The language of mental health nursing reports: firing paper bullets?

A theory-based research literacy intervention for nurses: A pilot study

OBJECTIVES

Difficulties with understanding research literature can lead to nurses having low engagement with evidence-based practice (EBP). This study aimed to test the feasibility of an education intervention using an academic literacies approach to improve nurses' research literacy.

METHODS

An interactive workshop was devised utilizing genre analysis and tested in a pre/post pilot study. EBP self-efficacy was measured at baseline and posttest using the Self-Efficacy in Evidence-Based Practice instrument (26 items on an 11-point scale for total scores from 0 to 260). Research comprehension was measured with a 10-question quiz (range 0-10).

RESULTS

When analyzed with a paired t-test, EBP self-efficacy increased significantly (MD: 56.9, SD: 39.9, t = 4.5, df = 9, p < .001). Research comprehension also improved (MD: 1.1; SD: 1.1, t = 2.9, df 9, p < .01). The workshop evaluations (n = 9) were overwhelmingly positive.

CONCLUSION

This novel approach to research pedagogy aligns well with adult learning theory and social learning theory and is suitable for small group learning in continuing education. There is considerable potential for further work in this area. Genre analysis shows promise as a strategy for teaching nurses to understand research literature.

Remission from Depression in the DSM: Moving from Rhetoric to Restoration

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, uses the term "remission" to describe the reduction of depressive symptoms. This paper argues that by categorizing someone who no longer has depressive symptoms as "in remission," that person may feel indefinitely tied to his or her diagnosis. Considering the unfortunate stigma associated with mental illness, permanent linkage to diagnosis through records and professional memory may cause individuals to internalize pathology. In fact, the language of the diagnosis can affect self-perception in sensitive souls for a lifetime. As an implication for practice, we propose that cognitive and narrative therapy approaches, mood-memoirs, and use of metaphor present alternative uses of language that can reduce power imbalances between clinicians and clients, providing a bridge to healing.

Les notes « Observations de l’infirmière » du Département de psychiatrie de l’Hôpital Montfort : une source archivistique incontournable en santé mentale

Les notes des infirmières sont utilisées essentiellement comme outil de communication entre les infirmières, les médecins et les membres de l’équipe professionnelle pour assurer la continuité des soins des patients. Elles contiennent des parcelles d’histoire de vie des individus atteints de troubles de santé mentale. Cet outil de communication des infirmières décrit les épisodes de soins et les nombreuses hospitalisations des patients admis au département de psychiatrie de courte durée. En fait, ces notes d’observations représentent plus que le simple portrait de la maladie mentale. Elles racontent toujours un récit construit selon certaines normes socioculturelles. Leurs données narratives documentent l’intersection entre les expériences personnelles et les structures sociale, institutionnelle et professionnelle. Elles laissent des traces sur l’influence des politiques et des réformes gouvernementales en matière de santé mentale sur le réseau de la santé. L’étude de ces sources archivistiques permet d’élucider la relation entre les hôpitaux généraux et la société en général et ouvre une fenêtre sur l’ensemble des conditions de vie sociale de ces individus. Le but de cet article est de démontrer que ces données narratives sont une source complète d’information pour comprendre l’expérience de la santé mentale suite au projet de désinstitutionnalisation. Elles offrent une multitude de possibilités de recherche en santé mentale et peuvent être examinées sous différents angles d’analyse.

How writing records reduces clinical knowledge: a field study of psychiatric hospital wards

Through the practices of recording, psychiatric nurses produce clinical knowledge about the patients in their care. The objective of this study was to examine the conventionalized practices of recording among psychiatric nurses and the typical linguistic organization of their records. The study drew on data from an extended fieldwork on two Danish "special observation" wards. The results indicated that the nurses' recording produced "stereotyping" representations of the patients and reduced the nurses' clinical knowledge but that this particular way of recording made good sense in relation to the social organization at the wards.

'She's manipulative and he's right off': a critical analysis of psychiatric nurses' oral and written language in the acute inpatient setting

Remarks such as 'she's manipulative' and 'he's right off' are familiar to psychiatric nurses. This paper critiques the language nurses use in acute inpatient psychiatry services, highlighting the diverse discourses implicated in nurses' writing and speaking about patients. Based on a review of the literature, this paper examines ethnographic studies and discourse analyses of psychiatric nurses' oral and written language. A prominent debate in the literature surrounds nurses' use of standardized language, which is the use of set terms for symptoms and nursing activities. This review of spoken descriptions of patients highlights nurses' use of informal and local descriptions, incorporating elements of moral judgement, common sense language and empathy. Research into written accounts in patient files and records show nurses' use of objectifying language, the dominance of medicine and the emergence of the language of bureaucracy in health services. Challenges to the language of psychiatry and psychiatric nursing arise from fields as diverse as bioscience, humanism and social theory. Authors who focus on the relationship between language, power and the discipline of nursing disagree in regard to their analysis of particular language as a constructive exercise of power by nurses. Thus, particular language is in some instances endorsed and in other instances censured, by nurses in research and practice. In this paper, a Foucauldian analysis provides further critique of taken-for-granted practices of speech and writing. Rather than censoring language, we recommend that nurses, researchers and educators attend to nurses' everyday language and explore what it produces for nurses, patients and society.

Discourse analysis of an 'observation levels' nursing policy

The practice of special observation (or constant observation) is widely used in inpatient psychiatric facilities for the care of people who are suicidal. In this study, the policy of special observation was examined using a discourse analysis method to discern prevailing ideas and practices highlighted within the policy. After reading, studying and analysing the special observation nursing policy, the authors briefly describe the document and outline the terms and phrases prevalent within the document. These recurrent ideas are then organized into five categories: professional responsibilities, suicidality, the patient's immediate context, the patient's observable behaviour and the nursing checklist. In discussion of the policy document, the invisibility of the authors, target audience and patients is noted. The authors attempt to elicit evidence for the therapeutic nurse-patient relationship in the document. In the analysis of patient, nurse and doctor roles and responsibilities, it is evident that the policy document reinforces the traditional medical hierarchy of power relations. Some assumptions that underpin the document are postulated. Questions regarding the nature of risk assessment and the evidence base for the medical prescription of special observation are raised. As well as ideas and themes evident in the document, the absence of some relevant issues is explored. While the need for succinctness and clarity in policy documents is acknowledged, the fact that patient rights, therapeutic processes and ethical dilemmas are absent is deemed significant.