A hermeneutic approach to the characteristics of mental health nursing practice

The Process of Home-Visiting Nurses Supporting People with Mental Disorders

The number of people with mental disorders (PMD) living in the community is increasing; however, it is unclear how home-visiting nurses (HVNs) supporting them in the community acquire their support skills. This study aimed to reveal the process of how HVNs learn support skills for PMD. Semi-structured interviews were conducted with 14 HVNs supporting PMD living in the community. The grounded theory approach was used for data analysis. As a result, two stages were present: "Explore the personal recovery of PMD" and "Believe in the potential of PMD and accompanying them". The first stage is further divided into two themes: "Overlapping the worlds of PMD and HVNs", and "Easing difficulty in living for PMD". In the first stage, HVNs gained a better understanding of PMD and obtained insight into the support they needed in their daily lives. In the second stage, HVNs became to provide the support that PMD truly needed. HVNs gained a deeper understanding of the reality of PMD through their support. After HVNs found the support PMD required, they sought to provide it, ultimately resulting in finding ways to facilitate the personal recovery of PMD.

'Meet Me Where I Am': Mental health service users' perspectives on the desirable qualities of a mental health nurse

Nurses play a central role in the delivery of quality mental health services. Desired qualities of a mental health nurse, in particular therapeutic relationships, have been described in the literature, primarily reflecting the nursing paradigm. Service users' perspectives must be more fully understood to reflect contemporary mental health policy and to recognize their position at the centre of mental health service delivery and to directly influence and contribute their perspectives and experiences to mental health nursing education. A qualitative exploratory research project was undertaken to inform and enhance understanding of what service users see as the desired qualities of a mental health nurse. The project was co-produced by service users as experts by experience, and mental health nurse academics to ensure the service user perspective was privileged. This international project conducted in Europe and Australia included a series of focus groups with service users (n = 50). Data were analysed thematically. Being with me was a major theme identified and reflected the sub-themes: respect towards service users as persons; empathy, compassion and effective communication; understanding service users; knowledge of services; and fostering hope and believing that recovery is possible. These qualities specifically reflecting the service user perspective must be central to mental health nursing curricula to facilitate the development of holistic care and recovery-oriented practice. These findings were utilized to directly inform development of a co-produced mental health nursing learning module, to maximize genuine service user involvement, and to fully realize the benefits of service user led education for undergraduate nursing students.

'There's more to a person than what's in front of you': Nursing students' experiences of consumer taught mental health education

Holistic and person-centred nursing care is commonly regarded as fundamental to nursing practice. These approaches are complementary to recovery which is rapidly becoming the preferred mode of practice within mental health. The willingness and ability of nurses to adopt recovery-oriented practice is essential to services realizing recovery goals. Involving consumers (referred herein as Experts by Experience) in mental health nursing education has demonstrated positive impact on the skills and attitudes of nursing students. A qualitative exploratory research project was undertaken to examine the perspectives of undergraduate nursing students to Expert by Experience-led teaching as part of a co-produced learning module developed through an international study. Focus groups were held with students at each site. Data were analysed thematically. Understanding the person behind the diagnosis was a major theme, including subthemes: person-centred care/seeing the whole person; getting to know the person, understanding, listening; and challenging the medical model, embracing recovery. Participants described recognizing consumers as far more than their psychiatric diagnoses, and the importance of person-centred care and recovery-oriented practice. Understanding the individuality of consumers, their needs and goals, is crucial in mental health and all areas of nursing practice. These findings suggest that recovery, taught by Experts by Experience, is effective and impactful on students' approach to practice. Further research addressing the impact of Experts by Experience is crucial to enhance our understanding of ways to facilitate the development of recovery-oriented practice in mental health and holistic and person-centred practice in all areas of health care.

Engagement in help-seeking of dual diagnosed mothers at a low-threshold service: grasping life through co-created opportunities

Purpose

Mothers with a dual diagnosis (mental ill health and substance use) have delays in accessing services, or their care may be interrupted prior to therapeutic relationships being formed. The purpose of this paper is to explore and describe how engagement merges in the context of mothers with a dual diagnosis.

Design/methodology/approach

This is a qualitative, focused ethnographic study at a low-threshold service for substance abusing families. The data contain interviews, observations, field notes, and reflections. The analysis followed several systematic steps.

Findings

Engagement is the co-creation of possibilities between workplace staff and the client in different interfaces. It is not a single act, emotion, or verbal communication, but a complex intertwined system of events that can awaken or enable the client to get a grasp on life. The sensitivity of the worker is one tool for engaging the client in manifold ways in different interfaces: even the smallest events with connection are viewed as valuable. Engagement involves the intentional client in the process of interaction: the client needs to participate and become an acting and sensing part of the change, which occurs on an experiential level. The process is described with the metaphor of a seed.

