_________________________________________________________________________Swansea University E-Theses Talking about mental health nursing: a qualitative analysis of nurses’ and service users’ accounts. Terry, Julia Mary How to cite: _________________________________________________________________________ Terry, Julia Mary (2018) Talking about mental health nursing: a qualitative analysis of nurses’ and service users’ accounts.. Doctoral thesis, Swansea University. http://cronfa.swan.ac.uk/Record/cronfa43230 Use policy: _________________________________________________________________________ This item is brought to you by Swansea University. Any person downloading material is agreeing to abide by the terms of the repository licence: copies of full text items may be used or reproduced in any format or medium, without prior permission for personal research or study, educational or non-commercial purposes only. The copyright for any work remains with the original author unless otherwise specified. The full-text must not be sold in any format or medium without the formal permission of the copyright holder. Permission for multiple reproductions should be obtained from the original author. Authors are personally responsible for adhering to copyright and publisher restrictions when uploading content to the repository. Please link to the metadata record in the Swansea University repository, Cronfa (link given in the citation reference above.) http://www.swansea.ac.uk/library/researchsupport/ris-support/ Talking about mental health nursing: a qualitative analysis of nurses’ and service users’ accounts by Julia Mary Terry Submitted to Swansea University in fulfilment of the requirements for the Degree of Doctor of Philosophy 2018 Summary Summary This study explores talk about mental health nursing, in a policy and practice climate that promotes service user involvement in nursing processes. The intention of this study was to gain multiple perspectives about mental health nursing and service user involvement through in-depth research interviews and focus groups with mental health nurses, nursing students and mental health service users. Analysis centred on the meaning making of participants’ talk and how mental health nursing identities are accounted for and constructed. The opportunities for authentic service user involvement in nursing processes within mental health systems that include detention and a focus on compliance are under- explored. Historically mental health services have been linked with power and control, as treatments and interventions have often been coercive and at times involve forced assessment and treatment under mental health legislation. Challenges to power, control and coercion can be found in practices that promote service user involvement. However, a power imbalance in relationships between mental health service users and mental health practitioners is evident, with service users having partial agency and often limited involvement regarding their care and treatment. This study found that nurses and mental health service users talked about how nursing work was often task-focused, and made reference to nurses spending limited therapeutic time directly with service users, who then spoke of their dissatisfaction regarding engagements with nursing staff. Nursing students voiced limited knowledge and exposure to examples of how nurses engage in service user involvement activities in practice indicating they had little experience of this. Instead students said they felt compelled to go along with practices that appeared to work in opposition to involvement. Displays of understanding in participants’ talk about mental health nursing work indicated the existence of powerful professional cultures that included distance and separateness from service users and perpetuated limited involvement. It is important that mental health nurses consider imbalanced power relationships that exist in mental health environments and challenge cultures that discourage nurses from working more collaboratively with service users. 1 Declarations Declarations I confirm that this work has not previously been accepted in substance for any degree and is not being concurrently submitted in candidature for any degree. ……………………………………………………….. (candidate) ……………………………………………………….. (date) This thesis is the result of my own investigations, except where otherwise stated and that other sources are acknowledged by footnotes giving explicit references and that a bibliography is appended. ……………………………………………………….. (candidate) ……………………………………………………….. (date) I give consent for the thesis, if accepted, to be available for photocopying and for inter-library loan, and for the title and summary to be made available to outside organisations. ……………………………………………………….. (candidate) ……………………………………………………….. (date) 2 Contents Contents Summary ....................................................................................................................................... 1 Declarations ................................................................................................................................... 2 Contents......................................................................................................................................... 3 Acknowledgements ....................................................................................................................... 7 List of tables & figures .................................................................................................................. 8 Transcribing conventions .............................................................................................................. 9 Glossary....................................................................................................................................... 10 Chapter 1: Introduction ............................................................................................................... 12 1.1 An introduction to the thesis ................................................................................................. 12 1.2 The aim of the study .............................................................................................................. 13 1.3 Why study talk about mental health nursing and service user involvement in nursing processes ..................................................................................................................................... 14 1.4 An introduction to the researcher .......................................................................................... 24 1.5 The study ............................................................................................................................... 28 1.6 Influences and suppositions about my position as researcher ............................................... 30 1.7 Organisation of the thesis ...................................................................................................... 36 Chapter 2: Literature review ....................................................................................................... 40 2.1 Introduction ........................................................................................................................... 40 2.2 Researching mental health nursing and service user involvement in nursing processes ....... 41 2.3 Background ........................................................................................................................... 42 2.4 The biomedical approach to mental distress ......................................................................... 44 2.5 The interpersonal relations approach to mental distress ....................................................... 46 2.6 Fields of contention in mental health nursing ....................................................................... 49 2.7 Mental health nursing reviews and policy context ................................................................ 51 2.8 Mental health nursing roles and professional identities ........................................................ 54 2.9 What mental health nurses do ............................................................................................... 64 2.10 Service users’ views of mental health nurses ...................................................................... 70 2.11 The context of service user and carer involvement ............................................................. 72 2.12 Research aim and objectives ............................................................................................... 77 2.13 Conclusion ........................................................................................................................... 78 3 Contents Chapter 3: Methodology.............................................................................................................. 80 3.1 Introduction ........................................................................................................................... 80 3.2 Research method ................................................................................................................... 80 3.3 Research approach for this study .......................................................................................... 83 3.3.1 Using individual interviews ........................................................................................... 86 3.3.2 Using focus groups ........................................................................................................