title: 'You don't talk about the voices': voice hearers and community mental health nurses talk about responding to voice hearing experiences.
abstract: OBJECTIVE
  To explore service user and community mental health nurses views on responses to voice hearing experiences.
  
  
  BACKGROUND
  People who hear distressing auditory hallucinations (voices) are often in contact with mental health services. Nursing responses to this experience have been limited, although emerging evidence suggests some utilitarian alternative interventions, such as discussing the content and meaning of the voices.
  
  
  METHODS
  Using exploratory interviews, this study investigated the response to voice hearing, with a purposive sample of community mental health nurses (n = 20) and service users (n = 20). This paper reports on a thematic content analysis of transcribed interviews, which highlighted differences in perspectives of voice hearers and the nurses supporting them.
  
  
  RESULTS
  Voice hearers reported that interventions from community mental health nurses were limited to reviews of medication, access to the psychiatrist and non-directive counselling. They identified alternative needs, which involved talking more about the content and meaning of their voices. Conversely, community mental health nurses regarded their responses to voice hearing as being considered, titrated and demonstrating an awareness of the personal contexts of service users. These responses were however restricted by their perception of skill limitations.
  
  
  CONCLUSIONS
  The contrasting views of nurses and users of services demonstrated in this study, reveal multiple social realities that represent a challenge to accepted professional responses in the provision of mental health care.
  
  
  CONCLUSIONS
  People who hear voices express an interest in more helpful responses from community mental health nurses. The findings of this study indicate that nurses must begin to orientate themselves towards a more critical practice stance that encompasses available knowledge on the voice hearing experience.
authors.affiliation: Community Mental Health Nursing, Centre for Mental Health Studies, School of Health Science, Swansea University, Swansea, UK. m.j.coffey@swansea.ac.uk
authors.forename: Michael
authors.initials: M
authors.lastname: Coffey
authors.forename: Jeanette
authors.initials: J
authors.lastname: Hewitt
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002983:Clinical Competence; D003142:Communication; D003152:Community Health Nursing / Q000458:organization & administration*; D003156:Community Mental Health Services / Q000458:organization & administration; D005260:Female; D006212:Hallucinations / Q000451:nursing / Q000523:psychology; D006801:Humans; D008297:Male; D020380:Needs Assessment; D024802:Nurse's Role / Q000523:psychology*; D009723:Nurse-Patient Relations; D009730:Nursing Assessment; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000458:organization & administration / Q000523:psychology; D011568:Psychiatric Nursing / Q000458:organization & administration*; D012017:Referral and Consultation; D020377:Self Efficacy; D012944:Social Support; D011795:Surveys and Questionnaires; D014852:Wales