The importance of ambivalence: caring for people with learning disabilities who engage in self injurious behaviour.

This work addresses the question of how nurses care, on a daily basis for people with learning disabilities who engage in self injurious behaviour. It suggests that the nature of the emotional component of the care work undertaken differs from that which the mainstream literature presents. This difference, it is proposed, lies in the necessary length of the relationship between these carers and their clients and in the intractability of the behaviour - self injury - which forms the focus of nursing care. The work explores the frameworks which have been used in caring for and "treating' those with self injurious behaviour in the past and suggests that some of these models resonate through the current care situation. The history of the professional group who constitute the research participants- nurses for people with learning disabilities - also forms a theme in the consideration of where current defence mechanisms may have originated. A grounded theory approach was taken to illuminate the defences which may be in play in this difficult care situation. Carers from two residential health service homes participated in the study, all of whom have continuing contact with people with learning disabilities and self injurious behaviour. The participant group constituted ; nineteen registered nurses for people with learning disabilities; two registered general nurses; and eighteen care assistants. Their ages ranged from nineteen to mid-fifties and their care experience from a few weeks to over twenty years. The data from the first round of unstructured interviews, which asked the question, "How do you feel about your work with people who self injure?" was analysed to form the themes for a second, semi - structured round of interviews. The transcribed data was analysed by means of coding, constant comparison and memoing, which enabled the emergence of central categories. These were organised into: emotional reactions; behaviour; and belief systems. The analysed data was referred back to the participants following data analysis and after data interpretation for verification.The interpretation of the analysed data flowed from both the epistemological stance of the researcher and the methods adopted. The work proposes that nurses continue to care for their clients by holding together and holding apart conflicting feelings and beliefs about their clients and their work. This is undertaken in the context of the concept of themselves as carers which they receive from the care environment which includes the professional and historical issues above. The tension which is inherent in this situation is formed by the ambivalence carers feel about their work, their clients and their role and these processes together constitute the process by which nurses continue to care for this needy client group