Psychiatric nurses' clinical decision-making for adults clinically judged to have childhood maltreatment-related attachment difficulties: A qualitative study employing the steps for coding and theorization method.

چکیده اصلی

AIM: To describe how experienced psychiatric nurses notice, interpret, and respond to adult inpatients whom they clinically judge to have childhood maltreatment-related attachment difficulties and to clarify the practical reasoning underlying these judgments. METHODS: Eleven experienced psychiatric nurses from two private psychiatric hospitals in Japan were purposively sampled. Participant observation and semi-structured interviews focused on care of adults clinically understood to have childhood maltreatment-related attachment difficulties. Case identification relied on nurses' clinical judgment and routine team discussions or record information; no standardized attachment assessment or independent verification of childhood maltreatment history was used. Data were analyzed using the steps for coding and theorization (SCAT) method. RESULTS: SCAT generated 54 themes or concepts organized into 10 categories and 24 subcategories. Nurses noticed recurrent relational patterns, including distrust, checking behavior, dependency-aggression cycles, misinterpretation of staff intentions, self-harm, and distress around proximity, and adjusted their responses to stabilize the patient-nurse dyad, avoid re-traumatization, support emotional expression, and coordinate team care. Only a limited subset of subcategories was attachment-specific; many others reflected broader psychiatric nursing practices applied through an attachment-informed lens. A trauma-focused noticing process was visible in nurses' attention to nonverbal cues and early behavioral change. CONCLUSIONS: The findings describe situated clinical reasoning rather than a new diagnostic technique or intervention model. Experienced psychiatric nurses adapted everyday psychiatric nursing practices to relational patterns they understood as childhood maltreatment-related and attachment-relevant. The model may inform education, supervision, and future patient-inclusive research.

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