Tony Warne

Towards an uncertain politics of professionalism: teacher and nurse identities in flux

This paper is about the nature of contemporary professional identity. It looks at the ways in which ‘discursive dynamics’ come to re-write the professional teacher and nurse as split, plural and conflictual selves, as they seek to come to terms with a political impetus written through what the authors term an ‘economy of performance’ in uncertain conflict with various ‘ecologies of practice’. The teacher and nurse are thus located in a complicated nexus between policy, ideology and practice. Epistemologically, the paper offers a deconstruction of professional identities, and criticizes the reductive typologies and characterizations of current professionalism. Politically, it reaches towards a more nuanced account of professional identities, stressing the local, situated and indeterminable nature of professional practice, and the inescapable dimensions of trust, diversity and creativity.

An exploration of the clinical learning experience of nursing students in nine European countries

The overall aim of the study was to develop a composite and comparative view of what factors enhance the learning experiences of student nurses whilst they are in clinical practice. The study involved students undertaking general nurse training programmes in nine Western European countries. The study focused on: (1) student nurse experiences of clinical learning environments, (2) the supervision provided by qualified nurses in clinical placements, and (3) the level of interaction between student and nurse teachers. The study utilised a validated theoretical model: the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale. The evaluation scale has a number of sub-dimensions: Pedagogical atmosphere on the ward; Supervisory Relationships; the Leadership Style of Ward Managers; Premises of Nursing; and the Role of the Nurse Teacher. Data (N=1903) was collected from Cyprus, Belgium, England, Finland, Ireland, Italy, Netherlands, Spain and Sweden using web-based questionnaire 2007-2008. The findings revealed that respondents were generally satisfied with their clinical placements. There was clear support for the mentorship approach; 57% of respondents had a successful mentorship experience although some 18% of respondents experienced unsuccessful supervision. The most satisfied students studied at a university college, and had at least a seven week clinical placement supported by individualised mentorship relationships. Learning to become a nurse is a multidimensional process that requires both significant time being spent working with patients and a supportive supervisory relationship.

Using patient experience in nurse education

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The shackles of abuse: unprepared to work at the edges of reason.

Childhood sexual abuse is an international public health problem. Research suggests similar prevalence rates in both Western and non-Western societies. The long-term consequences of child sexual abuse include wide ranging mental health problems in adult life. Psychiatric services and, in particular, counselling has been highlighted as being the most helpful to those who have experienced child sex abuse. This evidence base should be informing mental health nursing education and practice. However, we argue there is a divergence between the discourse of evidence-based theory and practice reality. The aim of this paper is to explore the preparedness of mental health nurses to work with adults who have experienced sexual abuse during their childhood. It is the first part of a three-part research project and reviews the literature relating to how (and if) mental health nurses are prepared to work with those who have sexual abuse histories. An important issue considered in this review is the impact upon patient/nurse relationships as a consequence of the nurse themselves being survivors of sexual abuse. We argue that a number of conflicting discourses need to be addressed, if mental health nurses are to be appropriately prepared to offer cogent, sensitive care to those in their care who are shackled to their past sexual abuse through the confines of their current mental illness.

Young, gifted, and caring: A project narrative of young carers, their mental health, and getting them involved in education, research and practice

Young carers are a global phenomenon. The UK estimates it has in excess of 175 000 young carers, the onset of their caring role often occurring between 8 and 10 years of age. Of these, 17 000 are caring for a parent who has severe mental illness, a significant factor for children entering the health and social care system, as up to 60% experience mental health difficulties themselves. This paper reports on the outcome of a participatory project aimed at better understanding the needs of young people. A World Café event was hosted, bringing together those involved in promoting the mental health of young people in a partnership consortium. The event was led by young service users and carers. Important issues raised by the young carers were being excluded from being included; stuck in the here and now, ignoring the future; a hole in the net; and ensuring the hidden is on the agenda. The World Café gave the university the privilege of insight into what local young carers need to improve their mental health, and more importantly, how we can utilize our skills to help them achieve their goals.

