Autoethnography and Mental Health Nursing

It is no secret that it takes a special kind of person to be a mental health nurse. Qualities and abilities such as well-developed self-awareness, acceptance of self and others’ feelings, an understanding of the complexity of the human experience, an ability to accept ambiguity and uncertainty, willingness to take responsibility for self, and provision of trust and respect are crucial for the effective psychiatric mental health nurse (Foster, McAllister & O’Brien, 2006).
But how does one integrate all these qualities effectively in practice? How does one become an effective mental health nurse? Foster, McAllister & O’Brien, 2006, state that autoethnography is the answer. According to them, autoethnography, the study of "self" should be an integral part of every mental health nurse's practice to ensure the highest level of care.
Little research has been written on the topic of autoethnography, and its use. Foster, McAllister & O’Brien, 2006, in their article “Extending the Boundaries: Autoethnography as an Emergent Method in Mental Health Research” talk about the use of autoethnography as a new approach to caring for the mentally ill, as well as a research method, with the emphasis on mental health nursing research.
The same authors, in an article published in December 2006, talk about the experiences of a doctoral student whose mother is mentally ill, and the process through which she used autoethnography to generate new research in the field, and relate to other mentally ill patients.
Other articles such as “Nursing Student Attitudes to Psychiatric Nursing and Psychiatric Disorders in New Zealand” (Surgenor, Dunn & Horn, 2005) and “A Survey of Mental Health Nurses’ Experiences of Stalking” (Ashmore, Jones & Jackson, 2006) talk about the different experiences that nurses have with mental health patients. These articles show how different interactions with mental health patients change nurses’ attitudes, and the way that they interact with their patients thereafter.
It is a well known fact that attitudes, beliefs, values, life experiences and even religious practices greatly impact nurses’ ability to care. In most areas of nursing practice, attitudes and beliefs are mostly positive. When it comes to mental health however, these attitudes and beliefs become less positive. This in turn, negatively impacts the level of care that mental health patients receive.
Research by Reed & Fitzgerald, 2005, found that attitudes were linked to issues that influence nurses’ ability to provide care. Many nurses suggested mental health care was not their role. One of the most prevailing feelings however was fear, which caused avoidance. James & Cowman, 2007, identified attitudes towards clients with bipolar disorder to be less then favorable. The authors recognize that mental health patients are more difficult to care for than other patients. As a result, these patients receive care that is inadequate.
Autoethnography has been defined as “the study of self” (Foster, McAllister & O’Brien, 2006). A process through which a nurse looks at herself and identifies her own attitudes, beliefs and values about mental health, and issues that are involved in mental health nursing in order to improve her care of the mentally ill. This way, psychiatric mental health nursing is seen as being directed by the nurse’s own characteristics, working together with the client to create a therapeutic relationship and to improve or maintain the client’s health.
In order for the nurse to effectively interact with the client, the nurse needs to first be able to understand that her character has been constructed by a set of experiences that is different from the patient’s. Social constructivism is a perspective that maintains that people develop a sense of what is real through conversation with, and observations of others (Foster, McAllister & O’Brien, 2006). This means that whatever the nurse holds to be real, might not be real for the patient, because his experiences have been different. Thus, a nurse cannot impose her perception of reality onto the patient because of her different experiences. A nurse cannot be therapeutic until she realizes that what is real, and what makes sense to her, might not be real, or not make sense to a patient. Autoethnography works by having the nurse look at what her reality is, takes note of what the patients’ reality is, and only then, can the nurse make a final judgment.
“Psychiatric mental health nursing research literature also recognizes the importance of the quality of engagement between nurse and the client as being integral to the nurses effective use of self” (Foster, McAllister & O’Brien, 2006). The way that a nurse interacts with the patient, and the quality of their relationship, is crucial for a therapeutic environment. Foster, McAllister & O’Brien, 2006, also state that clients themselves have reported that provision of respect, security, confirmation, and companionship are some of the most valuable aspects of the nurse-client relationship. How can nurses provide these to the patients, when the nurses are afraid of the patients, avoid the patients and or believe that it is not their role to take care of these patients? It is impossible for the nurse to provide security, when they themselves are scared. It is impossible for the nurse to provide companionship to these patients, when the nurse avoids them. If the nurse cannot effectively talk to, listen to, and empathize with the patient, there is no therapeutic relationship.
Using autoethnography, the nurse first needs to understand that she dislikes these patients, is afraid of these patients, and avoids these patients. The nurse than must think and identify the reasons for these behaviors. Why is it that the nurse fears and avoids these patients? Then she must remedy the problem. By doing so, the nurse no longer fears and avoids the patient, and becomes a nurse who can develop a healthy therapeutic relationship with the patient.
Autoethnography is the process through which nurses evaluate their own attitudes and beliefs towards mental health. This way they can correct any misconceptions or false beliefs about mental health patients they might have. In this manner they can provide the best care possible. It is a process which should be applied by every nurse that has a mental health patient in her care.

