Mental health nurses' perceptions of the construct of attachment style in a medium secure hospital: a thematic analysis

Abstract

BACKGROUND - Attachment theory can be regarded as central to the concept of relational security. There is a paucity of research examining the coherence of this construct for ward-based staff. METHOD & PARTICIPANTS - Five female nurses from the acute admission and assessment ward of a UK medium secure unit acted as participants. Semi-structured interviews were conducted, and inductive thematic analysis was applied. RESULTS - Six themes; ‘staff-service user relationships’, ‘staff diversities’, ‘service user backgrounds’, ‘variability in service users’ presentations’, ‘service users with personality disorder are problematic’, and ‘nurses do not use attachment’ emerged from the data. The nurses used heuristic models of attachment related behaviour and they lacked knowledge of constructs associated with Attachment Theory. RESEARCH LIMITATIONS/IMPLICATIONS - Acute admissions may not be represetnative of all treatment contexts. Traditional models of attachment style may have only limitted relevance in forensic services. CONCLUSIONS – Limited knowledge and confidence in the nurses regarding how Attachment Theory might apply to service users is interesting because it may limit the extent to which care, treatment and risk management might be informed by an understanding of service user representations of therapeutic relationships. Training and educational interventions for nurses that enhance understanding of personality development and attachment styles are warranted.