Commentary: The experiences of inpatient nursing staff caring for young people with early psychosis

As asserted in the abstract of the reviewed study, interpretative phenomenological analysis (IPA) and the phenomenological approach certainly have the ability to focus attention on deeper relational and therapeutic issues. This is especially the case when applied to such issues as inpatient care of young adults undergoing treatment and support for first episode psychosis. Thompson and colleagues comment that the findings of the reviewed study have implications for staff, organisations and young people alike. This is true at many levels.

Let me start by underlining the importance of the statements made by Thompson and colleagues with regard to the capacity and capability of the staff to deliver appropriate care to this vulnerable and exposed group of young adults. Importantly, I wish to shine a light on the effectiveness of that same care, and its heavy reliance on a very clear understanding and experience – an aesthetic rationality, so to speak (Fisher and Freshwater, 2014) – of individual interpersonal boundaries, specifically those of the nursing staff.

In this regard, there are some definitive studies that appear to transcend the time, space and place continuum. Menzies’ seminal work of 1970 (Menzies, 1970) is one such study. Menzies took up the idea that organisations create opportunities for social cohesion, based on a shared defence against anxiety. In other words, institutions are used by individuals to help them defend against their own anxieties, consciously or unconsciously. Menzies famously tested out this hypothesis through a study at a large London teaching hospital.

Nearly five decades later, it is well known that, irrespective of the structure, context and organisation of an institution, the very nature of nursing work is anxiety provoking and as such is likely to arouse a range of emotions in the nursing staff. The arousal of these weighted emotions, as is pointed out in the reviewed study, is experienced as both an interpersonal and an intrapersonal threat. Menzies (1970) argued that social functioning in such environments is the result of collusion between each member of the institution, as they attempt to manage their own defence mechanisms – or as the authors point out in the reviewed study, preferred coping strategies. Such defences against anxiety are, of course, defences against reality; a reality that can be accessed and laid bare through the process of IPA, with its emphasis on meaning and purpose as explicated through the phenomenological approach. This shift from and between our individual neuroses and the underlying existential angst that is being defended against, while a fundamental tenet of the human condition, is nevertheless of primacy when viewed in the context of individual nursing practice, and its influence on the care given, the institution and the whole system.

As Benner (2000: 5), notes ‘Nursing practice invites nurses to embody caring practices that meet, comfort and empower vulnerable others’. She further argues that reading emotional states is ‘highly relevant’ to experiential nursing practice, specifically in reading other peoples’ anxieties. The ability to read emotional states in vulnerable others requires skilful and insightful, non-formulaic, communication skills on behalf of the individual practitioner. More importantly, it demands a degree of personal self-awareness and institutional perspicacity that, as the authors rightly reference, goes to the heart of human system redesign, thereby truly embedding the only real influence one might have on young adults in the inpatient setting for the first time, namely, the significance of the relationship.

Biography

Dawn Freshwater began her career as a health professional in the National Health Service (UK) in 1980. She was awarded her PhD at the University of Nottingham in 1998 and became professor of Mental Health in 2000. Following a period of developing and leading strategic change at the University of Leeds in the Faculty of Medicine and Health, she took up the post as Pro-Vice Chancellor for Organizational Effectiveness. Currently, she is the Vice Chancellor at the University of Western Australia.