Patient initiatives during the assessment and planning of psychiatric nursing in a hospital environment

The implications of Kristeva's notion of the abject in understanding the significance of therapeutic knowledge and practice in mental health nursing

Mental health nursing knowledge is largely excluded in certain key clinical guideline groups despite nursing practice being so important to service users. This exclusion may be because mental health nurses work close to what cannot be spoken of easily, or at all--the abject. Good mental health nursing practice depends on the individual person of the mental health nurse rather than any knowledge frameworks. Education should focus on relational aspects of practice to develop this and to define the core identity of mental health nursing as a therapy. This paper discusses therapeutic knowledge and practice in mental health nursing through Kristeva's notion of the abject as that which is the other side of language, closely linked to the feminine space of the chora. The chora is a provisional, stable space, associated with the mother's body, where the first possibility of signification can take place. Mental health nursing is a therapeutic practice that draws on knowledge that is practical, tacit, empirical, embodied and intuitive, as well as knowledge that is regarded here as beyond the tacit; the latter indicating an encounter with the abject. Mental health nursing as a practice potentially places an extraordinary ethical onus on the individual nurse in his/her relations with patients and indicates that it is the person of the nurse who is therapeutic rather than any knowledge framework, with major implications for education and professional identity. The presence of mental health nursing practice at the heart of the mental health care system, while effectively being ignored as a treatment by the National Institute for Health and Care Excellence, embodies a critique of the currently dominant evidence-based paradigm.

Clients' initiatives and caregivers' responses in the organizational dynamics of care delivery

Our aim with this article is to develop a typology for the analysis of client-caregiver encounters in health care. We first observed client-caregiver interactions in the homes of home care clients and during the care processes of surgical patients. We then conducted a data-driven analysis to identify the clients' initiatives and the degree of engagement in the responses they received. The clients shaped their care by commenting on, questioning, ensuring, and enriching their care. The responses from the caregivers consisted of neutral acceptance, disregard, and shared expansive development of the clients' initiatives. The typology developed from these will be a tool to widen our understanding of the complex interactions in care delivery and of the different conceptualizations of care that actors hold. In future studies this typology will help in the analysis of the organizational dynamics of health care delivery.

Patients' rights to complain in Finnish psychiatric care: an overview

Cuts in resources for Finnish psychiatric care may jeopardize the realization of patients' rights in mental health settings. The right to complain is a basic right of all patients in Finland, and is especially important to patients treated involuntarily and also to those who have experienced coercive treatment methods during their hospitalizations. In Finland, a patient's right to complain is guaranteed by law, both in legislation and in national quality recommendations. The complaint process in Finland is very complex, and there are several ways to make a complaint that are not always familiar to patients with severe illnesses. Psychiatric patients may have cognitive impairments that make the formulation of a complaint difficult. Despite help from the patient ombudsman, unbalanced power structures in psychiatric hospitals, insufficient information and long evaluation of appeals makes the complaint process very demanding for psychiatric patients.

A social constructionist analysis of talk in episodes of psychiatric student nurses conversations with clients in community clinics

AIM

This paper is a report of a study of the 'discursive doings' of psychiatric nursing students' practice as they are jointly constructed in conversations with clients in community psychiatric clinics.

BACKGROUND

This construction of psychiatric nursing as a therapeutic, holistic, person-centred, interactional process is central to the identity of psychiatric nursing as a discipline. However, recent studies are beginning to suggest a dissonance between the person-centred rhetoric and institutional practice.

METHODS

A discourse analysis was conducted in 2002-03 using the transcripts of seven conversations between nursing students and clients visiting psychiatric community clinics on a monthly basis. These were selected from a sample of 20 conversations based on their clarity and completeness. Texts were analysed using the notational systems of Silverman and Mishler and some of Fairclough's analytic text structure features.

FINDINGS

In all the transcripts, an agenda for surveillance was explicitly established in the students' opening sequences of each text. Almost all exchanges in the texts were organized around cycles of questions from students and responses from clients, which allowed students to control the conversations. Information delivery was also found to be at work within the texts, although it is not as prominent or as persistent as the question and answer structure. Students took up the responses of clients selectively as though working to a pre-set agenda.

CONCLUSION

These discursive activities manifest a symptom-like approach to nursing care and have the effect of disabling the development of client-authorized expressions of agency.

User involvement in mental health care: the role of nurses. A literature review

This literature review was carried out to examine the effects of user involvement in shared decision-making processes and the methods/tools available to psychiatric nurses to measure and encourage user involvement. A systematic literature review was then used in this study. Many studies indicate that an increased involvement of service users leads to better care, better treatment compliance, improved health outcomes and higher levels of patient satisfaction. The tools and methods described are designed to measure the ability to participate, the process of implementation and the evaluation of healthcare services. An adequate instrument to measure user involvement will be necessary to underpin the positive effects. Although care providers have a statutory duty to help shape user involvement, and the tools required are available, care providers are still insufficiently inclined to take up this duty.

