Experiences of mental health nursing staff working with voice hearers in an acute setting: An interpretive phenomenological approach

Abstract

Introduction Mental health nursing (MHN) staff in acute settings work with voice hearers at times of crises when they experience high levels of distress. Previous research has focused on community mental health staff's experiences and their service users views on exploring the content of voices. No studies have explored this from an acute mental health service perspective. Aim This study therefore sought to explore the experiences of staff working with voice hearers in an acute mental health service. Method Due to the exploratory nature of the research, a qualitative design was chosen. Three MHNs and five healthcare support workers (HSWs) were interviewed. The data were analysed using Interpretative Phenomenological Analysis. Results A group analysis elicited three master themes: "It's quite scary really, not unlike a horror movie;" "I can only influence what's in front of me;" and "Just chipping away". Discussion Staff working with voice hearers in acute settings experience feelings of powerlessness and helplessness, as they feel unable to reduce the distress experienced by voice hearers in their care. Staff employ coping strategies to help manage these difficult feelings, including using structured tools in their work with voice hearers and attending reflective practice forums. Implications for Practice Acute mental health services may need to protect time for staff to access regular reflective practice and other supervision forums to help manage their feelings of powerlessness and helplessness arising from their work with voice hearers.

A qualitative study exploring how Practitioners within Early Intervention in Psychosis Services engage with Service Users’ experiences of voice hearing?

“…The first theme examined the practitioner role in starting a conversation about voices. This was not always a straightforward process due to the previously reported barriers experienced by service users (Bogen‐Johnston, de Visser, et al, ) and practitioners (Coffey & Hewitt, ; McMullan et al, ). Our findings suggested that even within a specialist service for the treatment of psychotic experiences, practitioners may not always feel comfortable about having these conversations.…”

“…The current literature suggests that many service users with a diagnosis of psychosis have limited access to formal therapeutic conversations about voice hearing experiences that are consistent with the evidence base (RCP, ). Therefore, the availability of informal conversations can play an important role in bridging the all‐or‐nothing gap, yet barriers to such conversations exist for service users (Bogen‐Johnston, de Visser, et al, ) and practitioners (Coffey & Hewitt, ; McMullan et al, ). This study extends our understanding of these barriers from the perspectives of practitioners working in an EIP Service where these informal conversations are expected to occur (NICE, ).…”

“…These difficulties were attributed to feelings of shame, intimidation by voices, concern for others and uncertainty about the likely responses of others. Second, some practitioners may be reluctant to talk about voice hearing experiences with service users due to anxiety and a lack of confidence (Coffey & Hewitt, ; McMullan, Gupta, & Collins, ). This lack of confidence was attributed to the dominance of the medical model, concerns about making things worse and the limited meaning of voice hearing experiences.…”

Too Busy to Talk: Examining Service User Involvement in Nursing Work

“…Stenhouse's (2009Stenhouse's ( , 2011) study revealed service users' unfulfilled expectations of being able to talk with nurses, which mirrored participants' accounts in our study. It is reported that the limited interactions that occur between mental health nurses and service users on acute admission units are seldom therapeutic or theoretically informed (Cameron et al, 2005;McMullan, Gupta & Collins, 2018).…”

“…Mental health nurses certainly seem to be obligated to administer elements of the system rather than ensuring time is spent with people using services (Simpson, 2005). Nursing staff are reported to experience stress in acute environments that goes beyond concerns about capability and resources to encompass feelings of being ineffective (McMullan et al, 2018). According to Lee, Daffern, Ogloff and Martin (2015), higher levels of stress relating to organizational and staffing issues frequently leave nurses feeling dejected and unvalued.…”