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Overriding the choices of mental health service users; a study examining the acute mental health nurse’s perspective

Smith, GM (2018) Overriding the choices of mental health service users; a study examining the acute mental health nurse’s perspective. Doctoral thesis, Liverpool John Moores University.

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This study explores the mental health nurse’s experience of ethical reasoning while overriding the choices of mental health service users within an acute mental health context. When working with service users in acute mental distress a mental health nurse’s clinical decisions will have a controlling element, which can lead to the service user’s freedoms being restricted. This power to restrict freedoms also known as coercion can be explicit, it follows the rule of law, and implicit; ways of controlling that are ‘hidden’. The ethical use of this power requires the nurse to be an effective ethical reasoner who understands both the explicit and implicit nature of this power. Coercive power, which is explicit, has been thoroughly explored; however, there is limited work exploring the use of this power within an ethical context and as a ‘real-time’ practice issue. In addition, there is little work exploring implicit power as a practice issue or as an ethical issue. To examine this knowledge gap this study adopts an interpretative phenomenological analysis (IPA) approach to engender an understanding of the mental health nurse’s personal meaning and experience of using both explicit and implicit coercive power. This approach affords the researcher the opportunity to tease out the personal ‘ethical’ meaning of the participants’ experiences by facilitating an in-depth and sensitive dialogue, which focuses on stimulating conscious ethical reflection. IPA is an idiographic mode of inquiry where sample purposiveness and analytical depth is more important than sample size. On this basis, six qualified mental health nurses were recruited who have used coercive strategies while nursing service users in acute mental distress. The semi-structured interviews were thematically and interpretively analysed, the five superordinate themes that were generated are; the nurse as a practitioner, their values, their practice, their use of coercion, and their ethics. In addition, the results of the study highlighted that coercive strategies are a key part of a mental health nurse’s daily practice both explicitly and implicitly. These strategies can be beneficent; however, this is dependent on the ethical reasoning ability of the nurse and the professional support they receive in practice. Being an effective ethical reasoner requires the nurse to acquire ‘good habits’, a basis for enabling the nurse to work through an ethical challenge in ‘quick time’. Furthermore, to enhance these good habits they also need to have an ‘ethical imagination’. Considering these points, this study recommends mental health nurses when using coercive power use a multi-faceted ethical reasoning approach. This approach should aim to create good ethical habits through continually rehearsing good responses to common practice issues. In addition, this approach should not neglect the need for the nurse to use their ethical imagination and to feel for an ethical solution where required. As a future area for research, this study recognises the skilled use of ethical imagination in the field of mental health nursing requires further exploration.

Item Type: Thesis (Doctoral)
Uncontrolled Keywords: Mental Health Nursing, Coercion, Interpretative Phenomenological Analysis, Ethics, Ethical Practice, Pragmatism, Ethical Imagination
Subjects: B Philosophy. Psychology. Religion > BF Psychology
B Philosophy. Psychology. Religion > BJ Ethics
R Medicine > RT Nursing
Divisions: Nursing & Allied Health
Date Deposited: 19 Jul 2018 08:29
Last Modified: 05 Oct 2022 11:35
DOI or ID number: 10.24377/LJMU.t.00008976
Supervisors: Khatri, RJ and Harrison, JC
URI: https://researchonline.ljmu.ac.uk/id/eprint/8976
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