Reviews of Advances in Contemporary Nursing and Interpersonal Violence
Professor, Executive Director, The College of Nursing, Burwood NSW
School of Nursing, University of Southern Queensland, Toowoomba QLD
This special issue of Contemporary Nurse addresses a topic which not only dominates contemporary media and political discourse but also professional practice. Nurses deal with violence daily in all of its aspects as they manage an increasing level of violence from patients and families and care for those who are admitted as result of physical or emotional assault in their private lives.
The framework of this special issue facilitates the reader's journey through the varied articles, all written by individuals who have investigated a particular aspect. From a comprehensive preface by Anne McMurray to an Epilogue which focuses us all on how we can respond to violence, this issue covers most aspects of violence. These are categorised into three main sections including intimate partner violence, workplace violence and contemporary perspectives on health and violence. The articles in each section include opinion pieces, research reports and narratives making the edition very easy to read as well as rich in content.
The styles of the contributors and the variety of approaches to investigation and analysis make the whole issue interesting as well as instructive. Elaine Deitsch's article on women who have an abnormal cervical screening result utilises a phenomenological approach while the pilot study of child-mother violence in an area health service used a survey and Delphi technique to investigate a subject rarely scrutinised. In between there are opinion pieces on 'screening for violence', 'keeping nurses' safe' and 'aggression in nursing', all well researched and extremely informative.
Colin Holmes and Kim Walker both present well reasoned and well researched treatise on key contemporary debates. Colin Holmes addresses the issue of zero tolerance while Kim Walker explores the ‘idea of terrorism as a strategic device deployed by a range of actors and entities to manipulate and undermine the Western way of ‘life’’. Indeed, as I read this, I could easily see how the framework of his argument could be applied across the board from terrorism which struts the global stage to that which subversively undermines local areas in which we all might work.
The article on Domestic Violence health and health care provides insights into how women perceive they are being measured when they present to health professionals. How they feel judged and even discriminated against resulting in them feeling unworthy of care. The women in the study discussed in this article wanted health professionals who were not judgemental and who treated them with respect and care. One of the major impediments to effective care appears to be the way in which current services medicalise all presentations expecting them to follow a predictable pathway. Yet, for these women, the pathways are more often to be unpredictable leaving them feeling helpless and hopeless. This article is particularly concerning given the increase in domestic violence or at least the increase in reporting of domestic violence and the long term effects of such violence on families and the one who is abused. Surely we have a more sophisticated critique of such situations along with a more sensitive approach to individuals who are trapped in such abusive situations
An article towards the end of the issue reports on the way nurses understand domestic violence thus providing the mirror image of the above study. This later article which is part of a doctoral study examines how nurses understand and treat women who are abused. This grounded theory study is cross cultural investigating how Japanese and Australian nurses interpret domestic violence. While nurses in Australia follow set protocols and procedures, the restraint for Japanese nurses is the traditional belief system in which their culture views a woman who transgresses in a marriage as deserving of a degree of abusive behaviour such as a 'slap'.
The article on Domestic Violence health and health care is followed by an interesting research piece on the journey of healing once an abusive relationship is ended. As the authors remind the reader there are two realities which the abused person has to deal with. That of the 'loving relationship’ a view often perpetuated by the abusive partner, relatives and friends and the other which is the reality of the abuse itself which is denied by others. ‘Reconciling these two realities involves both a social and intrapersonal process.’
The preliminary findings of a national study of bullying in the nursing workplace were presented in another article. These early findings reports the more qualitative aspects of the study reflecting the way in which bullies are supported through informal organisational networks allowing them to continue their 'ritual indoctrination'. Ultimately, this study which is supported by an ARC grant may offer ways forward in managing workplace bullying to ensure it is not tolerated in our health facilities or indeed anywhere.
This study is followed by a well analysed literature review by Sandra Speedy which investigates several aspects of workplace violence such as gender and costs to the organisation which presently stands at $ 13 million annually. The next piece continues the theme of workplace violence through an examination and discussion about the theories of aggression and violence in relation to nursing and nurses. In this way the reader is taken though a variety of propositions and constructions about aggression and violence raising the issue of whether we need new ways of making sense of contemporary expositions of aggression and violence towards nurses.
The editors are to be congratulated on an issue which not only brings together a cast of excellent writers and scholars but also addresses so many aspects of the subject utilising a range of styles, voices and approaches. While violence is a subject we would rather avoid, particularly in its ugliest domestic guise, this volume forces us to confront the reality of its everydayness and the need to deal with it more effectively.
