Reflections on the philosophy of caring in mental health

The remarkable (Disappearing Act of the) mental health nurse psychotherapist

The aim of this Australian based qualitative study was to better understand key drivers for mental health nurses to undertake training in psychotherapy, and how these capabilities are integrated into their clinical practice. Open ended reposes from a national survey of 153 mental health nurses were supplemented with data from 12 semi-structured interviews of nurses with rich experience of integrating psychotherapy and mental health nursing capabilities. Key findings emerging from the thematic analysis were that mental health nurses are providing uniquely holistic psychotherapeutic services to consumers with often complex conditions, despite overtly hostile clinical and policy contexts. These often very well qualified mental health nurse psychotherapists are different to the traditional identity of either a nurse or psychotherapist. Recommendations from the findings of this study are that where appropriately qualified, mental health nurses be granted eligible provider status for existing Medicare funding items. Finally, training and building foundational capabilities in psychotherapy is highly recommended for all mental health nurses.

Seeking and defining the 'special' in specialist mental health nursing: A theoretical construct

In the context of an enduring debate about the distinct identity of mental health nursing, this qualitative study explored the nature, scope and consequences of mental health nursing practice. Data for interpretation were generated through interviews with 36 mental health nurses, five of their clients and one health care colleague, each of whom were asked to speak in as much detail as possible about what they believe is special about mental health nursing and what had influenced them to arrive at this understanding. Using a constructivist grounded theory approach, the study generated a substantive theory of recovery-focused mental health nursing expressed as 'Being in the here and now, side by side, co-constructing care'. The study revealed that the distinct nature and identity of mental health nursing provides the foundation that primes and drives practice scope and consequences. Conceptual interpretations of the data emphasized the mental health nursing perspective of care as an acquired lens founded in nursing as a profession and enhanced by the relational interplay between the nurse and the client that facilitates the nurse to adopt recovery-focused practices. This theoretical construct holds the potential to be the mediating connection between client and mental health nurse. By situating mental health nursing and its central role in practice as something co-constructed, findings from this study can be expanded beyond the Australian context, particularly in terms of mental health nursing's distinct professional identity and practice.

Efficacy of Bowen Theory on Marital Conflict in the Family Nursing Practice: A Randomized Controlled Trial

Family plays an important role in health and illness, and preparing the nurses to assess and improve the family functioning and relationship based on a theoretical framework is of critical importance. This randomized controlled trial was performed to evaluate the effectiveness of Bowen system theory on marital conflict in the family nursing practice. A total of 42 couples referring to the family court of Shiraz, Iran were randomly assigned to either the intervention (receiving eight 90-minute sessions of Bowen systemic family therapy) or the control group (receiving no interventions). Outcomes were measured before, after and after one month of the follow up by marital conflict questionnaire and analyzed using repeated measure ANOVAs and t-test. The study results revealed no statistically significant differences between the study groups regarding the total marital conflict scores (t = 2.8, p = .935) or any of the seven subscales of conflict before the intervention (p > .05). However, a significant difference was observed between the two groups in this regard immediately and one month after the intervention (p < .05). The results demonstrated a significant difference between the intervention and control groups regarding the conflict scores and its subscales during the three study periods and groups (F = 79.43, p < .001). This study highlighted the importance of applying Bowen systemic family therapy by nurses in decreasing marital conflicts. Similar studies with larger sample sizes and longer follow-ups are recommended to be conducted on the issue.

Mental health nursing and the politics of recovery: a global reflection

The concept of recovery increasingly dominates mental health policy and practice agendas in most Western countries. However, the many, often conflicting, definitions of recovery have led to theoretical and practical confusion. More importantly, the concept clashes with some of the established assumptions of psychiatric/mental health nursing, especially the traditional notion that the person is "ill" and requires "treatment" or some other active "intervention." The implications of recovery for the further development of person-centered care, especially within a globalized form of mental health nursing, are discussed with specific reference to the Tidal Model, an international midrange theory of mental health nursing.

Myth of mental health nursing and the challenge of recovery

Although the concept of 'mental health nursing' has grown in popularity over the past 35 years, it remains a myth. People believe that they know what it is and value it highly, but cannot describe or define it other than in vague terms. This paper briefly charts the rise of 'mental health nursing', emphasizing its political implications, and in particular, the drive towards an embrace of a person-centred, recovery-focused approach to care. If nurses are to realize such ambitions, they must resolve their historical association with psychiatric nursing. The concept of the 'mental health nurse' might signal the emergence of a new vision for human services, but might also signal the need for 'mental health nurses' to negotiate a formal separation from the traditional 'psychiatric' family.

