This paper reports the findings of a study into the management of change within a learning disability service in transition from medium to low security status. The relationship between the service culture and resistance to change was a key consideration. A focus group approach was utilized with eight professionals from a range of disciplines meeting on six separate occasions, and the data was subsequently subject to thematic analysis. The study findings revealed markedly different perceptions of the response of the staff team to the implementation of change, with three groups adopting markedly different identities and allegiances. A dynamic group, embracing change and showing initiative, a strategically resistant group, and a third group, the ‘toggle’, swaying towards one of the other two groups according to changing circumstances. The paper concludes that the toggle group were extremely influential with regard to the implementation of change, and may be of significance in analysis of strategies of resistance.
Mason, Tom; Coyle, David L.; Lovell, Andy (Blackwell, 2008)
This study reports on research undertaken to identify the skills and competencies of forensic psychiatric nurses working in secure psychiatric services in the UK. The rationale for this research is the lack of clarity in the role definition of nurses working in these environments and the specific content that may underscore the curriculum for training forensic nurses. Over 3300 questionnaires were distributed to forensic psychiatric nurses, non-forensic psychiatric nurses and other disciplines and information obtained on (1) the perceived clinical problems that give forensic nurses the most difficulty, (20 the skills best suited to overcome those problems and (3) the priority aspects of clinical nursing care that needs to be developed. A 35% response rate was obtained with 1019 forensic psychiatric nurses, 110 non-forensic psychiatric nurses and 43 other disciplines. The results highlighted a 'top-ten' list of main problems with possible solutions and main areas for development. the conclusions drawn include a focus on skills and competencies regarding the management of personality disorders and the management of violence and aggression.
Mason, Tom; Lovell, Andy; Coyle, David L. (Blackwell, 2008)
This paper reports on an investigation into the skills and competencies of forensic psychiatric nurses from the perspective of three groups (a) forensic psychiatric nurses, (b) non-forensic psychiatric nurses and (c) other disciplines. A national survey of freonsc psychiatric services in the UK was conducted, and information gathered on the perceived skills and competencies in this growing field of psychiatric practice. From 3360 questionnaires, 1172 were returned making a response rate of 35%. The results indicate a small discrepancy between forensic nurses' and non-forensic nurses' perceptions of the role constructs of forensic practice. However, a larger difference was noted between nurses'perceptions and other disciplines' perceptions of the constituent parts to forensic psychiatric nursing. Nurses tend ed to focus on personal qualities both in relation to themselves and th epatients, while the other disciplines focused on organizational structures both in defining the role and in the resolution of perceived deficits. The findings have implications for multidisciplinary working, as well as policy formulation and curriculum development in terms of the skills and competencices of forensic nurse training.
Hutchinson, John; Lovell, Andy; Mason, Tom (2012-02-19)
This study reports on research conducted to examine how community practitioners manage the difficulties of risk assessment in relation to people with a learning disability and a history of sexually offensive or abusive behaviour. Semi-structured interviews were conducted with a number of key professionals from various disciplines, all currently involved in the assessment process with the aim of determining potential referral to community settings. Data analysis revolved around a thematic exposition of factors influencing the relationship between the objective science of psychiatric investigation and the subjective interpretation of real-world practicalities in working with this group. Findings surrounded three major themes, frame conflict, relating to the difficulties of decision making in this area, therapeutic performance, whereby professionals were expected to engage in some form of active intervention, and safety outcomes, involving consideration of the problematic nature of judging the likelihood of re-offending.
This paper reports on the results of a study into the self-reported coping strategies employed by a small sample (n=12) of individuals diagnosed with Bulimia Nervosa purging sub-type, severe and enduring eating disorder (Seed-BN), referred to an out-patient clinic for psychotherapy. Data collection focused on the vomiting activities of participants through analysis of their self-management from diary extracts, which recorded vomiting patterns. Participants all experienced significant mental health issues, had complex histories of BN over a prolonged period, difficulties maintaining relationships, and many had an additional history of substance misuse including dependence on prescription drugs. The study findings indicated two different self-management strategies, anxiety-containment and compulsion-maintenance. There was a clear association between anxiety and controlled weekly vomiting patterns compared with compulsion and daily vomiting patterns. The implications for nursing practice relate to the potential for assessment of differences in vomiting patterns to indicate self-management status and subsequent interventions focusing on either anxiety or compulsive patterns.
Abstract Aim: To identify and discuss the personal attributes required by learning disability nurses to work effectively with people with an offending background in secure and community settings. Background: This paper was part of a larger research investigation into the nursing competencies required to work with people with an offending background. There are few existing studies examining the personal attributes necessary for working with this group. Design: A qualitative study addressing the perceptions of nurses around the personal attributes required to work with people with learning disabilities and an offending background. Methods: A semi-structured interview schedule was devised and constructed, and thirty-nine individual interviews subsequently undertaken with learning disability nurses working in high, medium, low secure and community settings. Data were collected over 1-year in 2010/11 and analysed using a structured thematic analysis supported by the software package MAXqda. Findings: The thematic analysis produced three categories of personal attributes, named as looking deeper, achieving balance and connecting, each of which contained a further three sub-categories. Conclusion: Nursing of those with a learning disability and an offending background continues to develop. The interplay between personal history, additional background factors, nurses’ personal attributes and learning disability is critical for effective relationship building.
Hutchinson, Andre; Lovell, Andy (Wiley-Blackwell, 2012-11-21)
Contemporary models of involvement within statutory services pay little regard to the identity of individuals beyond the ‘service user’ label and in doing so unwittingly perpetuate and sustain the negative impact of mental illness. The aim of this paper is to discuss the process of a 3-year participatory action research study facilitated by a mental health nurse. It highlights the perspective of those involved as co-researchers, all having experience of accessing statutory mental health services. It identifies both the process and the impact of this type of involvement on them illustrating their move beyond an illness identity. The study involved them undertaking a series of interviews with other service users in relation to their life stories. They subsequently mapped and analysed the transcripts. In order that the people were enabled to undertake these roles the study included a process of interviewing and appointing service user researchers followed by a programme of training workshops, supervision and discussion group/ peer support. The accounts provided reflect the six researchers’ attempts to make sense of their experience and reveal the path of transformation through collaboration.
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