The uses of photography in clinical nursing practice and research: a literature review

AIMS

The aim of this paper is to report a study to identify themes and provide a 'snap-shot' of the scope and uses of photography in clinical nursing practice and research.

BACKGROUND

Despite the dominance of vision as a way of understanding the world in Western societies, the applications of photography in clinical nursing practice and research have not been well synthesized or reported in the literature.

METHODS

A computerized search of CINAHL database was performed using the terms photographs, photography, photographic, photovoice, videorecording and videotaping. Hand searching for additional citations was also undertaken.

FINDINGS

The identified papers on photography were categorized into broad themes that reflected the different applications to which photography had been applied: documentation and surveillance; therapeutic intervention; teaching, learning and evaluating performance; research methods; and descriptive and instructional literature. Approaches to the use of photography, as recorded in the nursing literature, are broad and include: wound surveillance, covert patient surveillance, photo essay, art therapy, self-portraits, life albums, simulated recall, participant observation, photovoice, photo hermeneutics, production of research scenarios, and video modelling.

CONCLUSIONS

The most common applications of photography in nursing and related journals include photo elicitation to promote understanding in research, videorecording as a method of teaching and learning, and as a method of observation, with more creative approaches tending to be employed in health professions other than nursing. Few reports gave explanations of how researchers negotiated ethical concerns when seeking approval for studies in clinical settings, and few gave details of the processes of data analysis.

Observation of nurse-patient interaction in oncology: review of assessment instruments

The aim of this review is to identify assessment instruments that can be used for analyzing sequences and can be applied to research into nurse-patient communication in cancer care. A systematic search of the literature revealed a variety of methods and instruments applicable to studies recording nurse-patient interaction. The studies that were qualitative in nature offered valuable information on observational research in general, on procedures relating to informed consent and observational arrangements in nursing practice. The quantitative studies provided an insight into the content and structure of the interaction by describing communication concepts or by frequency counts of previously determined behaviours. Systematic research into interaction sequences was not found. However, some of the quantitative instruments identified could be adapted for this purpose. The complexity and time-consuming nature of observational research highlight the need for efficiency. For instance a combination of quantitative and qualitative instruments could be considered.

Video-cued narrative reflection: a research approach for articulating tacit, relational, and embodied understandings

The author's purpose in this article is to describe the effectiveness of video-cued narrative reflection as a research approach for accessing relational, practice-based, and lived understandings. Video-cued narrative reflection provides moment-by-moment access to tacit experience. The immediate nature of the videotape captures emotional nuances, embodied perceptions, spatial influences, relational understandings, situational factors, and temporal manifestations. By watching videotaped interactions, participants are able to re-collect, re-experience, and interpret their life world. Video-cued narrative reflection allows participants to be simultaneously engaged and reflective while describing significant understandings. By inserting audiotaped reflective commentary of participants into the original videotape transcript, contextual meanings can be located and articulated more easily. Although not appropriate for all types of research, this approach offers promise for certain studies.

Users' Involvement in Their Care: A Follow-Up Study

1. User involvement in both care planning and staff development helped staff and residents at a community rehabilitation unit in terms of attitudes and care delivery. 2. Undertaking follow-up work shows progress in care management for staff and in social skills development for residents. 3. The results of this study provide clear indications of positive progress and identify a few areas where work still need to be done to improve care.

The Tidal Model

1. The human experience of growth and development is a fluid phenomenon, occurring in small, barely visible changes. 2. The Tidal Model embraces a patient's expression of his or her experience by focusing on the lived experience of the narrative and its personally meaningful metaphors and symbols. 3. To re-empower a patient, the Tidal Model assessment is written in the patient's own voice and all care planning is conducted conjointly. 4. The Tidal Model was developed from empirical studies of the perceived need for nursing and the process of empowerment in clinical nursing practice.

Videotaped recording as a method of participant observation in psychiatric nursing research

This paper describes videotaped recording as a data collection method when conducting participant observation in a psychiatric nursing study. The videotaped episodes were part of the daily life of psychiatric nursing in a hospital environment. The advantages and limitations of using videotaped recording in nursing research will be discussed. This paper is based on two studies. The data consisted of 21 videotaped episodes of nursing report sessions or interdisciplinary team meetings in the psychiatric clinic of a university hospital. The participants consisted of patients, their significant others, nurses, doctors, social workers and physiotherapists. All videotaped material was transcribed verbatim. An essential advantage of videotaping is that most potentially useful interaction and behaviour can be captured. The advantage in terms of the credibility of videotaping was that the investigator was able to review the same videotaped situations again and again. Videotaped material is rich and provides several possibilities for analysing the data. In these studies data and source triangulation enabled the researchers to reduce personal influence on the results. The investigator must also be aware of the limitations concerning this method. The most essential limitations are mechanical problems and the influence of videotaping on behaviour. Careful ethical considerations are important concerning personal privacy, informed consent and respect for the self-determination of psychiatric patients.