Mental health recovery competencies for mental health workers: a Delphi study

BACKGROUND

Mental health recovery is a concept that is now widely promoted. Lengthy sets of competency statements have been published to assist mental health workers become more recovery orientated in their work. However, there continues to be a lack of clarity around what constitutes recovery focused practice or which competencies are most helpful to assist people towards recovery.

AIMS

To identify the most important or valued mental health worker competencies/practices that are supportive of mental health recovery.

METHOD

Experts by experience participated in an online Delphi survey to rate the importance of recovery competency statements, to reach consensus on the most important competencies and provide examples of specific practices that demonstrate competent practice.

RESULTS

The top rated competencies emphasized mental health workers listening to and respecting the person's view points, conveying a belief that recovery is possible and recognizing, respecting and promoting the person's resources and capacity for recovery.

CONCLUSIONS

These results serve to clarify some boundaries around recovery-focused practices and demark these from other examples of good mental health practice.

The tidal model of mental health recovery and reclamation: application in acute care settings

The development, over the last decade, of the Tidal Model of Mental Health Recovery and Reclamation is described, and a summary of the application of the various Tidal processes of care is provided. Studies of evaluations of the Tidal Model within acute care settings are summarised and the potential contribution that the model makes to the development of person-centred care, within acute settings, is discussed.

Perceptions on the standardization of psychiatric work: development of a care pathway

Policy development and practice for hospital care has shifted towards a more deterministic approach. Crucial within this development is the assumption that interventions can be standardized to fit within the confines of a practice framework. A system to deliver standardized approaches to care is a care pathway. A research study was carried out to determine how care could be standardized to fit within a care pathway for people diagnosed with schizophrenia. A range of interviews with the multidisciplinary team and observations of the working group process was the data collection technique. Analysis was driven by emergent themes across the data set. Clinicians expressed divergent views on the nature of standardized care for people with schizophrenia. Respondents also offered a deeper understanding of standardized care by arguing for a sense of flexibility to be built into care systems. Findings from this study have implications for the introduction of NICE core standards for people with schizophrenia. For example, clinicians may be so opposed to such structures as to work against them. By understanding different views on standardized care, it may ultimately support their introduction into practice.

The Tidal Model: psychiatric colonization, recovery and the paradigm shift in mental health care

Psychiatric research and practice involves the colonization of the personal experience of problems of human living. From a Western perspective, this process shares many similarities with the subjugation of women, people of colour and people embracing non-Christian faiths and cultures. The Tidal Model is a mental health recovery and reclamation model, developed to provide the framework for discrete alternatives to the colonizing approach of mainstream psychiatric practice. The Model asserts the intrinsic value of personal experience and the centrality of narrative in the development of contextually bound, personally appropriate, mental health care. This paper summarizes the features of the Model, which attempt to address the foci of the more significant critiques of psychiatric practice (and psychiatric nursing), against a background sketch of psychiatric colonization.

Nurse-patient relationship: a dichotomy of expectations

The nurse-patient relationship has traditionally been viewed as the essence of nursing practice. This paper disputes that the ideals of such a relationship occur effortlessly in nursing practice. Findings from a phenomenological study of individuals hospitalized with a depressive illness found that a therapeutic relationship did not come instinctively to the mental health nurses, and that there was a dichotomy between the close relationship expected by patients and the distant relationship provided by nurses. It is unclear whether nurses' distancing behaviour was as a result of the participant's depressive illness, a normal part of nursing practice, or whether other features such as nurses' workloads were an influencing factor. Further research is required to explore this issue.

Hospital care pathways for patients with schizophrenia

Greater emphasis is being placed on reducing clinical variation in managing patient groups in the reformed National Health Service (NHS) in the United Kingdom (UK). The use of a care pathway to enable greater control over the process and quality of care will be explored for patients suffering from schizophrenia. The paper addresses three main factors for the development of care pathways for people suffering from schizophrenia: predictability of the illness; nature of standardized care; and role autonomy. It is argued that the diagnosis of schizophrenia does not lend itself easily to predicting care and treatment within a care pathway framework. However, a care pathway may bring other benefits, such as standardized care and a greater control over the delivery of care. Development and implementation of hospital care pathways require extensiv research. Qualitative research directions are advocated due to the possib difficulties of conducting an experimental study.

Expertise in Caring: A Source of Power

1. Caring generates power in relationships with patients and helps them to evolve. 2. Caring is more than an emotional response. It is acting in ways that demonstrate that people, relationships, and issues are important. 3. Continuity of care providers across settings help yield positive outcomes for patients.

Issues for the development of care pathways in mental health services

AIMS

This paper seeks to discuss some of the issues for the development of care pathways for inpatients with schizophrenia.

