Mental health nurses, physical healthcare & people with serious mental illness: a Bourdieusian exploration

Abstract

BACKGROUND: People with serious mental illness (SMI) die between 10-20 years younger compared to the rest of the population. They experience higher rates of physical co-morbidities. The contributing factors are multifactorial and include medication side effects, genetics and socio-economic determinants of health. This is a global problem. There appears to be ambiguity surrounding nursing roles in addressing these health inequalities. Previous studies have highlighted certain organisational and structural factors which may play a role but without significant depth of how they impact on mental health nursing practice.

AIMS/OBJECTIVES: The aim of this study was to examine how registered mental health nurses working in one Scottish health board understood their role regarding providing physical healthcare to people of working age with SMI. In particular; Find out how relationships and structures within the work environment impact on mental health nursing practice. In what way do educational experiences and competencies assist mental health nurses in performing their role.

METHODS: This qualitative study was informed by Pierre Bourdieu’s Theory of Practice. Registered mental health nurses (n=7 inpatient, n=7 community) from one Scottish Health board were interviewed. Data was collected between January-May 2018, using semi-structured 1:1 interviews. Interviews were transcribed verbatim and analysis was informed by Braun and Clarke’s (2006) Thematic Analysis. The study received a favourable ethical opinion from the author’s institution and research development approval from the local health service. Results: Analysis reveals that Mental Health Nurses’ (MHNs) physical healthcare practices takes place in a complex field. All the participants voiced that they had a role in meeting the physical healthcare needs of people with SMI. They often did not realise that they were ‘doing’ physical healthcare tasks as they were embedded into their routine, every day work. Their work appears to be invisible and may not be conceptualised as physical healthcare. Several structural factors impact on participants to provide appropriate physical healthcare for people with SMI. These can be conceptualised as forms of symbolic violence. There is also tension between the boundaries of various fields that impacts on practice. It may account for nurses questioning their role. Nurses utilise many forms of capital within their field of practice, to varying degrees of success. Some of these forms of capital include the establishment and maintenance of therapeutic relationships, clinical experience, learning from peers and the development of confidence. It was clear that there was a significant emotional burden to this area of practice which is not always recognised or discussed.

DISCUSSION: The study highlights various structural factors impacting on mental health nurses ability to address patients physical health needs. Services need to give consideration as to how they are going to remove such barriers, which may help nurses to practice more competently and confidently. Specialist nursing roles may help overcome some of these barriers. Education providers and health services need to work in tandem to better meet the ongoing development needs of the workforce. In particular, education should empower MHNs to deliver health promotion in a way that is tailored to people with SMI. Pre-registration education should consider how physical healthcare can be delivered in a MH-specific context. There is need for a clear, strategic, longitudinal policy approach.