INTERVENTION 1
The nurse will identify her own thoughts, feelings and perceptions about the mentally ill client and the disease process that can interfere with the quality of care provided and set them aside while caring for the mentally ill client.

Disadvantage 1
Knowledge deficit
Knowledge deficit is a big problem in mental health nursing. Many research studies have concluded that most nurses are undereducated about how to care for mentally ill patients. Because of the limited amount of education, nurses rely on their own beliefs, perceptions and values when setting standards in their care for the mentally ill clients (Reed & Fitzgerald, 2005). A lot of nurses have their preset beliefs that mentally ill patients are difficult to take care of, assaultive and non cooperative and simply hard to take care of. A lot of times nurses attribute these qualities to all mentally ill patients (Reed & Fitzgerald, 2005). It is hard for them to understand that this is not necessarily true and that she needs to set these feelings aside. Because of the lack of education in caring for these clients, these nurses make further mistakes in their care which in turn reinforces their false beliefs. The nurse goes on attribute these qualities to the patient’s condition and does not perceive them as their own beliefs and perceptions. This makes it even harder for the nurse to implement this nursing intervention while caring for the mentally ill client.

Disadvantage 2
Pt. discrimination/dislike.
Dislike and discrimination of mentally ill clients has been thoroughly studied and documented. Most of the time, this attitude stems as a result of the choices the patients make. Choices which make it more difficult for the nurse to provide care (Reed & Fitzgerald, 2005). Mentally ill clients can become easily agitated, non cooperative, resistive and paranoid (Reed & Fitzgerald, 2005). They also make poor choices and judgment calls. In most cased hygiene standards are usually very low also. This leads the nurse to develop a sense of dislike towards these patients. This attitude makes the nurse more reluctant to identify her own attitude as a barrier in quality care. As a result, there is a further increase in the nurses' anxiety, dislike and avoidance of the patients. This type of attitude also increases the use of medical and mechanical restraints which can be very detrimental to the patient.
Intervention 2
The nurse will sit with the mentally ill pt. for at least 20 minutes to listen to the pt’s “story”, identify the pt’s belief system, thoughts, perceptions and degree of cooperativeness to help nurse better understand patient and increase comfort level with patient.

Disadvantage 1
FEAR.
Fear is the biggest barrier in providing quality care for the mentally ill patient. The nurses are worried about their physical safety and the safety of other coworkers on the ward. They also feel vulnerable professionally, ethically and legally about the action they might have to take to avoid harm if such action should be necessary (Reed & Fitzgerald, 2005). This can cause a gap in between the nurse and the patient. As a result, the nurse can end up avoiding the patient, keep their distance and take shortcuts when interviewing them. For communication to be effective in the nurse/mentally ill client relationship, the nurse has to show empathy, warmth, respect, patience and trustworthiness (Foster, McAllister & O’Brien, 2006). When the nurse fears these patients, she can’t show any of these qualities to these patients, thus making it hard to implement this intervention.