BACKGROUND

Managed care pathways are becoming increasingly popular for general adult conditions. Little is known about the development or application of care pathways for mental health services, and in particular, for inpatients diagnosed with schizophrenia.

METHODS

Action research principles were adopted to engage and develop support to examine care pathways. Participant observation and unstructured interviews were the primary methods used during this phase of the research. The paper draws on the experiences of one of the authors (AJ) and his attempt to discuss the potential development of a care pathway for in-patients with schizophrenia in one inner city locality in London.

FINDINGS

Four central issues were identified by the group; individualized care versus standardized care, generic practice and generic education.

CONCLUSIONS

The development and application of care pathways for mental health services requires the consent and commitment from the work force. Many crucial barriers to development arose during the discussion groups and these will require further attention by prospective organizations wishing to apply care pathways to complex diagnostic groups such as schizophrenia.

Sexuality, sexual abuse. Omissions in admissions?

The main focus of this paper is to highlight the evidence relating long-term effects of childhood sexual abuse to presenting complaints on acute admission wards and to explore how sexuality, as an aspect of nursing concern, is broached by mental health nurses. There are few nursing articles on sexual abuse issues which are research-based, this literature has to be drawn from a wider field. Several authors recognize this paucity highlighting the need for future research in this area. The evidence from the literature review (1985-1995) makes it clear that the environment, the perceived interpersonal skills of the nurse and a general lack of definition of the nurse's role has a large influence on whether or not these issues are addressed. Following discussion about these findings, recommendations are made for inclusion of teaching on sexuality and sexual abuse, interpersonal skills training and illumination of assessment practice, with space for personal growth and development, in pre- and post-registration nurse education. This theme is developed further by considering how these recommendations could be introduced on acute admission wards.

Reinstating the person in the professional: reflections on empathy and aesthetic experience

Although the literature seems to suggest that the caring professions have embraced a view of the 'whole' person, there are some important weaknesses in current models and practices. Nurses, as people, are often left out of the care equation. To offer creative and rounded care, nurses need to accept all aspects of both their own personalities and those of their clients. This exploratory paper argues that aesthetics and the arts are influential forces in all our lives, however, despite this, they are rarely discussed explicitly in the nursing literature. The value of aesthetics and the arts to the nursing profession is introduced and explored through reflections on the concept of empathy.

Patients' perceptions of the quality of psychiatric nursing care: findings from a small-scale descriptive study

This study tested a development of the Critical Incident Technique (CIT) (Flanagan, 1954) in a field-study to gather incidents of high- and low-quality nursing care as perceived by 24 patients with mental-health problems in two admission wards of a psychiatric hospital. The development of the CIT used took the form of an interactive, guided interview, developed previously for the same purpose with other groups of patients and their nurses and is discussed in detail elsewhere. This paper describes the results of the study which throws light on patients' perceptions of high- and low-quality nursing care in an acute-care setting. Qualitative analysis of the interviews revealed 239 indicators of high- and low-quality psychiatric nursing care which were grouped into six main categories. Patients' responses indicated the importance attached to the therapeutic functions of the psychiatric nurse, in particular the value placed by patients on nurses being active listeners. Aspects of practice most often identified as of poor quality included nurses' failure to explain their actions, the negative impact of nurses' group behaviour on ward atmosphere, their inadequate knowledge base and the negative consequences of inadequate staffing. The CIT fulfilled its potential as an interactive method of eliciting the views of this patient group of the quality of nursing care.

Notes on narrative knowledge in psychiatric nursing

This paper reports briefly on one part of an empirical study of nurses' accounts of conversations with patients diagnosed as 'neurotic' and addresses issues related to narrative knowledge in psychiatric nursing. A rationale for analysing psychiatric nurses' narratives of practice is presented, and one framework for doing so is outlined. The form and grammar of nurses' narratives are sketched, and limitations of the present analysis are discussed. While the paper is based on research on practice in psychiatric hospital admission wards, the argument presented is relevant to psychiatric nursing practice generally.

A Critique: WATSON'S CARING IDEOLOGY: The Proper Focus of Psychiatric Nursing?

1. Watson's (1989) conceptualization of care possesses limited clinical utility in psychosocial contexts, given that there already exists an extensive lineage of human concepts of helping, within various psychotherapeutic traditions. 2. Watson's (1989) use of language delimits any utility that the "caring" construct might possess, Watson's conceptualization of caring is an inappropriate focus for psychiatric nursing, and historical precedents exist for many of the propositions upon which the science of caring is based. 3. Four decades of psychiatric nursing practice research and education render Watson's notion of a "science of caring" redundant.