To correct and to acknowledge: two simultaneous and conflicting perspectives of limit‐setting in mental health nursing

Abstract

This article reports about a study of nurses' limit-setting in mental health and the rationality behind correcting and therapeutic limit-setting interventions. Based on action science design, the study comprised three phases; namely a descriptive, reflective and concluding phase. Qualitative data were collected from various data sources; namely participant observations, interviews and written narratives. Eleven nurses participated. The main findings relate nurses' limit-setting interventions to two simultaneous and conflicting perspectives. That is: the dominating perspective of correcting, aimed at changing patients' behaviour by external control through three nursing roles of caregiver, educator and gatekeeper; the weaker perspective of acknowledging, where patients are seen as capable of changing themselves from within. The nurse's role reflects compassion and values patients' integrity. The nurses' work was based on a rationality of coping, because of a balancing act between the two perspectives and conflicting intrapersonal feelings aroused in challenging encounters with patients and colleagues. In reflection groups, relational interventions were developed, grounded in wondering reflection. Patients were regarded as participants in an open dialogue with the aim of securing collaboration.

Evaluating clinical ethics support in mental healthcare

“…Although we do not support an essentialist distinction between 'reflection' and 'ethical reflection' and we assume that the reflections within these reflection groups touched upon values and norms, our aim with this study was to include ethics support services that explicitly focused on ethics. The same arguments for exclusion were applicable to the studies of Vatne and colleagues [44][45][46] …”

A game of asymmetric information between a therapist and a mentally ill patient

“…The reason why we are interested in comparing these two situations is an inherent hypothesis (to some extent confirmed by [20][21][22][23]) of real world existence of too much patient independent treatment in psychiatry. Given such a hypothesis, the constraints (4.9), (4.10) tell us how it might be possible to move from one (undesirable) situation to another (desirable) situation.…”

“…Vatne's research [20][21][22][23] is concentrated on such topics. In her studies of milieutherapists' limit-setting in mental health, she uses the terms Acknowledging as opposed to Corrective actions -symbolizing a simplification of the "treatment space".…”

Event-Oriented Data Integration: A Qualitative Strategy in Studying Professional Practice

“…We were interested in exploring why this is perceived to be a core method in mental health nursing practice and the professional logic it embodies (Vatne & Fagermoen, 2007). Setting limits for patients in an acute mental health ward presents problematic situations where the nurses are engaged in highly complex patient/nurse encounters.…”

“…This integration is similar to a "within method approach" (Denzin, 1989) and to what Johnson et al (2007) describe as a "pure qualitative mixed method." In presenting the strategy event-oriented data integration (EODI), we illustrate the whole process with examples from a study of nurses' limit-setting actions (Vatne & Fagermoen, 2007). This study was approved by the Regional Committee for Medical Research Ethics and the Norwegian Data Inspectorate.…”