A Co-operative Inquiry Into Generating, Describing, and Transforming Knowledge About De-escalation Practices in Mental Health Settings.

De-escalation is concerned with managing violent behaviour without resorting to coercive measures. Co-operative Inquiry provided the conceptual basis for generating knowledge regarding de-escalation practices in acute mental health care settings. The research included service users and staff members as co-researchers and knowledge was generated in dynamic research cycles around an extended epistemology of knowing: experiential, presentational, propositional, and practical. Through this process, co-researchers became de-escalation learners, implementing de-escalation practices while transforming violence management. Neighbouring mental health communities' involvement strengthened the transformation process and assisted in validating the research results.

Mental health nurses responding to suffering in the 21st century occidental world: accompanying people in their search for meaning.

Much of contemporary health and mental health practice pays little attention to suffering, and when it does, invariably suffering is conflated with pain. Within such views, the health care practitioner ought to be concerned with removing or stopping the suffering as, for many parts of the occidental world at least, suffering is regarded as antagonistic to the pursuit of happiness. However, it has been recognized since ancient times that the experience of suffering can give rise to growth. This view sees suffering as an inevitable aspect of the human condition and experience; as something that might need to be endured, minimized, relieved, explored for meaning and maybe even learned from. The former conceptualization of suffering leaves little, if any, room for the sufferer to be to be proud of his suffering and to consider it ennobling rather than degrading, and such views are highly congruent with the increased pathologizing of 'everyday life' and with that, the inexorable proliferation of pharmacological 'treatment'. Accordingly, we assert that there is a clear need for Psychiatric/Mental Health nurses to re-think their views of suffering and consider how they might help the person discover meaning in the experience; how they might accompany the individual on his/her suffering journey. We therefore identify a range of approaches and interventions that Psychiatric/Mental Health nurses can use when attempting to help those experiencing mental health-related suffering.

Experiences of motherhood when suffering from mental illness: a hermeneutic study.

Being a mother is inseparable from women's existential life. Mothers with mental illness struggle with conflicting and distressing feelings related to motherhood. They seldom obtain the necessary support to increase their control over the determinants of their role as a mother, thus their opportunity of improving their own and their children's mental health is weakened. The aim of this study was to explore the experiences of being a mother with mental illness. The research question was: How can mothers' experiences of motherhood when suffering from mental illness be understood? The understanding emerged through a hermeneutical interpretation of the empirical material on four different levels of abstraction. The inductive-deductive approach, inspired by the philosophy of Gadamer, was used. The mothers' experiences were understood in their way of struggling to become good enough mothers, managing to become the mother they longed to be, being present in the caring relationship with their child, as well as being recognized as a mother and living openly and honestly in relationships with others. Addressing the existential needs of motherhood is important for their improvement and recovery, as well as for promoting their children's mental health and well-being.

Researchers' experience of co-operative inquiry in acute mental health care.

AIM: The aim of this article is to reflect upon our experiences of using co-operative inquiry in an acute mental health care setting, with a focus on the methodology used in a 4-year intervention programme developed in Norway between 1999 and 2003. BACKGROUND: Action research plays a crucial role in assisting nurses to integrate theory and research with nursing practice. The central characteristic of this approach is the grounding of research in practice in collaboration with clinical practitioners. METHODS: The research was a co-operative inquiry based on a hermeneutic-phenomenological approach. The research methods used were ethnographic, including participant observation and face-to-face interviews, questionnaires, focus group interviews, and our process notes. FINDINGS: The different methods used in the co-operative inquiry design of the Project Teaching Ward (PTW) had both benefits and drawbacks. In particular, the focus group method proved useful due to its ability to stimulate participants' research interest, and thus motivating them to be actively involved in the development of knowledge. The particular knowledge development process used has been described as a local knowledge dialogue. This dialogue must incorporate critical subjectivity on the part of participants in order to ensure that the research has a reflective resistance, which is decisive for its validity and quality. The findings also highlight the importance of the different roles of project leader in lengthy action research collaboration. CONCLUSIONS: The PTW has illustrated that co-operative inquiry was well suited for developing knowledge relevant to practice, thus contributing to bridging the gap between practice and theory. In order for this to happen, the research collaboration should be characterized by patience, realism and engagement.

Nursing staffs' perceptions of persons suffering from mania in acute psychiatric care.

AIM: The aim of this study was to illuminate nursing staff perceptions of persons suffering from mania and how this influences the provision of nursing care. BACKGROUND: Nursing staffs' experiential knowledge in relation to their work with persons with manic illness is explored, guided by a theoretical framework of mania as suffering. METHODS: The study was carried out with a participatory inquiry design, and focus group interviews were employed for the collection of data. The data analysis followed the qualitative content analysis procedure. FINDINGS: Four main themes emerged from the analysis: staff views of patients' self-image, needs and desires, a united stance, nursing strategies, and ethical dilemmas. Nursing staff discern the 'disease suffering' based on what is typical in the patient's behaviour, apprehend the existential suffering through the uniqueness of the patient's situation, and finally, realize the various ways in which patients can experience suffering as a consequence of nursing care and treatment. The findings further revealed that one of the greatest challenges of working with persons suffering from mania is that they are often admitted against their will and do not perceive themselves as being ill or in need of help. CONCLUSIONS: In conclusion, the findings from this study are theoretically transferable to similar contexts. We suggest that the themes identified above could be used by nursing staff to reflect on their perceptions of and encounters with persons suffering from mania. Furthermore, value-based psychiatric nursing practice, focusing on patients' experiential knowledge, is needed in order to assess the influence of suffering on a person's life and their experiences of treatment and care.