title: Never good enough--part 2: Clinical implications.
abstract: This paper is the second part of two papers that explore the affect of shame and its role in the manifestation of symptoms that could be regarded as evidence of mental disorder. The clinical implications for nursing a person with an overwhelming shame response are discussed in this paper. It is proposed that a discursive approach to nursing care may assist mental health nurses to provide care that best meets the needs of people experiencing these symptoms. The paper suggests that this nursing care involves recognizing the impact of shame; making connections between how the person has learned to cope with shame and their current mental distress; situating shame in its socio-cultural context; focusing on subject-object differentiation and promoting acceptance of difference and exploring alternative subject positions for managing feelings of shame. The focus of these interventions is to encourage awareness of interactions with others, how the person positions her or his self in relation to others, and the communication patterns that perpetuate feelings of shame. It also involves helping the person to integrate the ideal image of her or his self with subject positions that are more flexible.
authors.affiliation: Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand. marie.crowe@chmeds.ac.nz
authors.forename: M
authors.initials: M
authors.lastname: Crowe
mesh_terms: D001883:Borderline Personality Disorder / Q000451:nursing / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009730:Nursing Assessment / Q000592:standards; D010342:Patient Acceptance of Health Care; D011568:Psychiatric Nursing / Q000592:standards; D011785:Quality Assurance, Health Care; D012649:Self Concept; D012752:Shame; D006113:United Kingdom