A psychosocial approach to understanding the capacities to care and think critically in student mental health nurses

The thesis focuses on mental health nurse motivation and education. Both caring behaviours and critical thinking are essential components of being a capable mental health nurse. By positioning student mental health nurses as psychosocial defended subjects, the research reported here shows theoretically and empirically that caring behaviours and critical thinking dispositions are mutually inclusive and both are influenced by dynamic psychosocial factors. Using Melanie Klein and other psychodynamic theorists, the research questions generated for the study were: What psychosocial factors influence the desire to be a mental health nurse? And, How do psychosocial factors influence mental health nursing students’ pedagogic experiences? These questions were addressed by using a narrative, participatory research methodology to explore with 14 undergraduate student mental health nurses: (1) the relationship between their backgrounds and the psychosocial motives for career choice; and, (2) the influence these motivations had on their capacity to learn compassionate caring behaviours and critical thinking dispositions. They were each interviewed once at the beginning and once towards the end of their final semester of the pre-registration programme (twice each). Data was coproduced using two approaches: a life-grid method for gaining auto-biographical information retrospectively; and a Free Association Narrative Interview (FANI) technique, developed by Hollway and Jefferson (2000). Narratives analysed through the lens of the psychosocial defended subject revealed that the students had experiences of loss and unmet needs which directed them towards a career in mental health nursing motivated by a desire to heal vulnerable others. Seeking ‘reparation’ arises as an unconscious defence mechanism against anxieties provoked by prior and present losses and unmet needs. The study also found that the student mental health nurses shared pedagogical situations both in classrooms and in practice which generated common unconscious defence mechanisms, specifically: splitting, systematicity, compliance and reparation. In this way, the study offers a unique insight into the anxieties and defences experienced during a three-year mental health nurse undergraduate programme, revealing how unconscious defence mechanisms both enable and constrain caring behaviours and critical thinking dispositions, as well as affecting the well-being of the students. There are implications and recommendations for mental health nurse education, policy and research. If society wants both caring and critical mental health nurses (and other health and care workers likely to be motivated in similar ways), we need to acknowledge the emotional content and psychosocial characteristics of becoming and practicing as a professional. How mental health nurses are educated can contain and or fuel their anxieties and enable or constrain their capacity to mobilise defences which are productive of caring and thinking critically. Moreover, the same considerations can be brought to bear on workplace culture and possibilities for supporting resilience in other healthcare practitioners. The wider contribution of the study is to offer an alternative way of thinking about issues related to producing a healthy, caring and competent NHS workforce. The findings engage with the current ‘crisis of care’ whereby it is argued that high profile cases of patient neglect are contributing to an erosion of public confidence and trust in health care provision and professionals. There are many accounts of detached, de-personalised and defensive behaviour on the part of care staff. From a psychosocial perspective, affect cannot be ignored: ‘caring’ involves a cluster of complex processes, difficult to define and open to interpretation: being a caring nurse involves (conscious and unconscious) moral, relational and practical dimensions; it is interwoven, intersubjective and expressed in practical situations. Flourishing as caring and thinking people and professionals involves the interplay between individual psyche and social structures and systems