will be an important predictor of customers’ complaint behaviours (CCBs), i.e., voice, negative word of mouth, negative “word of mouse”, third party action, false loyalty and exit, in dissatisfactory SST encounters. The “need to vent” is defined as the need, when one has a problem, to seek relief by expressing one’s problem / “getting it off one’s chest”. This construct has been subject to little conceptual or empirical scrutiny, and to the researchers’ knowledge, has not been previously operationalised or measured. This paper begins to address this gap by presenting a conceptual model and hypotheses depicting the relationships between the need to vent and CCBs in the context of SSTs.

Integration or collision? : middle managers' concerns for work-life balance

As increased work demands and longer working hours become the reality for many employees, the concept of work-life balance has received increasing attention. This paper presents findings from an exploratory study of Australian middle managers, which investigated the impact of middle managers’ daily organisational experiences on their lives both in and beyond the workplace. We focus on respondents’ concerns for the encroachment of work on their personal lives, both through the advent of new technologies and the introduction of flexibility initiatives in the workplace. The unwelcome effects of frustration, stress and fatigue highlight the need for organisations to gain a better understanding of employees’ experiences related to work-life balance.

Stories seldom told: paediatric nurses` experiences of caring for hospitalized children with special needs and their families.

Stories seldom told: paediatric nurses' experiences of caring for hospitalized children with special needs and their families

Aims of the study. This study explored paediatric nurses' experiences of caring for children with special needs and their families in an acute care setting. The aim of the study was to increase understanding of nurses' experiences of caring for these children and their families. The study was designed to reveal the caring practices embedded within these relationships through exploring nurses' stories.

Study design/methods. Gadamerian hermeneutic phenomenology and feminist research principles were the approaches used to guide the study. Interviews were held with experienced paediatric nurses and interpretation of interview transcripts using a Gadamerian hermeneutic phenomenological approach resulted in the identification of four themes.

Findings. The four themes revealed were: Special Relationships; Multiple Dimensions of Who is Expert; Development of Trust Between Nurses and Families; and Feelings of Frustration and Guilt.

Conclusions. The study emphasized the context-specific nature of relationships between nurses and children and their families. The nurses spoke about the difficulties they encountered in their practice and some of the ways that they dealt with these problems. They discussed the things that they valued and those that made them feel guilty and frustrated. In doing so, they revealed their warmth, strength, humanity and caring.

Press shop machine analysis and trending

Historically downtime data collection and reporting systems in many automotive body panel press shops has been somewhat adhoc. The impetus for this study stems from frustration in respect of how this data is collected, assessed for trends and presented. Ideally this data should be used to identify costly repetitious faults for actioning of maintenance work and for feedback to tool design for consideration when designing new parts.

Presently this data is stored largely in the form of tacit knowledge by press shop operators; the encumbrance of transferring such information being that there is very often only limited channels to quantify it into something more tangible. Findings show that there tend to be two related obstacles to plant data recording. The first is that automation of down time data collection alone cannot determine fault causes as the majority of press shop events are initiated primarily from operator observation. The second is that excessive subjective operator input can often result in confusion and end up taking greater time in recording than remedying the actual fault.

This Paper presents the development of a system that through press mounted touchscreens encourages basic subjective operator input and relates this with basic objective data such as timekeeping. In this way all responses for a given press line become valuable and can be trended and placed in a hierarchy based on their percentage contribution to downtime or statistical importance. This then is capable of statistically alerting maintenance, line flow and/or toolbuild areas as to what issues require their most urgent attention.

A usability instrument for evaluating websites-navigation elements

Many small businesses websites have become an important advertising medium. However little consideration is given to how these websites might be made more effective. Many factors impact on website effectiveness, including navigation. Research here describes a usability instrument developed for evaluating small business websites and uses navigation as an example of its application. The research found that the quality of navigation does have an impact on ease-of-use of a site, user's emotional response and frustration levels and a user's intention to return to that website. The research also established the statistically significant elements that contribute to navigation.

SME myths: if we put up a website customers will come to us-why usability is important

Many businesses use their Websites primarily as an alternative marketing strategy. How a business’s image, via a Website, is presented to potential customers is therefore important. There are many factors that will influence the effectiveness of a Website, two critical factors are how easily users are able to navigate and how easy the site is to use. The research reported here examined these two factors on users’ responses to small and medium-sized business Websites. The research found that the quality of navigation and how easy a site is to use does have an impact, how much information is read, the importance of the graphical components, a user's emotional response to a Website, users’ frustration and the user’s intention to return to that Website. The research established the statistically significant elements that contribute to navigation and ease-of-use, and describes the design and successful application of a usability evaluation instrument.

Reflective thinking : turning a critical incident into a topic for research

Clinical nurses encounter critical incidents every day.  While these may be a source of frustration they also have the potential to be turned into research projects so that problems can be examined and others can learn from them.  This paper describes the reflective process used to generate a research project from a critical incident encountered in the clinical area.

