Treading lightly: spirituality issues in mental health nursing

ABSTRACT: Spirituality has been recognized as an important part of nursing practice since its early beginnings. However, debate continues about whether and how nurses and other mental health professionals should include spirituality within their daily work. This paper aims to contribute to the discussion of spirituality within mental health nursing, through considering findings from a Heideggerian phenomenological study conducted with six people with mental illness living in regional Australia. This study aimed to provide a greater understanding of the phenomenon of spirituality by answering a primary research question, ‘What does spirituality mean for people with a mental illness?’ Participants were interviewed and data analysed using an iterative approach. Findings emerged through multiple readings and meanings were gradually constructed from the data into themes. The themes describe that spirituality is experienced uniquely for the participants, and that spirituality became vitally important to them when they became mentally unwell. In addition, issues of interest to mental health nurses were raised but not completely addressed by the study. The issues relate to potential interactions about spirituality between nurses and their patients. Although participants wanted to discuss their experiences of spirituality with others, they raised concerns about whether their mental health care providers would be accepting of their beliefs. Spirituality was deemed to be a highly individual phenomenon; it could be experienced as a journey and it was life‐sustaining. For these reasons, it is proposed that mental health professionals must be prepared to discuss patients’ spiritual needs in the context of their health concerns.     

Interpersonal psychotherapy: an effective psychotherapeutic intervention for mental health nursing practice

Interpersonal psychotherapy (IPT) is well-recognized for the treatment of depression with many efficacy trials supporting its use. However, there is little discussion of its use in mental health nursing practice. This paper explores how IPT can be a useful intervention for mental health nursing practice and demonstrates the process of IPT with reference to a case study. The case study illustrates how IPT facilitates a shift for one woman from a passive subject position to a more self-assertive one. This shift was facilitated by identifying how she was constructing herself in relation to others by utilizing tactics of passivity and avoidance of conflict. The development of more satisfying subject positions facilitated an improvement in mood and recovery from depression.     

Interpersonal psychotherapy: an effective psychotherapeutic intervention for mental health nursing practice

Interpersonal psychotherapy (IPT) is well-recognized for the treatment of depression with many efficacy trials supporting its use, however, there is little discussion of its use in mental health nursing practice. This paper explores how IPT can be a useful intervention for mental health nursing practice and demonstrates the process of IPT with reference to a case study. The case study illustrates how IPT facilitates a shift for one woman from a passive subject position to a more self-assertive one. This shift was facilitated by identifying how she was constructing herself in relation to others by utilizing tactics of passivity and avoidance of conflict. The development of more satisfying subject positions facilitated an improvement in mood and recovery from depression.     

The challenges of mental health care reform for contemporary mental health nursing practice: relationships,power and control

This ethnographic investigation was concerned with the way mental health nurses' construct their practice in an acute inpatient psychiatric unit in light of the current challenges, demands and influences brought about by service reforms of the 1990s. The setting for this study was a 22-bed acute inpatient mental health facility. Over a 5-month period, data were collected through fieldwork observations, focused interviews and discussion groups. In this article, common cultural practices in relation to the imperatives of relationships, power, restrictions and safety are discussed. The findings demonstrate how the client stabilization role of the unit locates these imperatives as central to the delivery of nursing care. The discussion reveals nurses negotiating relationships that are contradictory and challenging in ordinary and everyday ways within the exigencies of daily practice.     

Global issues in mental health across the life span: challenges and nursing opportunities

This article describes what is known about mental health in children, adolescents, adults, and the elderly globally in high-, middle- and low-income countries. The social determinants of health are described as well as the paradigm shift from focusing on psychopathology to looking at ways in which individuals and communities can embrace mental health promotion to decrease stigma and provide care for all individuals in resource-rich and resource-poor environments. The need to expand the content in nursing curricula to include mental health concepts at all levels of training, foster mental health research, and promote international collaboration around best practices is also discussed.     

