Storytelling in mental health nursing: clinical and educational purpose

Research Doctorate - Doctor of Philosophy (PhD)Mental health nurses and those working in mental health tell stories in formal education sessions such as lectures, tutorials, and in informal teaching and also in the workplace. Many are told to undergraduates and to new recruits. The purposes of the storytelling and the possible interpretations and messages taken away by the listeners have not often been explored. I collected 100 stories directly from mental health nurses and also from a few previously published sources to uncover the purpose of stories told by experienced mental health nurses to undergraduates and new recruits. The study determines: 1)The implications of these anecdotes about mental health nursing for the exploration of contemporary mental health practice and education; 2)The educational value of the stories (the essence and rationale of the narratives) for use as stimulus material i.e. as catalysts for learning for both the novice and more experienced mental health nurse; and 3)The relationship between concepts relevant to the enhancement of both practice and education in order to develop a conceptual framework for professional practice and education. A case study methodology was used to analyse the stories and explore their fitness for educational purpose. This methodology is flexible and often used in educational research. It is particularly suitable where the question is “How?” or “Why?” The components of a case study are people, things, events, contexts and relationships, components which are suitable for analysis of stories about mental health nursing. Three workshops were held, both to collect stories, and to record insights about the stories. Participants were two groups of experienced mental health nurses, and one group of undergraduates close to registration. Their insights about how the stories could be interpreted and the purpose of telling selected stories were also written down. A Data Analysis Template (based on the work of Tripp (1994) and McCormack (2000a) was used to analyse the stories and this showed that the most significant aspects of the stories were Events, Relationships and Moments. The stories fell into three main groups, the first at the surface level, dealing with the history of mental health nursing and providing examples of mental health nurse humour, the middle level offering a variety of insights into daily work in mental health nursing whether in the hospital, the community, the prison or other setting, and the deepest level stories showed the attitudes and skills developed by experienced mental health nurses. What was highlighted was the use of silence, the place of tears, the use of apology, the discounting of aggressive behaviour and potentially dangerous situations (although the risk was always understood and recognised), the ability of the mental health nurse to engage with and relate to the most challenging people, the advanced assessment skills held, the strong advocacy by the mental health nurse for the patient or client or consumer, the willingness to be a change agent in new settings for mental health care, and, whether the story contained some reflection or comment or not, the lack of self-aggrandisement and matter-of-fact acceptance of all that is involved in the daily life and work of a mental health nurse. Many of these skills are also required in the facilitation of student learning, particularly when students undertake their first clinical placement in a mental health setting. In this respect there may be similarities between the work of an experienced mental health nurse and the catalysts for effective learner engagement. These clinical anecdotes capture much which is not contained in textbooks and allow students to enter the real world of mental health nursing, where not everything is predictable and orderly, and where “inspired creativity” is often required to manage difficult situations, and where the essential ambiguity of mental health nursing is demonstrated in a variety of ways. The value of the stories is that educators can use them to provide authentic stimulus material and facilitate discussions using the questions suggested in Chapter 5. These open questions encourage individual responses which may then allow for multi-faceted interpretation by groups of students. This in turn may be a useful preparation for a first clinical placement in mental health nursing, or a way to debrief after a first placement is completed