title: Managing and caring for distressed and disturbed service users: the thoughts and feelings experienced by a sample of English mental health nurses.
abstract: This paper reports the thoughts and feelings experienced by registered mental health nurses caring for distressed and/or disturbed service users in acute inpatient psychiatric settings in England. The prevailing thoughts of nurses were of cognitive dissonance and the conflict between benevolence and malevolence if coercive measures were seen as negative rather than positive; prevailing feelings experienced by nurses were fear, anxiety and vulnerability. To enhance care quality, nurses expressed the need for better communication with service users, and preventing the use of coercive measures and promotion of alternative methods of care and management. The nurses considered that debriefing dialogues following untoward incidents, practice development initiatives, education and training together with clinical supervision could be the way forward. The paper builds on the existing literature in offering clear explanations of nurses' thoughts and feelings when caring for distressed and/or disturbed service users in an English acute, inpatient psychiatric setting. Despite the small sample size and the limitations that it generates, the study findings will be of interest to the wider mental health nursing community. The findings will link to other national and international studies and therefore be valuable for future research studies of this kind. Collectively, they are building up a general picture of the distress, cognitive and emotional dissonance experienced by mental health nurses when using coercive interventions. The findings will help to develop mental health nurse education and enhance practice. High levels of distress and disturbance among service users experiencing acute mental illness is a major problem for mental health nurses (MHNs). The thoughts and feelings experienced by these nurses when caring for service users are of paramount importance as they influence clinical practice and caregiving. Similarly to research by other countries, this paper reports national, qualitative data regarding the thoughts and feelings of English MHNs who care for these service users within acute inpatient psychiatric settings. Data were collected from focus groups in which MHNs working in acute inpatient settings in England participated and analysed using inductive content analysis. Findings highlighted three broad themes: (1) emotional and cognitive dissonance; (2) therapeutic engagement; and (3) organizational management and support. The prevailing thoughts of nurses were of cognitive dissonance and the conflict between benevolence and malevolence if coercive measures were seen as negative rather than positive; the prevailing feelings experienced by nurses were fear, anxiety and vulnerability. Nurses would like better communication with service users, prevention of coercive measures and the use of alternative methods of care and/or management to ensure enhanced care. Participants considered practice development initiatives, education, training, staff and managerial support including debriefing and clinical supervision as the way forward. Despite the small sample size and its limitations, these national data add to the existing literature, and the study findings link to those of other studies both nationally and internationally. Collectively, these studies are building up a general picture of the distress, cognitive and emotional dissonance experienced by MHNs when using coercive interventions. The findings will help to develop MHN education and enhance practice.
authors.affiliation: Faculty of Health, Social Care and Education, Kingston University and St. George's, University of London, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Chambers
authors.affiliation: Faculty of Health, Social Care and Education, Kingston University and St. George's, University of London, London, UK.
authors.forename: X
authors.initials: X
authors.lastname: Kantaris
authors.affiliation: Department of Health Studies, Faculty of Social Science, University of Stavanger, Stavanger, Norway.
authors.forename: V
authors.initials: V
authors.lastname: Guise
authors.affiliation: Department of Nursing Science, Turku University Hospital, Turku, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Välimäki
mesh_terms: D000328:Adult; D004739:England; D005260:Female; D017144:Focus Groups; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000592:standards*; D011568:Psychiatric Nursing / Q000592:standards*
keywords: acute; feelings; inpatient; mental health nursing; thoughts