Originality/value

Engagement as inner involvement challenges the current working methods, and requires sensitivity, because the mothers with a dual diagnosis may not have verbalisable goals when arriving to the services.

First-line nurse managers' perceptions of the challenges involved in decision-making when older patients' wish to die

Aim

The aim of this study was to explore first‐line nurse managers’ perceptions of the challenges involved in decision‐making concerning older patients who wish to die.

Design

A descriptive qualitative design in three communities in Norway between January 2016 and June 2016.

Methods

Qualitative focus group interviews with eight first‐line nurse managers.

Results

One main theme and two themes were identified: Struggling to make the right decision, The challenge of social isolation and loneliness and When life becomes too painful and problematic. The sub‐themes revealed that: Arranging social meeting places where the older patients can talk to other older people is crucial. The participants explained that it was not an easy task to gain an overview of the older patients situation. The right decision could be encouraging the patients to talk about their problems by giving them more time, thereby showing that somebody cares about them.

'Your experiences were your tools'. How personal experience of mental health problems informs mental health nursing practice

WHAT IS KNOWN ON THE SUBJECT?: 'Expertise by experience' has become an increasingly valued element of service design and delivery by mental health service providers. The extent and influence of mental health professionals' personal experience of mental ill health on clinical practice has seldom been interrogated in depth. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: We investigate how mental health nurses' own personal experience of mental ill health informs their mental health nursing practice with particular reference to direct work with service users. Participants said that personal experience could impact on work in three positive ways: to develop their relationship with service users, to enhance their understanding of service users and as a motivation for potential mental health nurses to join the profession. This study moves the discussion of the state of mental health nurses' mental health further towards the recovery and well-being focus of contemporary mental health care, where 'expertise by experience' is highly valued. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: We must address the taboo of disclosure within clinical nursing practice and debate the extent to which personal and professional boundaries are negotiated during clinical encounters.

ABSTRACT

Introduction 'Expertise by experience' is a highly valued element of service delivery in recovery-oriented mental health care, but is unacknowledged within the mental health nursing literature. Aim To explore the extent and influence of mental health professionals' personal experience of mental ill health on clinical practice. Method Twenty-seven mental health nurses with their own personal experience of mental ill health were interviewed about how their personal experience informed their mental health nursing practice, as part of a sequential mixed methods study. Results The influence of personal experience in nursing work was threefold: first, through overt disclosure; second, through the 'use of the self as a tool'; and third, through the formation of professional nursing identity. Discussion Mental health nurses' experience of mental illness was contextualized by other life experiences and by particular therapeutic relationships and clinical settings. In previous empirical studies, nurses have cited personal experience of mental illness as a motivator and an aspect of their identity. In this study, there was also an association between personal experience and enhanced nursing expertise. Implications for practice If drawing on personal experience is commonplace, then we must address the taboo of disclosure and debate the extent to which personal and professional boundaries are negotiated during clinical encounters.

The Therapeutic Relationship in Inpatient Psychiatric Care: A Narrative Review of the Perspective of Nurses and Patients

PURPOSE

To study the significance of 'therapeutic relationship' between nurses and patients within the context of a psychiatric hospital.

METHOD

Narrative literature review. Content analysis.

FINDINGS

The significance of the therapeutic relationship is quite similar for both nurses and patients in psychiatric hospital units. Nevertheless, several factors may separate the two positions: the time available for the relationship, the negative perceptions on the part of both parties, and the insecurity of the setting.

PRACTICE IMPLICATIONS

Increased knowledge and understanding of the significance of the therapeutic relationship from the perspective of nurses and patients would allow the strengthening of areas of mutual interest.

From judgment to understanding: mental health nurses' perceptions of changed professional behaviors following positively changed attitudes toward self-harm

Nurses experience feelings of frustration, anger and fear when caring for patients who self-harm. Training programmes were developed that aimed to positively influence nurses' knowledge, attitudes and skills. The aim of this study was to investigate professional behavior of mental health nurses with positively changed attitudes after following a training program. Using grounded theory, semi-structured interviews were conducted with 11 mental health nurses. Participants reported using less restrictive interventions, being more patient oriented, and choosing a more empathic and exploratory approach after the training. A work environment conductive to making autonomous professional decisions with supportive colleagues enabled these changes.

