Critical Social Analysis of Acute Institutionally Based Mental Health Nursing Following an Action Research Project

Abstract

This thesis, using action research, describes the ongoing development of a nursing service within an acute mental health inpatient setting. The choice of an action research method with twelve registered mental health nurse co-researchers reflected the intention of using a participative method to develop theory grounded in practice. Initial focus groups informed the project which concentrated on improving continuity and consistency of nursing care delivery. It was anticipated that the process would enable revised explanations of the practice world leading to emancipatory action. This ideal proved a challenge in the face of complex and under-explored structural and historical factors which are explored later in the thesis. Nonetheless a cultural shift was beginning to occur as the researchers reported an expanded understanding of their practice world and an increasing confidence in their ability to negotiate change. A restructuring of nursing’s role within the multidisciplinary team was informed by the research. The action research experience echoed the findings reported in the literature and contributed to the growing body of knowledge about the characteristics challenges and efficacy of the method. Critical Social Research has informed the theoretical chapters of the thesis. The data revealed three type of false-consciousness (Fay, 1988) which serve to hold nurses within a difficult and unsupportive context. These were that mental health nurses are complementary to medicine; that the pursuit of profession-hood is in the best interests of mental health nursing and that nursing is synonymous with caring. The theory of false consciousness is predictive of a theory of crisis (Fay, 1988). Three impending crises were predicted. First, a crisis of identity, in which nurses experience confusion over roles, knowledge and loyalty. Second, a crisis of confidence, stemming from role confusion and unaccommodating systems, and third a crisis of authority in which nurses are calling into critical question contemporary mental health nursing and mental health practices, structures and knowledge positions. Crisis is an important motivator for change. A theory of education considers the requisite conditions for sufficient and adequate cultural change. A theory of transformative action outlines possible strategies for emancipatory action.