Marie Crowe

While the need to develop and conduct research has been prominent in mental health nursing for some time, the current funding climate in tertiary institutions has created even more pressure for research outputs. The Research Assessment Exercise is well ingrained in UK institutions, New Zealand is about to enter the second round of the Performance-based Research Funding model, and Australia is committed to a Research Quality Framework. There is much to learn from nursing departments in those countries that have already been part of the process. This paper will present a content analysis of what mental health nursing research is currently being published in nursing journals and discuss the implications of the research assessment exercises on its future. Those mental health nursing articles sampled in the study revealed a shift beginning towards more consumer-focused research was occurring but that there was a need for more research into the effectiveness of specific mental health nursing interventions. Most of the articles also reported on small-scale research. It concludes that research needs to be more clinically orientated and less profession-orientated. It also suggests a need to focus on larger-scale studies possibly situated within a collaborative research programme. These programmes need to be more collaborative both cross-institutional and cross-disciplinary.

Aim.  This paper presents a literature review conducted to establish what was already known about critical reflection in the nursing literature and what work had been done on using a critical social theory framework as the basis for critical reflection.Background.  Critical thinking emerged as a significant aspect of nursing education and practice in the late 1980s. It has been promoted as a means by which issues in clinical practice can be examined through a systematic process of exploration and reasoning. Traditionally, critical thinking has commonly involved an attempt to link practice with theory using a scenario or exemplar from practice to illustrate a practice dilemma. This process is often constructed as a retrospective narrative of events. This paper provides a deconstructive–reconstructive approach that differs from some traditional approaches by taking a critical social theory perspective with an emphasis on improving practice.Methods.  The nursing literature reviewed was accessed through Cumulative Index of Nursing and Allied Health Literature (CINAHL). The search was restricted to English language and published between 1995 and 2005. Based on these findings, we developed a postgraduate advanced mental health nursing programme.Findings.  There were 490 articles related to ‘nursing’ and ‘critical thinking’; 34 articles related to ‘nursing’ and ‘critical reflection’; 23 articles related to ‘nursing’ and ‘critical social theory’; 15 articles related to ‘mental health nursing’ and ‘critical thinking’; and two articles related to ‘mental health nursing’ and ‘critical reflection’. In the programme we developed based on these findings, students were facilitated to deconstruct concepts and knowledge integral to their own practice. In the reconstructive phase, students implement a change project in clinical practice, supported by a mentor.Conclusion.  The deconstructive–reconstructive approach to the development of critical thinking skills provides advanced practitioner with the opportunity to integrate practice, theory and research.

ABSTRACT:  Depression is a common psychiatric disorder that is acknowledged to be increasing in disease burden. The rates of adolescent depression is particularly concerning as they continue to increase. The seriousness and pervasive effects of depression on young people's lives supports the view that research that extends the knowledge in this area is vital. This is a descriptive study of the characteristics of depression in a sample of 121 adolescents attending an outpatient specialist adolescent mental health service in New Zealand. The adolescents were required to complete two self‐report measures to assess presence of depressive symptoms, severity of depression, and particular characteristics of the depression. The findings revealed that irritability was the most common characteristic along with other interpersonal and thought processing symptoms. It is important that mental health nurses are able to identify the specific characteristics of adolescent depression that may differ from adult depression in order to manage this patient population effectively.

Interpersonal psychotherapy (IPT) is well-recognized for the treatment of depression with many efficacy trials supporting its use. However, there is little discussion of its use in mental health nursing practice. This paper explores how IPT can be a useful intervention for mental health nursing practice and demonstrates the process of IPT with reference to a case study. The case study illustrates how IPT facilitates a shift for one woman from a passive subject position to a more self-assertive one. This shift was facilitated by identifying how she was constructing herself in relation to others by utilizing tactics of passivity and avoidance of conflict. The development of more satisfying subject positions facilitated an improvement in mood and recovery from depression.

This paper describes a discourse analysis of the process of interpersonal psychotherapy (IPT) in the recovery from depression. It demonstrates how IPT is an effective treatment strategy for mental health nurses to utilise in the treatment of depression. The discourse analysis highlights how the development of more meaningful subject positions enables one woman to recover from her depression. The process of recovery is underpinned by an understanding of women's depression as promoted by contemporary social and cultural expectations for detachment and reflexivity. This paper shows how IPT provides an opportunity for recovery from depression for one woman by facilitating a reconstruction of her subject positions in relation to others. The discourse analysis revealed that the therapist facilitated this through the use of a range of techniques: seeking information, exploring beliefs/values/assumptions, exploring communication patterns, exploring affective responses and exploring alternative subject positions.

This case study involves a set of transcripts of Interpersonal Psychotherapy (IPT) sessions from the Christchurch Psychotherapy for Depression Study. The case study explores the techniques employed by the therapist for a depressed patient who has identified interpersonal disputes as the interpersonal area to focus on. The psychotherapeutic interventions utilized by the IPT therapist included: seeking information; exploring parallels in other relationships; exploring relationship patterns; exploring communication patterns; signalling what is significant; providing support, exploring affect; exploring options; problem-solving; drawing analogy; and challenging. The themes that emerged in the patient's response to IPT were: struggling, deconstructing, connecting, practicing and reconstructing.

ABSTRACT:  Interpersonal psychotherapy (IPT) is well‐recognized for the treatment of depression with many efficacy trials supporting its use, however, there is little discussion of its use in mental health nursing practice. This paper explores how IPT can be a useful intervention for mental health nursing practice and demonstrates the process of IPT with reference to a case study. The case study illustrates how IPT facilitates a shift for one woman from a passive subject position to a more self‐assertive one. This shift was facilitated by identifying how she was constructing herself in relation to others by utilizing tactics of passivity and avoidance of conflict. The development of more satisfying subject positions facilitated an improvement in mood and recovery from depression.

This paper takes a deconstructive approach to the historical, clinical, and social context of the diagnosis of borderline personality disorder (BPD). This is undertaken by providing an overview of pertinent literature, an examination of the diagnostic criteria, a discussion of the development of the shame affect, a discussion of women's narratives and a reinterpretation of the symptoms of BPD as an overwhelming shame response. An argument is developed that shame is an integral but neglected feature in the experiences of mental distress that are characteristic of BPD. This discussion is supported with evidence of shame in narrative quotes from women with a diagnosis of BPD. There are striking similarities between what is currently pathologized as BPD and an overwhelming shame response. Recognizing the influence of shame may assist mental health nurses to provide mental health nursing care that best meets the needs of women experiencing these symptoms.

This paper is the second part of two papers that explore the affect of shame and its role in the manifestation of symptoms that could be regarded as evidence of mental disorder. The clinical implications for nursing a person with an overwhelming shame response are discussed in this paper. It is proposed that a discursive approach to nursing care may assist mental health nurses to provide care that best meets the needs of people experiencing these symptoms. The paper suggests that this nursing care involves recognizing the impact of shame; making connections between how the person has learned to cope with shame and their current mental distress; situating shame in its socio-cultural context; focusing on subject-object differentiation and promoting acceptance of difference and exploring alternative subject positions for managing feelings of shame. The focus of these interventions is to encourage awareness of interactions with others, how the person positions her or his self in relation to others, and the communication patterns that perpetuate feelings of shame. It also involves helping the person to integrate the ideal image of her or his self with subject positions that are more flexible.