The lived experience of community mental health nurses working with people who have dual diagnosis: a phenomenological study

Abstract

Dual diagnosis (the combination of mental health and substance misuse problems) is a significant facing mental health nurses in the UK. The purpose of the study was to describe the lived experience of community mental health nurses working with people who have a dual diagnosis. A phenomenological approach was us and a purposive sample of seven community mental health nurses with experience of working with people with a dual diagnosis was selected. Data were collected through audiotaped, semi-structured interviews lasting approximately 1 h in duration and analysed using Colaizzi's (1978) method. Thirteen theme clusters relating to three major themes were identified: (1) difficulties in understanding the concept of dual diagnosis; (2) feeling deskilled when working with people who have a dual diagnosis; (3) struggling to work in a system which seeks to avoid people with dual diagnosis. Recommendations regarding the need for increased joint working between professionals, improved education and further research are made.

Recovery From Comorbidity

“…Notwithstanding debate in the literature regarding the value, methodology, and risks of member checking (Goldblatt, Karnieli-Miller, & Neumann, 2011;Julie, 2010), a lack of iterative feedback to participants is a potential flaw in research in this area and the rationale when excluding member checking is only occasionally considered (Coombes & Wratten, 2007;Staiger et al, 2011;Strickler et al, 2009;Wadell & Skarsater, 2007). As with reflexivity, this can be a conspicuous absence when not explicitly addressed by the researcher.…”

“…There is a paucity of qualitative research in the field of comorbidity in general, where we might seek answers that are driven by a search for understanding, as opposed to measuring, by exploration rather than confirmation, and by accessing the vast store of knowledge and experience held by consumers as a means of informing research: the need for qualitative data collection from consumers (and their families and carers) is identified as a major deficiency in research in the field (Coombes & Wratten, 2007;Green & Thorogood, 2004;Staiger et al, 2011).…”

“…There is growing criticism of this directional focus in research, and the area is replete with epidemiologically contradictory findings (Back, Brady, Sonne, & Verduin, 2006;Coombes & Wratten, 2007;Kofoed, 1993;Kuo, Gardner, Kendler, & Prescott, 2006;Maremmani et al, 2011;Marquenie et al, 2006;. The focus is on the quantitative analysis of specific etically hypothesized criteria and associations, with little underlying or associated qualitative or exploratory research (Boschloo et al, 2011;Horsfall et al, 2009).…”

“…Health care providers can have a negative attitude toward people with comorbidity and feel untrained and unable to provide help (Barry, Tudway, & Blissett, 2002;Canaway & Merkes, 2010;Coombes & Wratten, 2007). Consumers with comorbidity encounter challenges including a lack of staff knowledge, judgmental and moralistic interactions, inflexibility, poor intersectoral referral, and exclusion from services (Lawrence-Jones, 2010; Staiger et al, 2011).…”

“…Differences in conceptualization, epistemology, and treatment philosophies remain a barrier to comorbidity consumers (Canaway & Merkes, 2010;Coombes & Wratten, 2007;Karen Leigh & Ian, 2009;L. Schmidt, 1991).…”