Stephen K. Bradley

Reconstructing Normality: Characteristics of Staff Interactions with Forensic Mental Health Inpatients

Forensic psychiatry is an area of priority for the Danish Government. As the field expands, this calls for increased knowledge about mental health nursing practice, as this is part of the forensic psychiatry treatment offered. However, only sparse research exists in this area. The aim of this study was to investigate the characteristics of forensic mental health nursing staff interaction with forensic mental health inpatients and to explore how staff give meaning to these interactions. The project included 32 forensic mental health staff members, with over 307 hours of participant observations, 48 informal interviews, and seven semistructured interviews. The findings show that staff interaction is typified by the use of trust and relationship-enabling care, which is characterized by the establishment and maintenance of an informal, trusting relationship through a repeated reconstruction of normality. The intention is to establish a trusting relationship to form behaviour and perceptual-corrective care, which is characterized by staffs endeavours to change, halt, or support the patients behaviour or perception in relation to staffs perception of normality. The intention is to support and teach the patient normal behaviour by correcting their behaviour, and at the same time, maintaining control and security by staying abreast of potential conflicts.

Reflections on the ethics of Internet newsgroup research

entification of key ethical issues specifically applicable Internet newsgroup research. uggested resolutions to key ethical issues specifically pplicable to Internet newsgroup research. The potential of the Internet as a setting for the duct of health research; particularly into reported nt experiences has become of interest to both earchers and those who supervise research projects. ever, Haigh and Jones (2005) note that nurses have n slow to realize the potential of such research, possibly due to unfamiliarity with the attendant ethical issues. Consequently, they present an overview of the ethical implications for researchers (and their supervisors, particularly nurse educators) ‘‘in cyberspace’’ and present their ideas for further debate; suggesting that issues surrounding consent, privacy, identification verification and disguise are particularly problematic within Internet research. However, as those authors acknowledged, they were largely extrapolating existing guidance to this ‘‘new’’ domain; a common practice, not without drawbacks (Eynon et al., 2008). Sixsmith and Murray (2001), drawing on their own experience of running an Internet research project, suggest that there are particular problems for researchers to consider regarding the ethical conduct of Internet based health research that are complex and not always amenable to ‘‘straightforward answers’’ (p. 429). Consequently, Flicker et al. (2004) call for ongoing dialogue and debate as to ethical conduct of Internet research; a call echoed by Whitehead (2007). Holmes (2009) concludes that ‘‘ethical standards for Internet research are not yet well-developed’’ (p. 399). It would seem apposite, therefore, to present further consideration of the subject based upon our experience as nurses of conducting an Internet based health research project. Our reflections here arise from a general sense of sympathy and agreement with the above authors’ arguments, and are offered in the spirit of the called for ongoing dialogue; supplementing, rather than supplanting being the aim. The experience from which we derive these reflections comes from having developed and conducted a qualitative project in the area of Child and Adolescent Mental Health (CAMH) as graduate student (SB) and supervisor (BC); accessing and discursively investigating (discourse analysis/ narrative inquiry) accounts of personal mental health experiences to be found freely available and archived at ‘Google Groups’ (https://groups.google.com), focusing particularly on accounts of self-injury/suicide, voluntarily posted by young people to Internet newsgroup forums held on the ‘Google Groups’ archive and comparing/ contrasting them with the existing academic/professional T I C L E I N F O

Appreciating what works: discovering and dreaming alongside people developing resilient services for young people requiring mental health services.

Within this paper we report on a study undertaken to identify resilient services for young people requiring mental health services in the United Kingdom. Whilst undertaking the study we faced issues related to determining what constitutes mental health services, and issues related to different disciplinary perspectives and discourses. These were set within an environment that was changing rapidly as new ways of working were being implemented. Data were collected via interviews and surveys. Nearly every participant felt that young people were not served well. However, the study focused on things that were working well and were being achieved.

