John R. Cutcliffe

Reconsidering Reflexivity: Introducing the Case for Intellectual Entrepreneurship:

In this article, the author reconsiders reflexivity and attempts to examine some unresolved issues by drawing particular attention to the relationship between reflexivity and certain related phenomena/processes: the researcher’s a priori knowledge, values, beliefs; empathy within qualitative research; the presence and influence of the researcher’s tacit knowledge, and May’s “magic” in method. Given the limitations of some reflexive activity identified in this article, the author introduces the case for greater intellectual entrepreneurship within the context of qualitative research. He suggests that excessive emphasis on reflexive activity might inhibit intellectual entrepreneurship. Wherein intellectual entrepreneurship implies a conscious and deliberate attempt on the part of academics to explore the world of ideas boldly; to take more risks in theory development and to move away from being timid researchers.

Leveling the Playing Field? Exploring the Merits of the Ethics-as-Process Approach for Judging Qualitative Research Proposals

There has been a recent growth in claims that qualitative research proposals are not treated equitably by ethics committees. In response, recent arguments centered on establishing the ethics of qualitative research, in the eyes of ethics committees, have indicated the need for an “ethics-as-process” approach. Accordingly, in this article, the authors illustrate the merits of this approach and provide three examples from the field: the outcomes of participating in qualitative interviews, sensitive handling of ending in qualitative research relationships, and the ongoing establishment of informed consent. The authors hope to increase awareness of the potential benefits of this approach and contribute to the ensuing debate.

The Inspiration of Hope in Bereavement Counseling

While most healthcare workers would agree that hope is necessary for healthy living, the current understanding of hope and hoping is incomplete. This article reports on a study that attempted to answer the question: Do bereavement counselors inspire hope in their clients, and if so, how? The study used a modified grounded theory method and collected data, by means of interviews, from a total sample of 12 participants, comprising bereavement counselors and ex-clients who had received bereavement counseling. The data were coded and analysed using the constant comparative method, which produced an emerging, integrated, substantive grounded theory of hope inspiration for this client group. This theory includes a core variable: the implicit projection of hope and hopefulness; and three subcore variables: forging the connection and the relationship; facilitating a cathartic release; and experiencing a good (healthy) ending. The theory indicates that this hope inspiration appears to be a subtle, unobtrusive process that was bound up with the necessary and sufficient human qualities in the counselor and the projection of these into the environment (and client).

Prospective study of risk factors for increased suicide ideation and behavior following recent discharge

OBJECTIVE The purpose of this study is to prospectively examine the association between predictors from the three thematic areas - suicidality, personal risk factors and patient care factors - and the occurrence of postdischarge suicide ideation and behavior in recently discharged patients. METHODS The design is a prospective cohort study of all patients admitted to an inner city inpatient psychiatric service with a lifetime history of suicidal behavior and current suicidal ideation. Predictors of suicide ideation at 1, 3 and 6 months following discharge and suicide behavior over the 6 months of follow-up were examined. RESULTS The incidence of death by suicide during the study period was 3.3% [95% confidence interval (CI)=0.9%-8.3%], and 39.4% (95% CI=30.0%-49.5%) of the surviving participants reported self-injury or suicide attempts within 6 months of hospital discharge. Risk factors such as recent suicide attempts, levels of depression, hopelessness and impulsivity were predictive of increased suicide ideation or behavior after discharge from the inpatient service. CONCLUSIONS The high risk of suicide ideation, suicide attempts and suicide demonstrated in these recently discharged patients supports the need to develop selective prevention strategies.

Qualified Nurses' Lived Experience of Violence Perpetrated by Individuals Suffering from Enduring Mental Health Problems: A Hermeneutic Study

The incidence of violence within the National Health Service is rising and attention to the issue is increasing. Due to the ramifications in terms of physical, psychological and economic cost, the need to understand all the dynamics and variables involved in violence becomes evident. If nurses can provide care that reduces the frequency, intensity and negative consequences of violence, then clients, nurses and the organisation all benefit. This study attempted to discover the lived experience of nurses who experience violence perpetrated by individuals suffering from enduring mental health problems. It adopted a hermeneutic, phenomenological, method and produced an emerging theory comprised of the three key themes; Personal construct of violence, Feeling equipped and Feeling supported. Furthermore, the author suggests relationships between exposure to violent incidents and the nurses ability to deal with the incidents therapeutically and how formal support systems for nurses influence this relationship. Strategic plans that are concerned with caring for violent individuals need to consider this reciprocity, as staff who feel well supported may well have a substantial impact on the quality of care offered to these people.

