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Psychiatric and MentalHealth Nursing:The Field of Knowledge
Edited by
Stephen Tilley
BlackwellScience
Psychiatric and MentalHealth Nursing:The Field of Knowledge
Edited by
Stephen Tilley
BlackwellScience
© 2005 by Blackwell Science Ltda Blackwell Publishing company
Editorial offices:Blackwell Science Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK
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All rights reserved. No part of this publication may be reproduced, stored in a retrievalsystem, or transmitted, in any form or by any means, electronic, mechanical, photocopying,recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act1988, without the prior permission of the publisher.
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.
RC440.P7297 2004616.89′0231–dc22
2004009497
ISBN 0-632-05845-5
A catalogue record for this title is available from the British Library
Set in 10/12.5pt Palatinoby Graphicraft Limited, Hong KongPrinted and bound in Indiaby Replika Press Pvt. Ltd, Kundli
The publisher’s policy is to use permanent paper from mills that operate a sustainableforestry policy, and which has been manufactured from pulp processed using acid-free andelementary chlorine-free practices. Furthermore, the publisher ensures that the text paperand cover board used have met acceptable environmental accreditation standards.
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The opinions expressed in this book are those of the editors and authors concerned. Theseviews are not necessarily those held by Blackwell Publishing.
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
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
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