Disadvantage 2
NEGATIVE PAST EXPERIENCES.
Past experiences with mentally ill clients can either strengthen or ruin the perception of these clients to the nurse. Negative experiences heavily influence the nurses’ perception of these patients, the care they deserve, and even the nurses own perspective on her ability to provide care for these patients (Ashmore, Jones & Jackson, 2006). Nurses who had negative experiences with mentally ill clients experienced an increase in their level of anxiety, increased feelings of unhappiness and anger. They also said they felt less relaxed, outgoing, happy and competent in their care (Ashmore, Jones & Jackson, 2006). The same article stated that 37.5 percent of nurses who had a stalking experience ignored the patient afterwards, 14.3 percent of nurses yelled at the person, and 19.6 percent pleaded the person to stop (Ashmore, Jones & Jackson, 2006). Experiences as such, can make the nurse avoid a situation where she has to sit and talk with the mentally ill client. She will also be reluctant to develop nursing interventions in which the nurse has to spend time with the patient. This can make the relationship even worse and have a negative outcome on the plan of care.

References:

Ashmore R., Jones J., Jackson A. & Smoyak S. (2006, March). A survey of mental health nurses’ experiences of stalking. Journal of Psychiatric and Mental Health Nursing, 13, 562-569. Retrieved November 1, 2007 from CINAHL database.

Foster K., McAllister M. & O’Brien L. (2005 December). Coming to autoethnography: A mental health nurse’s experience. International Journal of Qualitative Methods, 1-13. Retrieved November 1, 2007 from CINAHL database.

Foster K., McAllister M. & O’Brien L. (2006, March). Extending the boundries: Autoethnography as an emergent method in mental health nursing research. International Journal of Mental Health Nursing,15, 44-53. Retrieved October 4, 2007 from CINAHL database.

James P. & Cowman S. (2007 October). Psychiatric nurses' knowledge, experience and attitudes towards clients with borderline personality disorder. Journal of Psychiatric and Mental Health Nursing, 14, 670-678. Retrieved November 1, 2007 from CINAHL database.

Reed F. & Fitzgerald L. (2005, December). The mixed attitudes of nurse’s to caring for people with mental illness in a rural general hospital. International Journal of Mental Health Nursing, 14, 249-257. Retrieved November 1, 2007 from CINAHL database.

Surgenor, L., Dunn, J. & Horn, J. (2005, June). Nursing student attitudes to psychiatric nursing and psychiatric disorders in New Zealand. International Journal of Mental Health Nursing, 14, 103-108. Retrieved October 20, 2007 from CINAHL database.

