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Personal and Professional Choices, Tensions, and Boundaries in the Lives of Lesbian Psychiatric Mental Health Nurses

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Personal and Professional Choices, Tensions, and Boundaries in the Lives of Lesbian Psychiatric Mental Health Nurses Personal and professional choices, tensions, and boundaries in the lives of lesbian psychiatric mental health nurses by Christine Mary Miriam Walsh A thesis submitted to the Victoria University of Wellington in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing Victoria University of Wellington 2007 Abstract This study breaks new ground in articulating how sexual identity impacts on the therapeutic relationship between the client and the lesbian nurse in psychiatric mental health nursing. There is little consideration given in the literature or in research as to how sexuality of the nurse impacts on nursing practice. Most attitudes held by the public and nursing staff are based on the assumption that everyone is heterosexual, including nurses. Fifteen lesbian psychiatric mental health nurses from throughout New Zealand volunteered for two interviews and shared their experiences of becoming and being a lesbian psychiatric mental health nurse. The stories they told give new insights into how these nurses negotiate and position their lesbian identity in the therapeutic relationship. To work therapeutically with people in mental distress the nurse uses personal information about themselves to gain rapport with the client through appropriate self- disclosure. Being real, honest and authentic are also key concepts in this relationship so the negotiation of reveal/conceal of the nurse’s identity is central to ongoing therapeutic engagement. One of the most significant things arising from the research is that participants are able to maintain their honesty and authenticity in the therapeutic relationship whether they self-disclose their lesbian identity or not. This is because the experiences in their personal lives have influenced how the participants ‘know themselves’ and therefore guide how they ‘use self’ in their therapeutic nursing. The concept of a ‘licensed narrative’ has also been developed during this research reflecting the negotiated understandings between the researcher and the participants. Further, the use of NVivo a qualitative software package helps to track and make transparent the research processes. These two aspects make a unique contribution to the field of narrative inquiry. Key words; lesbian, mental health nurse, narrative inquiry, therapeutic relationship. ii Acknowledgements I am deeply indebted to the participants who gave freely of their time and revealed so much about their lives as lesbians and as nurses. I hope that this research about them has been conducted and reported in such a way that they feel proud of their participation and contribution. A PhD journey is a story in many stories and while at times I have felt alone I have never been lonely. There are so many people to thank for their support, encouragement and confidence in my ability to complete this thesis. I would like to start with thanking both my parents for without them I would not be here. They taught me many things, but most of all to be proud of where I came from and who I am; the importance of people and family and from my father especially the need to create and enjoy laughter in our lives. My supervisors warrant special mention. Lynne Giddings has been my primary supervisor and offered support and guidance in our meetings for which I am very appreciative. Her feedback has been challenging, timely and gracious; her patience enduring. Margi Martin started the journey with me and encouraged me to be creative and walk outside the boundaries. Thank you Margi for listening to me ‘stressed’ and knowing just what to do to help a girl from a small town move on. Christine Alavi took up the reins for a while. Rose McEldowney helped on this whole journey and seemed to be there when I strayed; those impromptu chats in the corridor were good Rose and helped me to keep focused. You also took the ride down the home straight with me as primary supervisor and gave considered and speedy feedback on my final drafts. Thank you Rose for helping me make this happen and for giving me priority when you had so many other important ones. Thank you all for believing in me. My thanks go the academic staff at the Graduate School of Nursing, Midwifery and Health, Victoria University. You have understood my anguish and uncertainty and can now share in the relief. Administrative staff has been there to support throughout and especially thanks to Lesley for help with all those last minute ‘technical’ issues. Colleague and enduring friend Thelma Puckey has held the mental health mantle in iii the school, with little complaint, while I was so often distracted with this thesis. Your turn next my friend. Thanks to Kathy Nelson for her gentle inquiries on my progress and to Professor Jan Duke, Head of the Graduate School of Nursing, Midwifery, and Health who reminded me about all the ‘work’ things I often forgot and created space for me to get on with this thesis. Joy Draper and Belinda Hill, thanks for your editorial advice and guidance. Thanks too to the friends who read bits of my work and offered advice and support. The Faculty of Humanities and Social Science provided funds for me to travel and undertake the interviews throughout New Zealand and paid for the transcribing. Thanks to my dear friends, lesbian, gay, queer and otherwise who have helped me to be who I am and shared the joy of our collective identities. Your inquiries at various social events about my progress were very much appreciated. It was refreshing to see how your eyes did not glaze over when I started to talk about the thesis and you understood my ravings. Two close friends and colleagues Jane Khull and Heather Martin remain close in my heart. Both these lesbian psychiatric mental health nurses gave so much to their communities before their untimely and early passing. May the Goddesses continue to smile on you. Finally, I want to acknowledge the support, love, friendship and encouragement of my partner Sue Ellis. Your counsel was outstanding, your patience perfect and your presence essential. iv Table of Contents Abstract...................................................................................................................ii Acknowledgements ...............................................................................................iii Table of Contents ...................................................................................................v List of Figures.........................................................................................................x List of Tables ..........................................................................................................x Glossary .................................................................................................................xi Chapter One Introduction to the Study-Background and Positioning................1 Study aim and research questions............................................................................3 Background ..............................................................................................................4 Rationale for this study........................................................................................4 Rationale for the methodology ............................................................................5 Positioning the thesis................................................................................................6 Developing my thinking in preparation for this study ...........................................6 Heterosexuals researching lesbians....................................................................9 Language and this study ...................................................................................12 Language and lesbian identity...........................................................................12 Contexts of the participants...............................................................................14 The New Zealand context............................................................................14 The mental health nursing context...............................................................16 The therapeutic relationship..............................................................................17 Overview of the thesis ............................................................................................18 Chapter Two Review of the Literature.................................................................21 Search strategy ......................................................................................................22 What the literature offered.................................................................................23 The context and environment .................................................................................24 New Zealand socio-political context for lesbians ...............................................24 New Zealand psychiatric mental health nursing context....................................27 Lesbian identity.......................................................................................................30 Defining and naming lesbian identity.................................................................30 v Lesbian nurses identity .....................................................................................33 Lesbian identity development .................................................................................36 Stage theories and models of lesbian identity development ..............................36
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