GROUP SUPERVISION IN FACILITATING LEARNING AND TEACHING IN MENTAL HEALTH CLINICAL PLACEMENTS: A CASE EXAMPLE OF ONE STUDENT GROUP

Clinical supervision has become an essential component in nursing practice. This paper explores the experiences of two small groups of Finnish Registered General Nurse students receiving supervision during a clinical placement in mental health care (N = 23). Both groups worked in similar clinical placements, with one group receiving group supervision, the other individual supervision. Students reported that group supervision was a positive experience and a good alternative to the traditional supervision they had received earlier. Group supervision allowed students to begin to address their fears and anxieties over their ability to deal with the unfamiliar emotional and psychological demands of practice. Eighteen students reported that the staff nurse mentor was most important in helping them better understand the core concepts and practice of nursing. All the students who thought that nurse teacher was important in this regard came from the group supervision group.

'That was helpful ... no one has talked to me about that before': research participation as a therapeutic activity

There is considerable interest in the various ethical problems associated with undertaking health and social science research. Participants in such research are often considered vulnerable because of their health status, social position, or dependence on others for health and welfare services. Researchers and ethics committees pay scrupulous attention to the identification and amelioration of risks to participants. Rarely are the benefits to participants of engaging in research highlighted or drawn to the attention of potential participants. Such potential benefits need to be considered by researchers and reviewers when considering the balance of benefits and harms associated with research projects. In this paper, we particularly consider the psychotherapeutic benefits of participation in research.

Hearing the voices of young people who self‐harm: Implications for service providers

The incidence of adolescent self-harm and suicidal behaviour has increased globally, with many adolescents repeating the behaviour. While studies indicate that large numbers of adolescents who self-harm do not seek professional help, research focusing on barriers to help seeking from an adolescent perspective is limited. Locally, a rise in reported and unreported rates of self-harm and a number of suspected child suicides prompted the commissioning of a research project to ascertain young peoples experiences of help and support for self-harm and how their future needs could be best met. Qualitative research, adopting an interpretive phenomenological analysis, was used to elicit narratives of adolescents engaging in self-harm. Data were collected via 1:1 interviews with seven participants and analysed in two stages: an analysis of each individual narrative, and thematic analysis across the group. Three themes were identified: (i) cutting out the stress; (ii) stepping onto the path of help; and (iii) cutting to the chase. In conclusion, mental health nurses have a vital role in providing knowledge and support to those likely to have initial contact with this vulnerable group and to the wider population, ensuring we more effectively address the increasing use of this risky behaviour among young people.

Constructing a bricolage of nursing research, education and practice

Drawing upon post doctoral reflections of a shared methodology, the authors explore the use of bricolage as a way of better understanding the inter-related connections between theory, nursing practice and the felt experiences of service users. The origins of bricolage can be traced back to the work of Levi-Strauss, and Denzin and Lincolns contribution to qualitative methodologies. Bricolage is a multifaceted approach to the research process. Differing epistemological positions and mixed methods of data collection are utilised to bring a richer understanding of human beings and the complexities of their lived experiences. For the bricoleur the object of inquiry, cannot be separated from its context, that is the language used to describe it, its historical situatedness and the social and cultural interpretations of its meaning as an entity in the world. The paper discusses the importance of being able to move beyond the notion of the research method being merely a procedure, to one that respects the complexities of the lived world.

‘Connecting’ the Distance: relational issues for participants in a distance learning programme

Abstract This article explores the relational expectations of distance learning students and tutors. The authors’ experiences teaching a degree course to mature students (mainly practitioners working for the National Health Service) highlight that the reality of the relationship is often incongruent with the expectations. This incongruence appears to have a negative effect on the learning process. In order to develop a more effective distance learning programme the authors explored the experiences and needs of the students, via a series of focus groups and conversations. What emerged as being significant was the need for students to experience ‘connectedness’ with the tutor. How the students defined this concept and what practical measures the tutors took to ‘connect’ the distance between participants in the learning process are discussed.