Comparing the Obvious: Interactional Characteristics of Staff in Acute Mental Health Nursing and Forensic Psychiatric Nursing

This article reports on and compares two separate studies of the interactional characteristics of forensic mental health staff and acute mental health staff as they interact with inpatients, respectively. Both studies were conducted using participant observation, along with informal and formal interviews. Findings show that both acute and forensic mental health nursing practice is characterized by two overriding themes; ‘trust and relationship-enabling care’ and ‘behavior and perception-corrective care.’ The comparison of the two studies shows no major differences in the characteristics of staff interactions with patients or in the overall meanings ascribed by staff in the different practice settings.

Women's perspectives on illness when being screened for cervical cancer.

Background In Greenland, the incidence of cervical cancer caused by human papillomavirus (HPV) is 25 per 100,000 women; 2.5 times the Danish rate. In Greenland, the disease is most frequent among women aged 30–40. Systematic screening can identify women with cervical cell changes, which if untreated may cause cervical cancer. In 2007, less than 40% of eligible women in Greenland participated in screening. Objective To examine Greenlandic womens perception of disease, their understanding of the connection between HPV and cervical cancer, and the knowledge that they deem necessary to decide whether to participate in cervical cancer screening. Study design The methods used to perform this research were 2 focus-group interviews with 5 Danish-speaking women and 2 individual interviews with Greenlandic-speaking women. The analysis involved a phenomenological-hermeneutic approach with 3 levels of analysis: naive reading, structural analysis and critical interpretation. Results These revealed that women were unprepared for screening results showing cervical cell changes, since they had no symptoms. When diagnosed, participants believed that they had early-stage cancer, leading to feelings of vulnerability and an increased need to care for themselves. Later on, an understanding of HPV as the basis for diagnosis and the realization that disease might not be accompanied by symptoms developed. The outcome for participants was a life experience, which they used to encourage others to participate in screening and to suggest ways that information about screening and HPV might reach a wider Greenlandic population. Conclusion Women living through the process of cervical disease, treatment and follow-up develop knowledge about HPV, cervical cell changes, cervical disease and their connection, which, if used to inform cervical screening programmes, will improve the quality of information about HPV, cervical cancer and screening participation. This includes that verbal and written information given at the point of screening and diagnosis needs to be complemented by visual imagery.

The use of humor in forensic mental health staff-patient interactions

ABSTRACT Humor utilized in the practice of forensic mental health nursing might seem somehow inappropriate, given the serious circumstances surrounding most forensic mental health patients. However, some recent research has pointed to the use of humor as an important component in staff interactions with forensic mental health patients. This study reviews the existing international forensic mental health research literature on humor to investigate (a) what characterizes forensic mental health staff–patient use of humor and (b) what significance humor holds within the forensic mental health setting. The search was conducted in June 2013. Scopus, CINAHL, PubMed, and PsychINFO were searched using keywords relevant to the study. Articles were categorized using a literature matrix and analyzed using thematic analysis. Twelve research articles were reviewed and included in the analysis. Three themes were identified: (a) “humor as staff skill,” showing that staff found humor to be important as an interpersonal ability; (b) “humor as a relational tool” with the purpose of establishing and maintaining staff–patient interactions; and (c) “the impact of humor on patients,” describing impacts on conflicts, dimensions of health, and motivation. The results of the analysis are however limited because of the dearth of published articles on the subject.

Workforce, volume and access: graduate workers' contribution to primary care child and adolescent mental health services

This paper provides initial findings from a pilot to introduce graduate mental health workers into primary care, child and adolescent mental health services (CAMHS) across three localities in the north west of England in the UK. The progress of the pilot was monitored by gathering information from students, managers, supervisors and mentors regularly throughout the 12 month period, during which the pilot cohort were being formally trained. The potential of the new role of primary care graduate mental health workers to address problems of volume and access to services, particularly how the role might contribute to developing nonspecialist primary care services, is considered.