Social control agents or front-line carers for people with mental health problems: police and mental health services in Sydney, Australia.

The relationship between mental health services and police and people who have mental health problems, are suicidal or are drug- and/or alcohol-affected is examined in this paper. A survey of 131 police officers in Sydney, Australia, revealed that more than 10% of police time is spent dealing with people with mental health problems. Nevertheless, police felt unsupported in this role, unprepared for it and torn between the competing demands experienced in their work. A lack of confidence in dealing with suicidal people and a belief that work with mentally disturbed people does not constitute valid police work are also reported. Managing people with mental disturbance is a major concern for police. Specifically, there are difficulties relating to: inadequate training and education; deficiencies in services/resources; time and resource over-utilization; communication, liaison and feedback problems, and frustration related to accessing mental health facilities/services. It is argued that police work involving mentally disturbed people is a valid and necessary role that complements law enforcement. In order to facilitate this aspect of police work, recommendations are made regarding education and collaborative working relationships between police and mental health professionals, which, in turn, could improve the care of mentally disturbed people in the community.

'The experience of community mental health case management provided from an acute in-patient psychiatric unit'.

In Australia, case management is the cornerstone of mental health service delivery for seriously ill clients living in the community. In this study, case management was provided from an acute, inpatient psychiatric unit; a model thought to be unique. Findings from this qualitative study explicated the experience of case management from client and case manager (CM) perspectives. They note the nature, purpose, processes and outcomes of case management within that context. Findings were positive, suggesting clients and CM's develop a therapeutic alliance through which interventions are implemented and which result in clients experiencing personal (re) integration and enhanced well-being. These findings are discussed and they suggest an alternative model of service delivery well regarded by both clients and CM's.

Exploring Ricoeur's hermeneutic theory of interpretation as a method of analysing research texts.

Increasingly, researchers use hermeneutic philosophy to inform the conduct of interpretive research. Congruence between the philosophical foundations of a study, and the methodological processes through which study findings are actualised, obliges hermeneutic researchers to use (or develop) hermeneutic approaches to research interviewing and textual analysis. Paul Ricoeur's theory of interpretation provides one approach through which researchers using hermeneutics can achieve congruence between philosophy, methodology and method. Ricoeur's theory of interpretation acknowledges the interrelationship between epistemology (interpretation) and ontology (interpreter). Also, Ricoeur notes the way interpretation moves forward from naive understanding, where the interpreter has a superficial grasp of the whole of the text, to deeper understanding, where the interpreter understands the parts of the text in relation to the whole and the whole of the text in relation to its parts (the hermeneutic circle). In this way, Ricoeur's theory of interpretation provides researchers with a method of developing intersubjective knowledge. Through exposition of the concepts of Ricoeur's theory, which include distanciation, appropriation, explanation and understanding, guess, and validation, a hermeneutic approach to textual analysis is presented, discussed and critiqued. Examples from nursing research are also used to demonstrate points under discussion. It is suggested that, in conjunction with Gadamer's hermeneutic of understanding, Ricoeur's theory of interpretation warrants consideration as a method of textual analysis.

The milieu and milieu therapy in adolescent mental health nursing.

The milieu is a well discussed concept in the mental health nursing literature; so too is milieu therapy. Nevertheless, despite evidently clear understandings of the milieu's significance, and of its therapeutic potential, little published mental health nursing research focuses on these areas of practice. As a result, within the specialty, theoretical conceptualizations of the milieu remain unchallenged and theory development remains in its infancy. Findings from an inquiry into the practice of adolescent mental health nursing demonstrate the: (1) nature, (2) construction, (3) maintenance, (4) function, (5) therapeutic effects, and (6) outcomes of the milieu. Through these findings, present theoretical conceptualizations of the milieu are examined and expanded, and a beginning theory of the adolescent milieu, and of milieu therapy, is presented.

Hermeneutic interviewing: an example of its development and use as research method.

In a study exploring the practice knowledge of nursing on adolescent mental health units, I chose hermeneutic philosophy to guide the conduct of the research. Immediately, I encountered the problem that hermeneutics is essentially unconcerned with its use as research method. The need for congruence between the study's hermeneutic foundations and the methodological processes of the research, led me to develop a style of hermeneutic interviewing for the purpose of information gathering. I did this using Gadamer's (1979) fundamental principles of: (1) tradition, (2) dialectics of interpretation, and (3) dialectic of question and answer. These principles are examined and discussed. The actualization of hermeneutic interviewing, as a means of information gathering, proved challenging. Using interview excerpts, I demonstrate my use of hermeneutic interviewing as research method, and critique my interviewing skills in relation to the fundamental principles from which this style of interviewing was developed.

A review of the sociopolitical context of adolescent mental health and adolescent mental health nursing in Australia.

Examination of their sociopolitical situatedness, in Australia, allows adolescent mental health and adolescent mental health nursing to be understood within a broader context. This examination takes place through a review of: (i) epidemiology, (ii) health funding and services, (iii) training and education, (iv) research, and (v) nurse education. Implications arising from this review are presented. Questions are raised regarding the sociopolitical standing of adolescent mental health, and suggestions are made regarding future imperatives for adolescent mental health nursing.

Hermeneutic philosophy. Part I: Implications of its use as methodology in interpretive nursing research.