Lifeworld, the arts and mental health nursing

Various manifestations of the arts have been employed in mental health care as successful diversional and therapeutic interventions, and as an adjunct to mental healthcare professional education. There is now a current groundswell of the use of the arts and humanities in both the practice of research and the representation and dissemination of findings. Here, we first point to the potential ability of the arts that can be used to re-humanize the world of health and social care and its underpinning sciences. Second, we highlight the nature and relevance of this more aesthetic movement and its potential to enable meaningful engagement with people in order to facilitate shared understandings of concretely lived experiences. Finally, we use a long-standing philosophical framework, the 'lifeworld', as an exemplar to demonstrate how the wholeness and essence of human being can be revealed or shown through art. In doing so, we make the tentative suggestion that phenomenology and the lifeworld approach may be a useful philosophical framework for underpinning the use of arts in mental health nursing.     

Listening to young voices: challenges of research with adolescent mental health service users

Young people who have mental health problems and use the mental health services need to be consulted about their views regarding their experiences of care and treatment in the same way as adults do. Doing research with children and young people is relatively new but it is becoming more common and recent literature highlights a need to balance respect for their voices with responsibility for their best interests. This can be achieved by paying close attention to ethical and methodological issues throughout the course of every study. This paper reviews some of the issues involved in consultation research with adolescent mental health service users, and illustrates them with examples taken from an ongoing study into the experiences of young people in three Scottish child and adolescent mental health services.     

Nurse-client processes in mental health: recipients' perspectives

An ethnonursing method was selected to explore and describe nursing support relationships, from the perspectives of recipients, within the mental health subculture. Data sources consisted of three semi-structured client interviews (n = 14) and field notes. When nurses were described as nice and friendly, and validated the client as a person by listening, three overlapping phases of development emerged from the data. These included: a glimmer of help, exploring and problem solving, and saying goodbye. When clients had negative experiences with nurses, they felt a lack of trust towards nurses and felt that their feelings were left unexplored. As a result, the relationships deteriorated. Deterioration began immediately in the first phase called withholding, and continued through the phases of avoiding and ignoring, and struggling with and making sense of. These findings raise healthcare providers' awareness about developing and deteriorating nurse-client relationships, and support the value of the therapeutic relationship as an instrument to restore and promote clients' health.     

The biological sciences in mental health nursing: stakeholders' perspectives

To date, relatively little attention has been paid to optimizing the development of education programmes to support safe and effective health care professionals. In particular, the wider stakeholders, particularly health service users, are rarely consulted on the knowledge base expected of practitioners. We report here on an evaluation, involving students, lecturers, nurses and service users, aimed at reviewing the bioscience component of the preregistration mental health nursing course. Students and lecturers agreed that the current common foundation course in bioscience was biased towards the adult branch students, and failed to meet the needs of mental health nurses. The mental health lecturers' solution to the 'bioscience problem' was to curtail the input. In contrast, service users described serious shortfalls in professionals' abilities to inform them of common side-effects of medication; these problems were attributable to inadequate educational preparation. The knowledge deficits identified could be rectified by making pharmacology an important part of the mental health education programme. However, for the curriculum to accommodate applied pharmacology, its supporting bioscience, and essential preparation in psychosocial interventions, some restructuring of the biological science programme for mental health nurses will be necessary. Our findings suggest that such restructuring should be informed by service users' views of their needs.     

Evidence-based uncertainty in mental health nursing

The drive towards evidence-based practice is part of a modern reflective and caring service. However there is a paradox at the heart of the notion of evidence-based care. In order to perform any systemized examination of treatment there has to be a conscious acknowledgement of uncertainty about that treatment. This is uncomfortable and when research does find evidence in favour of a treatment, there is a relief and a return to conviction about what is the best. The paradox is that it seems the most valued research practices are predicated on generalizations about patient treatments and categories. However, nursing care is based on the notion of the uniqueness of the patient and the nurse-patient relationship. Sometimes it is necessary to address the particular and not to rush to generalizations and certainty. The psychoanalytic framework promotes a capacity to tolerate uncertainty and provides a model for understanding conflicting feelings, which can occur within the nurse-patient relationship. The author proposes the psychoanalytic observational method as an adjunct to other research methods. This method places certain kinds of evidence within the rubric of evidence-based nursing practice. The evidence collected in this method is the evidence of the conscious and unconscious experience within the nurse-patient relationship. The author will describe and argue for the place of this research method within the canon of other more widely practised methods within mental health practice. She will propose that for safe practice it is necessary to value and examine the veracity of the feelings and tacit understanding of the nurse. She contends that the current climate of excessive bureaucracy and persecutory risk management is having a damaging effect on both the research process and effective nursing care.     