The role of emotions in member renewal and non-renewal : an exploratory study

This paper examines the emotions of lapsed and continuing members of a high involvement, subscription based organisation. In-depth interviews were conducted with 400 renewing and non-renewing members of an Australian Football League Club in order to gain initial insight into the role emotions play in renewal (loyalty) behaviours. The interviews highlighted the complexity of the relationship between emotions and behaviours. There is a range of both positive and negative emotions present in responses of both renewing and non-renewing members. As expected, the negative emotions of disappointment and frustration were present amongst those who did not renew, while there were many positive emotion examples of satisfaction and joy present for those who had renewed. Surprisingly, there were also examples of annoyance, fear, and guilt amongst those that had renewed. These feelings were often linked to the particular member's history and level of family involvement in the Club over many years. In addition, there were positive feelings of hope and loyalty expressed by those respondents that had not renewed. On a positive note for the Club, many still expressed a strong emotional connection to the Club and had not ruled out joining again in the future.

Antecedents and consequences of customer satisfaction with interactive voice response

The aim of this study was to empirically test a model of antecedents and consequences of customers’ satisfaction with interactive voice response (IVR). IVR is a commonplace selfservice technology, yet it has seldom been the focus of academic research. As customers’ frustration with IVR is apparent, understanding how customers evaluate IVR and their subsequent behavioural intentions is important. Findings of a study of Australian Football League members who were users of its IVR system indicated that customer satisfaction resulted when it was easy to use, offered fast service and provided customers with feelings of control. Overall satisfaction with the IVR system was related to customers’ intentions to reuse it and their trust in the AFL. Managerial implications of the findings are discussed.

Syphilis and AIDS : historical and social comparisons

Drawing on the literatures of history, sociology, epidemiology, and microbiology, this thesis compares syphillis with human immunodeficiency virus, with special reference to the social and historical factors likely to be relevant to the control or eradication of acquired imune dificiency syndrom (AIDS). The sudden appearance of a new disease causing suffering and death in a community, engenders apprehension and fear which is often manifested as hysteria against, and vilification of, those who have the disease. This fear is greatly increased should the disease be sexually-transmitted. Syphilis in a venereal form, occured in Europe toward the end of the 15th Century. Initially it was an acute, fulminating disease which rapidly spread through Europe and Asia. Attempts to control the disease have gone through periods of either partial successes or massive failures and have ended in frustration for the authorities. When the syndrome of acquired immune deficiency (AIDS) was first reported, it was seen in Western countries in homosexual men. However, as non-homosexual community members and children became infected, it became apparent to authorities that a pandemic was accurring. Within a few years, the disease was identified worldwide. Isolation of the virus (HIV-1), and development of test for detection of carriers, plus restoration of clean blood and blood-product supplies, have reassured the community to some extent. The history of syphilis shows that neither the epidemiological medical, nor the economic political approaches to disease control work, although there are positive aspects resulting from both. It is social responses that will offer the most hope in the long term for the control of AIDS and other sexually-transmitted diseases.

Living with cancer : an ethnographic study of Thai cancer patients

This thesis is an ethnographic investigation aimed at describing the lived experiences of Thai cancer patients residing in Cancer Hostel, a shelter provided for the needy whilst undergoing radiation treatment at Siam Hospital. All names, including the hospital, the shelter, and all respondents have been altered to preserve anonymity. The practice of withholding the true diagnosis from Thai patients meant that very little was known about their own feelings on cancer and its treatment. That, coupled with entrenched medical practice beliefs, presented an unusual challenge, for which an ethnographic research method was advocated as being most appropriate in helping toward a better understanding of the problem and resolving the existing dilemma. To understand the real experiences of Thai cancer patients, it was extremely important that the researcher get as near as possible to becoming one of them. Therefore, by physically 'being with’, establishing rapport, and gaining patients trust, the researcher was assured of acceptance as an insider, and was thus allowed to share the experiences of their life encounters. Research findings graphically illustrated the flaws in the practice of protecting patients from their diagnosis, who almost universally, wanted to know more about their diagnosis in order to seek help from the medical care system. Towards this, patients created meaning by linking folk beliefs, culturally inherited knowledge and a common sense, albeit naive approach in trying to make sense of their illness and treatment. Although patients saw cancer illness and its treatment, especially radiotherapy, as life threatening, it was the fear of radiation treatment, not cancer illness which turned patients away from medical treatment. As well, uncertainty, fear and frustration through the lack of information and involvement in their treatment saw patients employ strategies of both reciprocal and fatalistic acceptance; stoic resistance; and thinking positively in their efforts at coping with those life threatening situations.

Perceptions of stress among people with an intellectual disability

A new stress scale was devised based on issues raised by people with an intellectual disability and entitled the Lifestress Inventory. The Inventory was used in a number of studies in order to assess the impact of daily hassles and life events on their perceived stress levels and quality of life. Data suggests that they experience general worries, negative interpersonal relations with others, and frustration with their restricted coping skills as their principal areas of stress.

Motivations for seeking treatment for ED: the woman's perspective

There is increasing evidence that partners have a major role in treatment-seeking behavior for men with ED. This study investigated the motivations of 100 females for seeking medical treatment for their partner's ED. Semi-structured interviews focused on reasons for seeking treatment from the female's perspective. The themes that emerged from the data centered on the importance of sex in the relationship, with closeness and intimacy frequently being seen as more important than sex. The second major theme related to hopes that females had in relation to the medication, particularly in relation to increasing their partner's confidence and reducing his sexual frustration. Enhancement of the relationship as well as improving the female's own feelings of self-doubt and sexual frustration were also mentioned. The results of this study show the multi-faceted nature of the motivations that females express in terms of seeking help for their partner's ED.