It is no secret that it takes a special kind of person to be a mental health nurse. Qualities and abilities such as well-developed self-awareness, acceptance of self and others’ feelings, an understanding of the complexity of the human experience, an ability to accept ambiguity and uncertainty, willingness to take responsibility for self, and provision of trust and respect are crucial for the effective psychiatric mental health nurse (Foster, McAllister & O’Brien, 2006).
But how does one integrate all these qualities effectively in practice? How does one become an effective mental health nurse? Foster, McAllister & O’Brien, 2006, state that autoethnography is the answer. According to them, autoethnography, the study of "self" should be an integral part of every mental health nurse's practice to ensure the highest level of care.
Little research has been written on the topic of autoethnography, and its use. Foster, McAllister & O’Brien, 2006, in their article “Extending the Boundaries: Autoethnography as an Emergent Method in Mental Health Research” talk about the use of autoethnography as a new approach to caring for the mentally ill, as well as a research method, with the emphasis on mental health nursing research.
The same authors, in an article published in December 2006, talk about the experiences of a doctoral student whose mother is mentally ill, and the process through which she used autoethnography to generate new research in the field, and relate to other mentally ill patients.
Other articles such as “Nursing Student Attitudes to Psychiatric Nursing and Psychiatric Disorders in New Zealand” (Surgenor, Dunn & Horn, 2005) and “A Survey of Mental Health Nurses’ Experiences of Stalking” (Ashmore, Jones & Jackson, 2006) talk about the different experiences that nurses have with mental health patients. These articles show how different interactions with mental health patients change nurses’ attitudes, and the way that they interact with their patients thereafter.
It is a well known fact that attitudes, beliefs, values, life experiences and even religious practices greatly impact nurses’ ability to care. In most areas of nursing practice, attitudes and beliefs are mostly positive. When it comes to mental health however, these attitudes and beliefs become less positive. This in turn, negatively impacts the level of care that mental health patients receive.
Research by Reed & Fitzgerald, 2005, found that attitudes were linked to issues that influence nurses’ ability to provide care. Many nurses suggested mental health care was not their role. One of the most prevailing feelings however was fear, which caused avoidance. James & Cowman, 2007, identified attitudes towards clients with bipolar disorder to be less then favorable. The authors recognize that mental health patients are more difficult to care for than other patients. As a result, these patients receive care that is inadequate.
Autoethnography has been defined as “the study of self” (Foster, McAllister & O’Brien, 2006). A process through which a nurse looks at herself and identifies her own attitudes, beliefs and values about mental health, and issues that are involved in mental health nursing in order to improve her care of the mentally ill. This way, psychiatric mental health nursing is seen as being directed by the nurse’s own characteristics, working together with the client to create a therapeutic relationship and to improve or maintain the client’s health.
In order for the nurse to effectively interact with the client, the nurse needs to first be able to understand that her character has been constructed by a set of experiences that is different from the patient’s. Social constructivism is a perspective that maintains that people develop a sense of what is real through conversation with, and observations of others (Foster, McAllister & O’Brien, 2006). This means that whatever the nurse holds to be real, might not be real for the patient, because his experiences have been different. Thus, a nurse cannot impose her perception of reality onto the patient because of her different experiences. A nurse cannot be therapeutic until she realizes that what is real, and what makes sense to her, might not be real, or not make sense to a patient. Autoethnography works by having the nurse look at what her reality is, takes note of what the patients’ reality is, and only then, can the nurse make a final judgment.
“Psychiatric mental health nursing research literature also recognizes the importance of the quality of engagement between nurse and the client as being integral to the nurses effective use of self” (Foster, McAllister & O’Brien, 2006). The way that a nurse interacts with the patient, and the quality of their relationship, is crucial for a therapeutic environment. Foster, McAllister & O’Brien, 2006, also state that clients themselves have reported that provision of respect, security, confirmation, and companionship are some of the most valuable aspects of the nurse-client relationship. How can nurses provide these to the patients, when the nurses are afraid of the patients, avoid the patients and or believe that it is not their role to take care of these patients? It is impossible for the nurse to provide security, when they themselves are scared. It is impossible for the nurse to provide companionship to these patients, when the nurse avoids them. If the nurse cannot effectively talk to, listen to, and empathize with the patient, there is no therapeutic relationship.
Using autoethnography, the nurse first needs to understand that she dislikes these patients, is afraid of these patients, and avoids these patients. The nurse than must think and identify the reasons for these behaviors. Why is it that the nurse fears and avoids these patients? Then she must remedy the problem. By doing so, the nurse no longer fears and avoids the patient, and becomes a nurse who can develop a healthy therapeutic relationship with the patient.
Autoethnography is the process through which nurses evaluate their own attitudes and beliefs towards mental health. This way they can correct any misconceptions or false beliefs about mental health patients they might have. In this manner they can provide the best care possible. It is a process which should be applied by every nurse that has a mental health patient in her care.

INTERVENTION 1
The nurse will identify her own thoughts, feelings and perceptions about the mentally ill client and the disease process that can interfere with the quality of care provided and set them aside while caring for the mentally ill client.

Disadvantage 1
Knowledge deficit
Knowledge deficit is a big problem in mental health nursing. Many research studies have concluded that most nurses are undereducated about how to care for mentally ill patients. Because of the limited amount of education, nurses rely on their own beliefs, perceptions and values when setting standards in their care for the mentally ill clients (Reed & Fitzgerald, 2005). A lot of nurses have their preset beliefs that mentally ill patients are difficult to take care of, assaultive and non cooperative and simply hard to take care of. A lot of times nurses attribute these qualities to all mentally ill patients (Reed & Fitzgerald, 2005). It is hard for them to understand that this is not necessarily true and that she needs to set these feelings aside. Because of the lack of education in caring for these clients, these nurses make further mistakes in their care which in turn reinforces their false beliefs. The nurse goes on attribute these qualities to the patient’s condition and does not perceive them as their own beliefs and perceptions. This makes it even harder for the nurse to implement this nursing intervention while caring for the mentally ill client.

