Psychiatric and MentalHealth Nursing:The Field of Knowledge

Edited by

Stephen Tilley

BlackwellScience

152 Psychiatric and Mental Health Nursing

Psychiatric and MentalHealth Nursing:The Field of Knowledge

Edited by

Stephen Tilley

BlackwellScience

© 2005 by Blackwell Science Ltda Blackwell Publishing company

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First published 2005

Library of Congress Cataloging-in-Publication DataPsychiatric and mental health nursing : the field of knowledge / edited by Stephen Tilley.

p. ; cm.Includes bibliographical references and index.ISBN 0-632-05845-5 (pbk. : alk. paper)1. Psychiatric nursing–Great Britain. 2. Psychiatric nursing–Study and teaching–GreatBritain. 3. Psychiatric nursing–Philosophy.[DNLM: 1. Psychiatric Nursing–Great Britain. 2. Education, Nursing–Great Britain.3. Mental Disorders–nursing–Great Britain. 4. Nursing Theory–Great Britain.WY 160 P9712 2004] I. Tilley, Stephen.

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2004009497

ISBN 0-632-05845-5

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Contents

Dedication ixEpigraph xForeword xiAcknowledgements xiiContributors xiii

Section 1 Background and Stance on the Problem of Knowledge

in the Field 1

Chapter 1 Introduction 3

Stephen Tilley and Desmond RyanMethodology of the book – architecture of the text 6The whole field, and nothing but the field? 8The sociology of knowledge model adopted in this book 9

Institution 10Discipline 11Tradition 11Influence 12

References 13

Section 2 Looking Across the Field: Case Studies of

Institutionalisation of Knowledge of Psychiatric

and Mental Health Nursing 15

Chapter 2 The Institute of Psychiatry: Nursing within the

Health Services Research Department 17

Kevin GournayIntroduction 17Current contributions to psychiatric nursing knowledge 19High quality research 20Research relevant to mental health policy 23Providing assistance to Government in developingpolicy initiatives 23The development of a critical mass of individualsfrom a psychiatric nursing background suitablytrained in research 25

iii

The development, testing and dissemination ofinnovative programmes of education and training 26Providing input to service developments within localand national services 27Framework for the future development of nursingactivities within the Health Services Research Department 28Conclusion 28References 30

Chapter 3 Fragile Tradition: Institutionalisation of Knowledge

of Psychiatric and Mental Health Nursing in the

Department of Nursing Studies, the University

of Edinburgh 32

Stephen TilleyIntroduction 32An emblematic story 34The University of Edinburgh: context for the tradition 35Teaching, supervision and research in the Department 37

Teaching 37Supervision 42Research 45

Sustaining the fragile tradition 52References 54

Chapter 4 Nursing Mental Health at the Tavistock 57

Peter Griffiths and Vicky FranksIntroduction 57Historical context 57

The evolution of nursing at the Tavistock Clinic 57Psychodynamic nursing – models of practice 60Psychodynamic nursing – therapeutic communities 62Psychodynamic nursing – the dissemination of ideas 64

The distinguishing features of psychodynamicknowledge in mental health nursing 66

A psychodynamic and systemic view of mental health 66Psychodynamic features of mental health nursing 67

The role of psychodynamic nursing within the widerfield of mental health nursing 70The influence of the institutions in which we work on ourrole as knowledge producers 71

Work across institutional/agency boundaries 72Form an attachment to the work content 73Reflect on self in relation to others 74Teach and learn in applying theory to practice 74Work with competing and complementary paradigms 75

iv Contents

Conclusions 76Acknowledgement 77References 77

Chapter 5 Mental Health Nursing: Principles in Practice 85

Alexander McMurdo CarsonIntroduction 85Principles in practice 86Mental health nursing: theory 89Mental health nursing: practice 91The production of competence 92The whole story 96Conclusion 98References 99

Chapter 6 Shaping Pre-Registration Mental Health Nursing

Education Through User and Carer Involvement in

Curriculum Design and Delivery 101

Susanne Forrest and Hugh MastersIntroduction 101Background 101Involvement as a knowledge base for pre-registrationmental health nursing education 102The shift in approach 103The impact of ‘the process of involvement’ onprofessional and personal outcomes 105A user- and carer-informed curriculum – opportunitiesand contradictions 107References 112