I strongly recommend this Special Issue as a resource for teachers and students whatever the discipline since violence is something we now live with daily in both our public and private lives. These articles may go some way in helping us to name it and therefore recognise, respond and resist it. The major restriction may be that this journal is mainly read by nurses when we need a wide spread of society including politicians, to read, discuss and digest the powerful and rich material in this issue.
Professor Judy Lumby RN. ICN. PhD (Deakin), MHPEd (UNSW) BA (UNE), MAICD, FCN
I found this special issue of Contemporary Nurse focusing on mental health nursing interesting for a number of reasons, the foremost being the very fact of its focus on mental health nursing. It also represented the views and work of some of the leaders in the profession across a range of scholarly and research articles. I found myself debating and discussing (in my head) many of the issues as they were presented.
I am interested in consumer participation in mental health services. In the future, the changes brought about by consumer participation will have a greater impact than the changes that were the result of deinstitutionalization. Views on the changing roles of consumers are only beginning to take hold in Australia. This special issue strengthens my belief that consumers are nurses’ natural partners in mental health care and that in the future we can look forwards to working side by side. Naturally I was pleased to see that a number of consumers were included as co-authors on papers.
This special issue is based around the guest editorials from Kenneth Walsh, Stephen Elsom and Dianne Wynaden. It is divided into three sections: consumers and mental health, mental health nursing practice and mental health nursing education. The guest editorials are followed by scholarly and research articles. Below I have attempted to capture the essence of the wide range of topics addressed.
In the editorial, consumers and mental health, Kenneth Walsh asks us to remember that we (nurses) have a lot in common with consumers and that we should be considering the people we work for or with holistically. Unfortunately, there is pressure on the ‘bottom line’ to be reductionist and efficient and this is not always consistent with holism. The research presented in this section suggests that consumers still feel excluded from decision-making processes, and often when they are included the ‘consumer participation’ is tokenistic. Although in another study consumers were found to have a positive attitude to mental health nurses and value their role in emergency departments. This is an interesting and emerging area of research, that of consumer evaluation of service delivery.
Issues we need to address in our practice include racism towards minority groups especially Indigenous Australians. One of the consequences of racism is that we know little about the mental health of minority groups and often treat them with one size fits all approach. This section also encourages us to remember that consumers are people; the final article’s findings indicate that exercise can make a very real difference to people with dementia. In the second section, mental health nursing practice, Stephen Elsom acknowledges the broad and changing role of mental health nurses. There is an interesting article on the challenges mental health nurses face when working with people diagnosed with a borderline personality disorder. An emphasis is placed on the relationship nurses have with consumers. Respect for consumer’s rights is ‘embarrassingly simple’; unfortunately we are often unnecessarily coercive in practice with people admitted involuntarily.
Mental health nurses suffer more violence as a result of their work than other nurses. Not only from patients but also from co-workers, the violence includes physical and verbal attacks as well as sexual harassment. This violence is accepted as part of the job.
Mental health nurses also work with new mothers and there is an interesting review of the literature on medications and breast feeding. There is also an article which encourages us to be more aware of post-partum depression. Apparently only about half of women in the United States who suffer post-partum depression are detected despite the availability of effective screening tools. At the other end of the life scale, people with dementia are increasingly being admitted to acute care services. The research on this topic suggests that life would be better for this group of consumers if we were people focused and consider the individual needs of the person with dementia in the acute setting.
Mental health nursing education is the subject of the final section and guest editorial. The significant changes to mental health care in general and nursing in particular are discussed. Dianne Wynaden, the author of the editorial (an academic), clearly values the opportunity to work with a clinician. Future education needs to value a partnership between clinicians, consumers and educators. The article on education in a clinical setting also recognizes the critical role clinicians and clinical settings have in developing/educating the next generation of mental health nurses.
Borderline personality disorders come under the spotlight again with research that examines training staff in the use of dialectic therapy in treating people diagnosed with a borderline personality disorder.
This section then moves us to the workplace and mental health with an interesting article that draws attention to the emphasis on physical health and the lack of interest in mental health in the discussions around primary health care in the work place. The next article challenges us to broaden our practice to include not only care of the people with mental illness but also primary mental health care. The issue finishes with two book reviews: one on mental health care for people with learning disabilities and one on the social consequences of closing the asylums.
This special issue is a valuable resource not only because it acknowledges the contribution mental health nurses make, but also because it represents some of the developments in the specialty. It encourages us to critically review our practice in the light of these developments.
School of Nursing and Midwifery
Griffith University, Gold Coast, QLD, Australia