Therapeutic engagement between consumers in suicidal crisis and mental health nurses

Registered nurses within public mental health services play crucial roles in helping people recover from suicidal crisis. However, there is a lack of understanding of how care is experienced in this context, and available evidence suggests that nurses and consumers are often dissatisfied with the quality of care. There is thus an imperative to generate understanding of needs and experiences of both groups with a view to informing practice development. This article summarizes qualitative findings from a multimethod study undertaken in Australia, which surveyed and interviewed mental health nurses who had recent experience of caring for consumers in suicidal crisis in a hospital setting, and interviewed consumers who had recovered from a recent suicidal crisis. A framework was developed to guide the study and support ethical imperatives; in particular, the promotion of consumer well-being. The findings highlight that therapeutic interpersonal engagement between nurses and consumers was central to quality care. This was particularly noted, as engagement could help reduce consumer isolation, loss of control, distress, and objectification of the delivery of potentially-objectifying common interventions. Of concern, the results indicate a lack of therapeutic engagement from the perspective of both consumers and nurses. Recommendations to promote fuller therapeutic engagement are presented.

Forgiveness, flourishing, and resilience: the influences of expressions of spirituality on mental health recovery

The relationships of spirituality, religion, and health have been the subject of research in a variety of disciplines over the past two decades. Findings have varied: Some findings appear to have strong evidence of relationships while other findings are deemed inconclusive. A few studies have distinguished between religion and spirituality, but most investigators have treated the two as one concept with no clear lines of distinction between them. This theoretical study, focusing on the topic of spirituality, explores several related concepts, including forgiveness, flourishing, and resilience, as a basis for developing approaches to facilitate recovery in mental health clients using spiritual interventions.

Strengthening practical wisdom: mental health workers' learning and development

BACKGROUND

Practical wisdom, understood as knowing how to be or act in any present situation with clients, is believed to be an essential part of the knowledge needed to be a professional mental health worker. Exploring processes of adapting, extending knowledge and refining tacit knowledge grounded in mental health workers' experiences with being in practice may bring awareness of how mental health workers reflect, learn and practice professional 'artistry'.

RESEARCH QUESTION

The aim of the article was to explore mental health workers' processes of development and learning as they appeared in focus groups intended to develop practical wisdom. The main research question was 'How might the processes of development and learning contribute to developing practical wisdom in the individual as well as in the practice culture?'

RESEARCH DESIGN

The design was multi-stage focus groups, and the same participants met four times. A phenomenological hermeneutical method for researching lived experience guided the analysis.

PARTICIPANTS AND CONTEXT

Eight experienced mental health workers representing four Norwegian municipalities participated. The research context was community-based mental health services.

ETHICAL CONSIDERATIONS

The study was reported to Norwegian Social Data Services, and procedures for informed consent were followed.

FINDINGS

Two examples of processes of re-evaluation of experience (Association, Integration, Validation, Appropriation and Outcomes and action) were explored. The health workers had developed knowledge in previous encounters with clients. In sharing practice experiences, this knowledge was expressed and developed, and also tested and validated against the aims of practice. Discussions led to adapted and extended knowledge, and as tacit knowledge was expressed it could be used actively.

DISCUSSION

Learning to reflect, being ready to be provoked and learning to endure indecisiveness may be foundational in developing practical wisdom. Openness is demanding, and changing habits of mind is difficult.

CONCLUSION

Reflection on, and confrontation with, set practices are essential to building practice cultures in line with the aims of mental health services.

Jacques Lacan's theory of the subject as real, symbolic and imaginary: how can Lacanian theory be of help to mental health nursing practice?

This paper presents an outline of Lacan's theory of the human subject, in particular focusing on Lacan's concepts of the real, symbolic and imaginary registers, and how an understanding of these can inform change and practice in mental health nursing. Mental health nursing is under pressure to define itself as a practice distinct from other professions in the field, and to respond in new ways to promoting mental health to the individual and a wider public. Lacan's theory of the subject is of particular relevance to mental health nurses working with mental distress but has received little attention in mental health nursing literature. Six implications for practice are outlined in terms of: against normalization, the importance of the function of the symptom, what cannot be known, meaning as ever-changing, against empathy and against holistic ideas of the self.

Older persons' lived experiences of depression and self-management

Mental ill-health, such as depression in the elderly, is a complex issue that is influenced by the life-world perspective of older persons. Their self-management ability should be strengthened based on an understanding of their situation, perspectives, and vulnerability. The aim of this study was to explore and increase understanding of old persons' lived experiences of depression and self-management using an interpretative explorative design. Understanding was developed by means of hermeneutic interpretation. One theme, Relationships and Togetherness, and four subthemes, A Sense of Carrying a Shoulder Bag, Walking on Eggshells, Holding the Reins, and Estrangement--a Loss of Togetherness, emerged. A collaborative approach can be important for empowering older persons through self-development and management. Although the findings of the present study cannot be considered conclusive or definitive, they nevertheless contribute new knowledge of older persons' lived experiences of depression in everyday life.