Increasingly, nurses use the philosophy of hermeneutics, especially Heideggerian and Gadamerian hermeneutics, to inform interpretive research. However, application of the work of these philosophers to interpretive nursing research has proved problematic as it fails to recognise, or act upon, obligations inherent in their work. Through a review of hermeneutically informed nursing research, methodological implications regarding the use of hermeneutic philosophy are examined in relation to: (i) the need to address forestructures and pre-understandings; (ii) checking interpretations with research participants; (iii) seeking objectivity, consensus and accuracy in textual interpretation; (iv) evaluating interpretations; and (v) gaining entry into the hermeneutic circle. This review suggests that despite obligations inherent in Heideggerian and Gadamerian hermeneutic philosophy, nurses fail to actualise these obligations in their research. In following Heidegger, nurses need to make the scientific theme secure by working out their forestructures in terms of the phenomenon under investigation. Those following Gadamer need to accept that interpretation seeks to manifest textual meanings rather than individual ones. And, whether following Heidegger or Gadamer, the way to make manifest textual meanings is to engage with the text within the hermeneutic circle by continuing to address forestructures and pre-understandings and by considering their influences upon the research.

Hermeneutic philosophy. Part II: A nursing research example of the hermeneutic imperative to address forestructures/pre-understandings.

Hermeneutic research requires that pre-understandings are brought to consciousness in order to provide the phenomenon under investigation with the greatest opportunity to reveal itself. This hermeneutic imperative is dealt with in the present study. My research involved explicating the practice knowledge of nursing on residential adolescent mental health units, and as I had worked on such units I held pre-understandings that would influence the research. I addressed pre-understandings in three ways: (i) by developing understandings of practice knowledge through a hermeneutic conceptualisation of it; (ii) by working out forestructures of the phenomenon under investigation. Using Heidegger's writing on forestructures, 20 statements were generated, interpreted and reconceptualised as my forestructures of residential adolescent mental health nursing. I used this work to review participant interviews in an effort to prevent myself from only finding what I already assumed I would find in relation to practice knowledge; and (iii) by formulating pre-understandings of the phenomenon of interest. Using Gadamer's writing on reflection, seven stories were written and interpreted as my pre-understandings of adolescent mental health nursing practice. I used this work to consider the presence of pre-understandings during textual interpretation in an attempt to prevent premature interpretive closure. In these ways, I brought my forestructures/pre-understandings to consciousness, reflected on them, questioned their origins, adequacy and legitimacy and thereby took account of their influence on myself and the research.

Nursing knowledge development: where to from here?

Issues related to nursing epistemology are reviewed. This review includes discussion of logical positivism, empiricism and interpretive-emancipatory paradigms, their influence on the construction of knowledge and on its methods of derivation and verification. Changes in the conceptualisation of science are explored, and scientific realism is introduced as a contemporary philosophy of science through which the discipline of nursing can develop. Questions surrounding the development of nursing knowledge are examined; for example, the implications of theory construction through the use of borrowed theory and the acceptance of external philosophies of science. Argument is offered for and against borrowing external theories and philosophies, or developing theories and philosophies from research into nursing practice. The relationship between research method and the phenomenon under study is discussed. The need to develop a broad base of nursing knowledge through diverse research methods is addressed. Links are created between the development of non-practice-based theories, the derivation of knowledge a priori, and the poor use of nursing theory and research in nursing practice. It is suggested that nursing science should develop through a dialectic between nursing research and practice, and that such a dialectic could assist the forward movement of nursing through the evolution of meaningful nursing theories and philosophies of nursing science.

Storytelling: a teaching-learning technique.

Nurses' stories, arising from the practice world, reconstruct the essence of experience as lived and provide vehicles for learning about nursing. The learning process is forwarded by combining storytelling and reflection. Reflection represents an active, purposive, contemplative and deliberative approach to learning through which learners create meaning from the learning experience. The combination of storytelling and reflection allows the creation of links between the materials at hand and prior and future learning. As a teaching-learning technique storytelling engages learners; organizes information; allows exploration of shared lived experiences without the demands, responsibilities and consequences of practice; facilitates remembering; enhances discussion, problem posing and problem solving; and aids understanding of what it is to nurse and to be a nurse.

Exploring nurses' storied accounts of practice.

The learning opportunities presented in nurses' storied accounts of practice are explored. This exploration is achieved through analysis and discussion of three nurse's stories documented in the literature, and uses Benner's (1991) narratives of learning theme as the conceptual framework. The narrative of learning sub themes: being open to experience, liberation, and disillusionment are examined. This examination suggests nurses stories can be used to: discover nursing knowledge, develop shared understandings of what it is to be a nurse, examine nursing's culture and ethics, document interactions for research, teaching and learning, and identify and preserve the practice of nursing. Whereas edited stories from the literature only begin to demonstrate the possibilities for learning that stories offer, through them alternative ways of learning about nursing, exploring nursing practice and developing nursing knowledge are presented.

Storytelling: what can it reveal about the knowledge of mental health nursing?

This paper uses a hermeneutic approach to examine nurses' stories as found in the literature. It raises epistemological issues surrounding questions of nursing knowledge: practical and theoretical. By examining nurses' stories holistically and selectively, the study uses a combined approach to interpretation and theme development, revealing issues, questions and themes generated by the hermeneutic process. The author suggests that revealing knowledge in this manner can support the knowledge claims of mental health nursing and provide opportunities for theory development or testing.