Chapter 7 Involving Individuals in Mental Health

Nursing Education 114

Mary Chambers, David Glenister, Carol Kelly andTessa ParkesIntroduction 114Writing, sharing and learning 115A return to lecturing 116Individualisation 118Teaching ‘us and them’ 118Living without barriers 120Transforming knowledge 122Institutions 123User/survivor experiences of employment and education 124The involvement of users and survivors in the curriculum 125

Contents v

Becoming loud and proud – the transformative potentialof experiential knowledge 126References 127

Chapter 8 Models of Mental Health Nursing Education: Findings

from a Case Study 129

Ian NormanIntroduction 129Background 129

The specialist–generic debate in mental healthnurse education 130

The study 133Research design and methods 133

Phase 1: Preliminaries 133Key informant interviews 133Selection of sites 134Developing interview schedules 134

Phase 2: Fieldwork 134Phase 3: Analysis and model development 134

The models 135Model 1: The specialist model 138

Desirable structure of pre-registration training andacademic progression 138The basis of nurses’ knowledge and emphasis ofthe pre-registration curriculum 138Expectations of service users 139Shared learning and joint training 139Advantages of specialist education and critiqueof genericism 140

Model 2: The generic model 141Desirable structure of pre-registration trainingand academic progression 141The basis of nurses’ knowledge and emphasis ofthe pre-registration curriculum 141Expectations of service users 142Shared learning and joint training 143Advantages of generic preparation and critiqueof the specialist model 143

Variations on the main models 144The pragmatic model 144The unity-of-nursing model 144

Relevance of the models five years on 145Repackaging UK pre-registration nursing programmes 145Common core education across health care occupations 147

Conclusion 148References 149

vi Contents

Section 3 Analytic and Critical Commentaries and Conclusion 151

Chapter 9 Reflective Commentaries by the Contributors to

Section 2: Each Sees the Field from Within the Field 153

Commentary 9.1Much in Common: Relationships and Knowledge in

the Developing Field 155

Kevin GournayCommentary 9.2On Readings on the Field 158

Stephen TilleyCommentary 9.3Are All as One Among Many and of Equal Value? 161

Peter Griffiths and Vicky FranksCommentary 9.4Re-searching Practice: A Critical Conversation 164

Alexander McMurdo CarsonCommentary 9.5Field of Knowledge: A Critical Commentary 168

Hugh Masters and Susanne ForrestCommentary 9.6Knowledge Camps and Difference: Critical Exploration

in the Field 171

Mary Chambers and Tessa ParkesCommentary 9.7A Tale of Two Mental Health Nursing Traditions 174

Ian Norman

Chapter 10 International Perspectives on the State of Knowledge

of Psychiatric and Mental Health Nursing in

Britain 179

Commentary 10.1Conflicting Knowledge/s: User Involvement in the

Field of Knowledge 181

Kathryn ChurchCommentary 10.2Response from a Canadian Perspective 186

Ruth GallopCommentary 10.3An Australian Perspective on the State of Knowledge

of PMHNing in the UK 189

Mike HazeltonCommentary 10.4The Field of Knowledge of Mental Health Nursing:

A New Zealand Perspective 195

Anthony O’Brien and Madeleine Heron

Contents vii

Commentary 10.5A German Perspective on Paradigmatic Issues in

Psychiatric Nursing 203

Susanne SchoppmannCommentary 10.6An American Commentary 212

Shirley A. Smoyak

Chapter 11 Dance of Knowledge, Play of Power: Intellectual

Conflict as Symptom of Policy Contradiction in the

Field of Nursing Knowledge 216

Desmond P. RyanIntroduction 216Level 1: power in the field of mental health nursing 217Level 2: power over the field – when mental healthknowledge is not nursing knowledge 220Level 3: power beyond the field 224Conclusion 229References 232

Chapter 12 Conclusion: From the Towers to the Piazza 235

Stephen TilleyThe conversation, the tower and the piazza 238References 244

Index 245

viii Contents

This book is dedicated to

Annie Altschul 1919–2001

who brought, gave, and left so much to the field

ix

‘The field cannot well be seen from within the field.’

