Critical realism and psychiatric nursing: a philosophical inquiry

Littlejohn, Christopher

doi:10.1046/j.1365-2648.2003.02742.x

Cited by 23 publications

(38 citation statements)

References 32 publications

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“…The approach is based on a retroductive research strategy, where model building, analogy and metaphor are used to postulate mechanisms that account for observed phenomena 18 . Littlejohn summarizes the ontological approach of critical realism as a world encompassing three layers of reality: empirical, actual and real 17 . The empirical layer comprises what is experienced and forms the intransitive aspect of the approach.…”

Section: Methodsmentioning

confidence: 99%

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Nursing prioritization of the patient need for care: A tacit knowledge embedded in the clinical decision‐making literature

Lake

Moss

Duke

2009

Int J of Nursing Practice

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Nursing prioritization of the patient need for care: A tacit knowledge embedded in the clinical decision-making literatureEvery day in clinical settings, nurses practise in complex and dynamic situations. Nurses work to achieve emergent order in these situations through nursing prioritization of the patient need for care. As direct research on nursing prioritization had not been reported, a study, using critical realism as method, was designed to discern the profession's embedded understanding from within the clinical decision-making literature. The research synthesizes a tacit knowledge on nursing prioritization of the patient need for care from key international literature (from 1966 to 2003). Nursing prioritization was discerned in both education and practice literatures; interrelationships between these and theoretical approaches were also identified. Nursing prioritization of the patient need for care was revealed both as a non-sequential decision-making process throughout unfolding patient situations and as an advanced skill of nursing practice. Increasing confidence with this skill is the hallmark of developing expertise.

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Section: Methodsmentioning

confidence: 99%

“…The actual layer where things happen but are not experienced forms the transitive aspect. The real layer, where generative mechanisms exist, forms the transcendental aspect of the approach 17 . Blaikie states that:…”

Section: Methodsmentioning

confidence: 99%

Nursing prioritization of the patient need for care: A tacit knowledge embedded in the clinical decision‐making literature

Lake

Moss

Duke

2009

Int J of Nursing Practice

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“…Such persistent performance‐driven demands for evidence‐based practice might paradoxically only serve to compromise the mental health nurses' ability to facilitate patient centredness (Welch 2005). For example, there is very little in the way of acceptable (hard scientific) evidence that can account for the efficacy of the therapeutic interaction , that is, the interpersonal encounter experienced by both nurse and patient (Gadd 2004; Littlejohn 2003). Laing (1967) described a concept of co‐presence that involved the nurse providing comfort by being with and being there for the patient, an intervention not easily measurable in terms of objective criteria.…”

Section: Ptolemaic Conceptsmentioning

confidence: 99%

Passive patient or engaged expert? Using a Ptolemaic approach to enhance mental health nurse education and practice

Warne

McAndrew

2007

Int J Mental Health Nurs

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This discussion paper seeks to explore an approach that metal health nurses can adopt that ensures the patient is at the centre of training and professional development opportunities. Although nurse training and education is shaped by practice and theory, the lived experiences of the patients as an educational resource often become lost in the milieu of 'doing' nursing. We argue that in addition to theoretical knowledge and practice knowledge, there is the need to harness the equally important patient experience knowledge. Drawing upon Ptolemaic concepts, this paper explores the potential tensions for mental health nurses resulting from the imbalance in power when engaging in therapeutic relationships with patients. It is argued that in order for mental health nurses to become more effective, they need to learn how to relinquish some of their power, even where this gives rise to uncomfortable tensions for the nurse. Such tensions result from the centrality afforded to theoretical knowledge and ritualized practice that underpins nursing and the difficulties this may cause for many nurses in accepting the value of patient experience as a primary source of knowledge. The difficulties of adopting this approach point to a need for mental health nurses and nurse educationalists to take a more reflexive approach to their patient encounters and within their encounters with each other.KEY WORDS: mental health nursing, patient experience knowledge, Ptolemy.

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“…Here the term ‘conceptual model’ applies not only to theory‐driven therapeutic approaches, such as cognitive‐behavioural therapy, but also the values and beliefs associated with various professions (e.g. Littlejohn 2003; Peck & Norman 1999). There are several qualitative methodological approaches that could be used to facilitate these aims.…”

Section: Introductionmentioning

confidence: 99%

A qualitative exploration of communication within the community mental health team

Donnison¹,

Thompson

Turpin

2009

Int J Mental Health Nurs

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This qualitative study sought to explore conceptual models employed by community mental health team (CMHT) staff in the care of their clients and how CMHT clinicians communicated with one another, particularly in relation to complex clinical work. The qualitative method of interpretive phenomenological analysis was used, and semistructured in-depth interviews with seven UK CMHT clinicians were conducted and analyzed. Four themes were evident in the data and showed that clinicians face complex and competing demands and draw on a range of therapeutic models in their work. It was also clear that much discussion centred primarily on pragmatic issues and lacked conceptual depth. The results underline the complex and challenging nature of CMHT work and suggest that a more systematic approach to interdisciplinary training within teams could be beneficial in increasing clinicians' knowledge, skills, and their understanding of the conceptual models used across different disciplines.

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Critical realism and psychiatric nursing: a philosophical inquiry

Abstract: Support is found for an autonomous and independent profession of psychiatric nursing, able to provide a helping response to those in mental distress independent of psychiatry and psychology.

Cited by 23 publications

References 32 publications

Nursing prioritization of the patient need for care: A tacit knowledge embedded in the clinical decision‐making literature

Nursing prioritization of the patient need for care: A tacit knowledge embedded in the clinical decision‐making literature

Passive patient or engaged expert? Using a Ptolemaic approach to enhance mental health nurse education and practice

A qualitative exploration of communication within the community mental health team

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