Tensions of difference: reconciling organisational imperatives for risk management with consumer‐focused care from the perspectives of clinicians and managers

Clancy, Leonie; Happell, Brenda

doi:10.1111/jocn.12564

Cited by 11 publications

(20 citation statements)

References 37 publications

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“…As in other research findings, nurses in this study defined risk as "a negative and harmful phenomenon located within the individual" (Higgins et al, 2016, p. 161) and one that needs to be managed and prevented (Clancy & Happell, 2014;Higgins et al, 2016). Suicide prediction is an inexact science and very few, if any, valid tools exist within mental health that can predict suicide.…”

Section: Discussionmentioning

confidence: 60%

“Attenuating Anxieties”: A grounded theory study of mental health nurses’ responses to clients with suicidal behaviour

Morrissey

Higgins

2018

Journal of Clinical Nursing

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Aims and objectives To develop a grounded theory to explain mental health nurses’ responses to clients with suicidal behaviour. Background Mental health nurses are an integral part of the multi‐disciplinary teams supporting people who experience suicidal behaviour, yet limited research is available that explores how nurses respond to the needs of people at risk of suicide and what factors influence their responses and actions. Methods Grounded theory was the methodology for this study. Interviews were conducted with 33 mental health nurses working in an urban area in the Republic of Ireland. Data were analysed using the concurrent processes of comparative analysis, theoretical sampling, theoretical sensitivity and memo writing. COREQ 32‐item checklist was used. Results The core category from the data was “Attenuating Anxieties.” Participants’ main concerns about caring for suicidal clients were related to their feelings of professional and personal vulnerability and the need to protect clients and themselves. This theory “Attenuating Anxieties” highlights the way in which nurses allay their anxieties by utilising historically known risk adverse strategies to care for the suicidal person. Acquisition of further psychotherapeutic training, clinical supervision as well as increased reflexivity protected some participants and enabled them to work creatively and collaboratively while supporting and facilitating therapeutic risk‐taking. Conclusions The theory of “Attenuating Anxieties” identifies how participants worked within the context of mental health as members of the “risk society,” wherein they worried about the possibility and probability of a negative or adverse effect for both the client and self, leaving them to feel constantly vulnerable and unsafe. Relevance to clinical practice This theory highlights the need for a culture of openness that acknowledges nurses’ and organisations’ anxieties surrounding suicide and promotes a discourse among nurses that moves from a position of risk aversion to a relational and recovery‐orientated approach.

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Section: Discussionmentioning

confidence: 60%

“Attenuating Anxieties”: A grounded theory study of mental health nurses’ responses to clients with suicidal behaviour

Morrissey

Higgins

2018

Journal of Clinical Nursing

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“…More importantly, focusing on potential risks posed by patients inherently erodes the formation of a therapeutic relationship, as patients who are viewed as risky are not trusted (Buckingham et al . ; Clancy & Happell ; Cleary et al . ; Lakeman ; Rose et al .…”

Section: Discussionmentioning

confidence: 99%

“…A working environment that is focussed on task-based nursing over therapeutic care is detrimental to nurses' abilities to implement the personcentred care they deem important (Rose et al 2015;Wright et al 2011). More importantly, focusing on potential risks posed by patients inherently erodes the formation of a therapeutic relationship, as patients who are viewed as risky are not trusted (Buckingham et al 2008;Clancy & Happell 2014;Cleary et al 2005;Lakeman 2006;Rose et al 2015;Stein-Parbury et al 2008;Wand 2012). Thus, therapeutic engagement with consumers experiencing distress related to voices is thwarted.…”

Section: Discussionmentioning

confidence: 99%

Working with consumers who hear voices: The experience of early career nurses in mental health services in Australia

White

Stein‐Parbury

Orr

et al. 2018

Int J Mental Health Nurs

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Mental health consumers who hear voices frequently experience distress and express a desire to discuss their voice‐hearing experience. Nurses do not regularly demonstrate a willingness to engage in such discussions. With the introduction of educational strategies that develop empathy and an understanding of voice‐hearing experiences, it is anticipated that early career nurses will be able to translate such understanding into their professional nursing practice. To explore early career nurses’ understanding of providing care to mental health consumers who hear voices, a qualitative exploratory descriptive study was conducted in which nine early career Registered Nurses were interviewed regarding their experiences of caring for people who hear voices. Thematic analysis was employed to analyse the data and generate themes. Participants reported difficulty in developing relationships with consumers who hear voices, due to a workplace culture that was focussed on risk and lacking professional support. Nurses need specific education to develop the skills necessary to respond to consumers who hear voices and engage in dialogue that assists consumers to relate to the voices in a meaningful way. However, for this to succeed in practice, changes need to be supported by addressing the cultural barriers, such as risk‐focussed environments, that prevent nurses implementing best practice.

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“…The shift towards a recovery model sits uneasily with an increase in corporate governance and clinical risk management envisioned in the modernisation of the clinical and community‐based mental health service sectors (Clancy & Happell, ; Sawyer, Green, Moran, & Brett, ). Peer support is one vehicle through which mental illness is being reframed in recovery‐oriented practice.…”

Section: Importance Of the Organisational Environmentmentioning

confidence: 99%

Finding the right connections: Peer support within a community‐based mental health service

2016

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Gray M., Davies K., Butcher L. Finding the right connections: Peer support within a community‐based mental health service This article reports on a qualitative study that examined the organisational enablers and barriers to implementing peer support work in an Australian, rural, community‐based mental health service. Interviews with 19 peer and non‐peer staff were conducted to identify attitudes towards peer support and whether there were organisational values, practices and strategies that might support the implementation of peer support. The findings revealed that peer support workers were valued for their ability to build trusting connections with clients and to accept client choice in a non‐judgemental way. However, peer support workers tended to ‘fill service gaps’ within intensive, administrative case‐management environments. These findings highlight the importance of an organisational‐wide approach to integrating peer support, where the responsibilities for adopting new ways of working fall to all staff, not just the peer support workers themselves. Key Practitioner Message: • Practitioners placed high value on the peer support workers on their teams due to their unique personalised engagement with clients; • The roles of peer support workers were poorly understood by team members; • Organisational integration of peer support principles could improve the way all staff engage with clients to reflect a recovery orientation.

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Tensions of difference: reconciling organisational imperatives for risk management with consumer‐focused care from the perspectives of clinicians and managers

Abstract: A deeper examination and reconceptualisation of the role and importance of risk in mental health care are needed to ensure the focus of service delivery remains consumer-focused.

Cited by 11 publications

References 37 publications

“Attenuating Anxieties”: A grounded theory study of mental health nurses’ responses to clients with suicidal behaviour

“Attenuating Anxieties”: A grounded theory study of mental health nurses’ responses to clients with suicidal behaviour

Working with consumers who hear voices: The experience of early career nurses in mental health services in Australia

Finding the right connections: Peer support within a community‐based mental health service

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