Ralph Waldo Emerson.

x

Foreword

This book was designed to give a picture of the field of knowledge of UK Psychi-atric and Mental Health Nursing. The strategy for doing this is described in theIntroduction. The core of the book is a set of seven accounts by UK authors ofnursing knowledge as institutionalised in their academic institutions. In someof these chapters authors also explore tensions between experiential and profes-sional knowledge of mental illness. There is then a collective reflection on thefield, made up of each author’s response to the papers by all the other authors.Then, to widen the reflexive arc all these documents were read by internationalrespondents, who commented on the UK authors’ text in light of their own senseof the field in their own countries. Finally, a sociologist, familiar with issues ofmental health nursing, read all this material and provided an interpretation ofsome salient features of the accounts from a sociology of knowledge perspective.

The reader will, therefore get most from reading the book in its entirety andin sequence. However, readers wanting to read selectively will learn about differ-ent perspectives on mental health nursing practice, education and research byreading individual chapters in Section 2; those interested in brief, well-informedaccounts of mental health nursing issues in selected countries outwith the UKmight like to start with Section 3. Readers from disciplines outwith nursing,particularly sociology and social policy, might find it useful to read Chapter 12first, as a view of the field refracted through a sociological lens.

The chapters and commentaries are written in varying styles, and with varyingdegrees of reflexivity. The book will be of interest to those psychiatric and mentalhealth nurses who, through individual and collective efforts, construct the fieldin practice, education and research, and whose experiences cause them to reflecton their relations with their institutions and on the repertoire of knowledges theymust master to be effective professionals.

Stephen TilleyEdinburgh 2004

xi

Acknowledgements

This book is the product of sustained collaborative effort over a long time. I amfirst of all grateful to all the contributing authors, who entered into a covenantbeyond the usual contract of publishing commitments, and stayed faithful to theproject on which we embarked. I thank Desmond Ryan for his generosity ofmind and spirit, without which I could not have completed my elements of thecollective task. The metaphoric extension with which the book concludes I owe tohim. Blackwell Publishing ‘trusted the process’ enabling outcome: I thank themon behalf of all contributors.

Stephen TilleyEdinburgh 2004

xii

Contributors

Alexander McMurdo Carson, RN, RNT, Dip Nurs (London), MSc, PhDReader in Nursing Studies, Faculty of Medical Education and Health, North-EastWales Institute of Higher Education, Wrexham, Wales

Mary Chambers, BEd (Hons), DPhil, RGN, RMN, DN (London), RNTProfessor of Mental Health Nursing and Chief Nurse, Kingston University/StGeorge’s Medical School and Southwest London Mental Health NHS Trust,London, England

Kathryn Church, BA (Hons), MA (Psych), PhDResearch Associate, Ryerson-RBC Institute for Disability Studies Research andEducation, Adjunct Professor, School of Disability Studies, Ryerson University,Toronto, Ontario, Canada

Susanne Forrest, MPhil, Dip CNE, PG Cert Education, RGN, RMNSenior Lecturer, School of Community Health, Napier University, Edinburgh,Scotland

Vicky Franks, TQAP, MSc, Dip Ned, Dip Psych, RNT, RGNVice-Dean and Senior Lecturer in Nurse Education and Consultancy, Tavistockand Portman NHS Trust; Principal Lecturer, School of Health and Social Sci-ences, Middlesex University, London, England

Ruth Gallop, RN, BSc N, MSc N, PhDProfessor Emeritus, Faculty of Nursing, University of Toronto, Toronto, Canada

David Glenister, BS, MSc, PGCEA, RMNLecturer in Nursing, University of Hull, Hull, England

Kevin Gournay, CBE, FRCPsych (Hon), FMedSci, PhD C Psychol, FRCNProfessor, Health Services Research Department, Institute of Psychiatry, London,England

Peter Griffiths, BSc (Hons), SRN, RMN, Cassel CertSenior Lecturer in Child and Family Mental Health Nursing/Child and FamilyDepartment, The Tavistock Clinic; Principal Lecturer, Middlesex University,London, England

xiii