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

Gemma Stacey & Kirstie Joynson

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.

Research Question

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

challenged in practice?

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.

Method

• Ethical approval granted by NRES and Nottinghamshire Healthcare Trust

• Sample12 participants who had been qualified for less than three years and were working in in-patient settings

• A narrative inquiryParticipants 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.

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.

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

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.

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.

Findings

• Coping with conflict – Acceptance

Individuals 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.

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.

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.

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.

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

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