Clinical formulation for mental health nursing practice

There are problems for mental health nurses in using psychiatric diagnoses as outcomes of their nursing assessments and nursing diagnoses present similar issues. However, there is a need in practice to link the assessment to nursing interventions in a meaningful way. This paper proposes that the clinical formulation can be regarded as central to providing this cohesion. The formulation does not merely organize the assessment findings but is also an interpretation or explanation, made in consultation with the client, of what meaning can be attributed to the issues explored in the assessment process. Because this interpretation is dependent on both the client's and the nurse's explanatory frameworks, there are multiple ways of developing the formulation. It is also an evolving and dynamic statement of understanding. A case example is provided in the paper to illustrate how the same case can be interpreted in different ways and the implications this has for the nursing interventions provided.     

The challenges of mental health care reform for contemporary mental health nursing practice: delivery of nursing care

This ethnographic account of mental health nursing in a 22-bed acute inpatient facility in New South Wales, Australia, uncovered cultural meaning and cultural realities associated with the delivery of nursing care within the context of current challenges, demands, and influences brought about by service reforms. The findings demonstrate that mental health nurses have been responsive to changes brought about by the reforms. The ability of nurses to readily identify service gaps in their everyday practice provides them with the opportunity to develop strategies to respond to workplace challenges. As such, findings of the study contribute to current discussions concerning acute inpatient mental health nursing practice.     

Israeli families immigration and intercultural issues: challenges to mental health counselors

Israeli families who immigrate to the United States present certain sociocultural issues that need to be recognized in order to provide culturally relevant, respectful and empowering mental health counseling. Israeli families are further situated within the complex social, cultural, economic and political context of Jews in the United States, who are themselves rarely recognized as a minority group. The purpose of this article is to present some major themes observed in working with Israeli families. A brief case example and analysis are presented, along with some general guidelines for counselors working with Israeli families.     

Triangulation in nursing research: issues of conceptual clarity and purpose

The controversy concerning the value of qualitative, quantitative and triangulation approaches to nursing research for understanding human behaviour and increasing nursing knowledge has been an increasing source of debate among nurse scholars. However, the differences and similarities of these three perspectives have not been fully compared as either philosophies or methodologies. The purposes of this paper are to provide an understanding of the origin and development of the triangulation research method, clarify major sources of confusion in the presentation of a triangulation study, and discuss the problems and possible solutions of a triangulation study. Finally, an example of multiple triangulation in a nursing research within a Taiwanese cultural context —turning points of recovery from cardiac surgery during the intensive care unit transition — is presented. In the course of the paper, suggestions are also given to help nurse researchers recognize when it is most appropriate to use a certain research method, whether that be qualitative, quantitative or triangulation.     

Misinterpretive phenomenology: Heidegger, ontology and nursing research

This paper argues that Heidegger's phenomenology does not have the methodological implications usually ascribed to it in nursing literature. The Heidegger of Being and Time is not in any sense antagonistic to science, nor does he think that everydayness is more authentic, more genuine, than scientific enquiry or theoretical cognition. It is true that social science must rest on interpretive foundations, acknowledging the self-interpreting nature of human beings, but it does not follow from this that hermeneutics exhausts all the possibilities. Positivist approaches to social science are certainly inconsistent with Heidegger's ontology, but realist approaches are not and structuration theory, in particular, can be seen as a sociological translation of his ideas. Social enquiry in nursing is not therefore confined to studies of lived experience. Indeed, lived experience research constitutes not a realization, but rather a betrayal, of Heidegger's phenomenology, being thoroughly Cartesian in spirit.     

Generating research in mental health nursing

This paper explores a number of areas for research development in mental health nursing in the United Kingdom. Several potential areas are identified: historical research, policy related research, the role of mental health nurse as a provider of a therapeutic milieu, as therapist and as teacher. Academic centres are identified in mental health nursing research and a plea is made for the preservation of valuable archive data being lost as mental hospitals are closed. Nurse leaders in mental health nursing are encouraged to make particular provision for research activity.