Providing Meaningful Care Learning From the Experiences of Suicidal Young Men

Little is known about young suicidal men’s preferences for care. Using a broad interpretive approach, we interviewed 36 formerly suicidal young men in a study addressing the development and provision of mental health services. Our analysis yielded three core categories: widening access and bolstering proactive outreach, on becoming a man, and equipping young men for future challenges. Collectively, these categories suggest key features and processes of appropriate service configuration and clinical care: (a) services that reach out proactively serve to encourage young men’s initial and ongoing engagement; (b) care delivered over the long term ensures a necessary focus on a meaningful future life; (c) mental health professionals (MHPs) are centrally involved alongside significant others, including those with personal experience of suicide; and (d) the development of a vital interpersonal connection is based on MHPs actively communicating their empathy, open-mindedness, and interest in a young man’s unique biography.

Providing Meaningful Care

Little is known about young suicidal men’s preferences for care. Using a broad interpretive approach, we interviewed 36 formerly suicidal young men in a study addressing the development and provision of mental health services. Our analysis yielded three core categories: widening access and bolstering proactive outreach, on becoming a man, and equipping young men for future challenges. Collectively, these categories suggest key features and processes of appropriate service configuration and clinical care: (a) services that reach out proactively serve to encourage young men’s initial and ongoing engagement; (b) care delivered over the long term ensures a necessary focus on a meaningful future life; (c) mental health professionals (MHPs) are centrally involved alongside significant others, including those with personal experience of suicide; and (d) the development of a vital interpersonal connection is based on MHPs actively communicating their empathy, open-mindedness, and interest in a young man’s unique biography.

Systemic perspective of violence and aggression in mental health care: towards a more comprehensive understanding and conceptualization: part 1.

Aggression and violence (A/V) in mental health care are all too frequent occurrences; they produce a wide range of deleterious impacts on the individual client, staff, organizations, and the broader community. A/V is a multifaceted and highly-complex problem, and is associated empirically with a wide range of phenomena. However, most attempts to reduce A/V in mental health care have invariably focused on one or two aspects of the problem at the expense of a more comprehensive, systemic approach; these have produced inconclusive results. As a result, this two-part paper seeks to: (i) recognize the wide range of phenomena that have been found to have an association with A/V in mental health care; (ii) synthesize these propositions according to fit or congruence into a systemic model of A/V; (iii) explore empirical evidence pertaining to these propositions; and (iv) begin to consider the application of this model to better inform our individual and/or organizational responses to A/V in mental health care. The paper advances a systemic model of these phenomena comprised of four thematic categories, with Part 1 of this paper focusing on the first two categories: environmental and intrapersonal (client-related) phenomena.

The Principles and Processes of Inspiring Hope in Bereavement Counselling: A Modified Grounded Theory Study – Part One

The concept of hope has received attention within nursing and healthcare literature of late yet it is fair to say that despite this increased interest, considerable gaps remain in our substantive knowledge base. Particularly noticeable is the paucity of empirically derived theory regarding the principles of inspiring and instilling hope in certain client groups and with persons enduring certain experiences. Accordingly, this two-part paper attempts to bridge one of these gaps by answering the question: do bereavement counsellors inspire hope in their clients and if so, how? Using a modified grounded theory method data were collected by means of semi-structured interviews; undertaken with a theoretical sample of bereavement counsellors and ex-clients who had received bereavement counselling. In keeping with the tenets of grounded theory, the data were coded and analysed using the constant comparison method, and this produced an emerging, substantive theory of the principles and processes of hope inspiration for this client group. This theory is comprised of a core variable: the implicit projection of hope and hopefulness, and three sub-core variables: forging the connection and the relationship; facilitating a cathartic release; and experiencing a healthy (good) ending. Given that the details of the core variable have been published previously, part one of this paper deals with a review of the literature and focuses on stage one; highlighting each of the individual categories. Where as part two focuses on stages two and three, again highlights the categories therein and offers a discussion and conclusion.

Misplaced epistemological certainty and pharmaco-centrism in mental health nursing

We read with interest a number of recently published papers in this journal, such as Jones & Gray (2008a,b) and wish to respond to these. In so doing, rather than take issue with individual specific points, we wish to draw attention to a trend that can be detected in these (and other similar) papers. The concerns we wish to raise should not be regarded as yet another debate paper on, for want of a better expression, the ‘biological versus interpersonal’ emphasis in psychiatric/mental health nursing as this literature is well developed.1 Instead, it is our intention to look at and subsequently consider the way arguments are presented in these (and similar papers); we wish to draw attention to the way that these pharmaco-centric arguments are constructed.