Disadvantage 2
Pt. discrimination/dislike.
Dislike and discrimination of mentally ill clients has been thoroughly studied and documented. Most of the time, this attitude stems as a result of the choices the patients make. Choices which make it more difficult for the nurse to provide care (Reed & Fitzgerald, 2005). Mentally ill clients can become easily agitated, non cooperative, resistive and paranoid (Reed & Fitzgerald, 2005). They also make poor choices and judgment calls. In most cased hygiene standards are usually very low also. This leads the nurse to develop a sense of dislike towards these patients. This attitude makes the nurse more reluctant to identify her own attitude as a barrier in quality care. As a result, there is a further increase in the nurses' anxiety, dislike and avoidance of the patients. This type of attitude also increases the use of medical and mechanical restraints which can be very detrimental to the patient.
Intervention 2
The nurse will sit with the mentally ill pt. for at least 20 minutes to listen to the pt’s “story”, identify the pt’s belief system, thoughts, perceptions and degree of cooperativeness to help nurse better understand patient and increase comfort level with patient.

Disadvantage 1
FEAR.
Fear is the biggest barrier in providing quality care for the mentally ill patient. The nurses are worried about their physical safety and the safety of other coworkers on the ward. They also feel vulnerable professionally, ethically and legally about the action they might have to take to avoid harm if such action should be necessary (Reed & Fitzgerald, 2005). This can cause a gap in between the nurse and the patient. As a result, the nurse can end up avoiding the patient, keep their distance and take shortcuts when interviewing them. For communication to be effective in the nurse/mentally ill client relationship, the nurse has to show empathy, warmth, respect, patience and trustworthiness (Foster, McAllister & O’Brien, 2006). When the nurse fears these patients, she can’t show any of these qualities to these patients, thus making it hard to implement this intervention.

Disadvantage 2
NEGATIVE PAST EXPERIENCES.
Past experiences with mentally ill clients can either strengthen or ruin the perception of these clients to the nurse. Negative experiences heavily influence the nurses’ perception of these patients, the care they deserve, and even the nurses own perspective on her ability to provide care for these patients (Ashmore, Jones & Jackson, 2006). Nurses who had negative experiences with mentally ill clients experienced an increase in their level of anxiety, increased feelings of unhappiness and anger. They also said they felt less relaxed, outgoing, happy and competent in their care (Ashmore, Jones & Jackson, 2006). The same article stated that 37.5 percent of nurses who had a stalking experience ignored the patient afterwards, 14.3 percent of nurses yelled at the person, and 19.6 percent pleaded the person to stop (Ashmore, Jones & Jackson, 2006). Experiences as such, can make the nurse avoid a situation where she has to sit and talk with the mentally ill client. She will also be reluctant to develop nursing interventions in which the nurse has to spend time with the patient. This can make the relationship even worse and have a negative outcome on the plan of care.

References:

Ashmore R., Jones J., Jackson A. & Smoyak S. (2006, March). A survey of mental health nurses’ experiences of stalking. Journal of Psychiatric and Mental Health Nursing, 13, 562-569. Retrieved November 1, 2007 from CINAHL database.

Foster K., McAllister M. & O’Brien L. (2005 December). Coming to autoethnography: A mental health nurse’s experience. International Journal of Qualitative Methods, 1-13. Retrieved November 1, 2007 from CINAHL database.

Foster K., McAllister M. & O’Brien L. (2006, March). Extending the boundries: Autoethnography as an emergent method in mental health nursing research. International Journal of Mental Health Nursing,15, 44-53. Retrieved October 4, 2007 from CINAHL database.

James P. & Cowman S. (2007 October). Psychiatric nurses' knowledge, experience and attitudes towards clients with borderline personality disorder. Journal of Psychiatric and Mental Health Nursing, 14, 670-678. Retrieved November 1, 2007 from CINAHL database.

Reed F. & Fitzgerald L. (2005, December). The mixed attitudes of nurse’s to caring for people with mental illness in a rural general hospital. International Journal of Mental Health Nursing, 14, 249-257. Retrieved November 1, 2007 from CINAHL database.

Surgenor, L., Dunn, J. & Horn, J. (2005, June). Nursing student attitudes to psychiatric nursing and psychiatric disorders in New Zealand. International Journal of Mental Health Nursing, 14, 103-108. Retrieved October 20, 2007 from CINAHL database.