A Narrative Inquiry Exploring the Values of Mental Health Nurses Working in In-patient Settings

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A Narrative Inquiry Exploring the Values of
Mental Health Nurses Working in In-patient
Settings

• Gemma Stacey Kirstie Joynson

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Background

• The political recognition of the importance of
  values in the delivery of care
• The relationship between values and clinical
  practice
• The impact of conflicts in values on job
  satisfaction, attrition rates and quality of
  care.

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Research Question

• How are the values of newly qualified Mental
  Health Nurses working in in-patient settings
  developed and challenged in practice?

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Aims

• To examine the values newly qualified mental
  health nurses hold in relation to working with
  mental health service users.
• To explore the factors which influence the
  development and maintenance of values in
  practice.
• To explore the relationship between values and
  experiences of mental health nursing over time.

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Method

• Ethical approval granted by NRES and
  Nottinghamshire Healthcare Trust
• Sample
• 12 participants who had been qualified for less
  than three years and were working in in-patient
  settings
• A narrative inquiry
• Participants were asked to tell the researcher,
  during a one to one interview, their story of any
  events and experiences that were important to
  them in relation to nursing.

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Why narrative?

• Allows for the detailed exploration of personal
  experiences and perspectives.
• Provides an appropriate forum for discussion of
  sensitive issues.
• Stories have an inherent morality-
• Characters make choices that turn out for
  good/bad.
• There are consequences to an action.
• Evaluations make judgements of a characters
  action.

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Findings

• Development of values
• Previous experience of working as a health care
  assistant
• Previous experiences of a family member receiving
  mental health services
• Inspirational role models during student
  placements
• Negative practice observed during student
  placements

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Findings

• Values described
• a client-focused approach which emphasised the
  importance of the therapeutic relationship,
  working towards the clients goals and improving
  services for the benefit of the client.
• Professional and ethical principles placed upon
  them by external governing or management bodies.

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Findings

• Conflicts of values
• lack of resources
• lack of support/ power to initiate new ideas
• resistant attitudes from more established members
  of the team
• a clash between client choice and duty of care.

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Findings

• Coping with conflict
• AcceptanceIndividuals who recognised their
  values were potentially challenged but appeared
  not to voice this in practice. These participants
  accepted they would continue to work within the
  system and measured their performance in line
  with adherence to externally defined ethical
  principals, policies and procedures.

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Findings

• Rejection
• These participants strongly questioned the
  organisational philosophy and the constraints
  this placed on their values in practice. In
  response participants were considering working
  outside of the organisation or had gained
  employment in research or education. These
  individuals have had specific and in-depth values
  based training.

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Findings

• Innovation Participants who held a strong
  client-focused values base within their practice.
  When their values came into conflict with
  organisational constraints they worked within the
  system to initiate change, despite potential
  resistance from others.

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Conclusions

• The values held when entering the profession
  remain intrinsically intact
• The expression of values is tempered by
  confounding factors.
• The long term implications of coping in this
  manner could provide an explanation for the high
  levels of stress, burnout and attrition.
• It could also have an impact on capacity to work
  with people in emotional distress as the nurses
  own emotional needs are not adequately met.

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What next?

• Educational developments
• Raise the awareness of values and their role in
  influencing the experience of nursing practice.
  Identification of own values and impact on own
  practice
• Recognition of alternative values within mental
  health care
• Responding to conflicts of values in the context
  of shared decision making
• Coping with scenarios where personal values are
  challenged and potentially compromised
• Involve of newly qualified nurses to facilitate
  discussion

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What next?

• Practice Developments
• Defined support strategies in place during the
  transition period. These include
• A formal preceptorship program including training
  for preceptors and a structured development
  package
• A virtual learning and support network with the
  following functions
• A chat forum to share experiences and gain advise
  
• Practice and career development opportunities
• Useful information such as relevant articles,
  policy documents and practice innovations