Cultural boundary surfing in mental health nursing: A creative narration

Jacquie Dianne Kidd
School of Nursing, University of Auckland, Auckland; Primary Mental Health Practitioner, Hamilton, New Zealand

PP: 277 - 288

Abstract

In the mental health context, nurses navigate multifaceted boundaries every day in an effort to develop and maintain the therapeutic relationship; an endeavour that is breathtaking in its complexity.

In this paper, I adopt an unconventional form of writing to explore the individual nature of cultural boundaries, and uncover hidden messages that impact on our efforts to build connections across cultures and ethnicities in mental health settings. Presented as a play, the conversation between protagonists explores cultural competence alongside the notion of 'discovery', and the potential of the Tidal Model to provide a vehicle for successful cultural boundary surfing.

I offer my heartfelt thanks to Phil Barker and Poppy Buchanan-Barker for allowing me to co-opt their words and personae from our many interactions over the years. My occasional segue into theory is indicated by a change in font and three asterisks.

Keywords

Cultural competence, Tidal Model, Mäori, ethnicity, relationship

Article Text

The stage is set, with a spotlight focusing on five chairs evenly spaced around a long white table. The table is covered with paper, ballpoint pens and plastic water bottles. Five people sit at the table, heads bent as an elderly Māori voice from off stage recites a karakia timatanga,asking for guidance so the meeting will be peaceful and productive.

            "Tihei mauri ora." As the voice fades away, Jacquie leans forward in her chair, frowning slightly.

            "Is this where we introduce ourselves, and explain what we hope to achieve in our paper?" She glances at her colleagues, Poppy and Phil, then they all turn to the two editors, expressions inquiring. At the confirming nod, Jacquie picks up a notepad from the table in front of her and reads:

*   *   *

In mental health settings, the story of the 'patient' is usually written from the perspective of the healthcare professional, and may strip the personal, cultural and social experiential context from the person who has been designated as 'patient'.

            In much of the mental health literature, treatment goals include the absence of the symptoms of mental illness, and the presence of 'wellbeing', within which people are assumed to be 'coping', or 'in control of their lives', and 'able to face challenges', and 'take on responsibility' (Ramon, 2005).   However, the specific meanings of these goals require personal and cultural definition.

*   *   *

            She stops reading and adds, "Our conversation today is about how, in contemporary mental health care settings, the personal and cultural realities which are central to the person must also be central to care. We want to talk about some of the difficulties of 'riding the cultural boundaries' between people when establishing a therapeutic relationship.

            "Cultural competence is a topical issue in the mental health arena, and is a more demanding and focused objective than that of merely professing sensitivity to cultural difference (Mahoney et al., 2006). For New Zealand nurses cultural competence relates firstly to Maori models of health and illness, and how they might be different to the models promoted in healthcare services (Nursing Council of New Zealand, 1996, , 2005, Rochford, 2004). It is particularly important to explore cultural competence in services and in individual practitioners when you consider that Maori health outcomes are considerably worse than those of non-Maori across the range of health indicators (Ministry of Health, 2002, , 2006). What is more, if we extend the idea of cultural competence beyond the indigenous relationship, we also have to consider the cultural needs of immigrant and refugee populations (O'Brien et al., 2009, Pernice et al., 2009). This paper will take a perspective that draws on the New Zealand context to propose a universal way of riding those boundaries that is grounded in everyday practice and supported by existing evidence."

            "To do this", Phil adds, "We'll show how the Tidal Model can be a vehicle to help healthcare professionals and services to move away from our own personal and cultural space, into a kind of middle ground that validates and respects those of the person in care."

*   *   *

            The Tidal Model emphasises that people are, as Auden noted, 'incomparable, unclassifiable, uncountable, irreplaceable' (Van Manen, 1990: 6),and should hold the primary focus of all work in the 'human services'. If this ideal is to be upheld, we must seek to understand something of people's experiences as people. A significant part of that personal position will derive from social and cultural influences.

*   *   *

            Poppy pushes her sleeves up, "I also want to raise the issue of recovery", she says. "What it is, what it isn't, and what it implies for everyone concerned with mental health care, but especially for people whose cultural context puts them at odds with the dominant culture of the service they are receiving care from."

            The three colleagues look at each other, confirming that each person has finished speaking. With a nod, Phil turns to the editors.

            "All right?"

            The editors are concerned. "Shouldn't this be a scholarly article? What is the point of writing up a series of conversations, and why should we publish your unorthodox paper?"

            "This is a difficult topic to explore," explains Jacquie. "Cultural identity can be invisible, especially for people who operate entirely within a dominant culture where their work, family and social context are homogenous and socially prominent (King, 1985). In writing about culture, a subject that is emotionally intimate yet forms an important part of practice, creative writing and first person narratives are tools which enable readers to engage with the paper and to draw out alternative understandings of issues around culture and mental health nursing practice (Leavy, 2009, Richardson & St. Pierre, 2005). For these reasons, a play is a useful and lighthearted way to explore a complex and serious area of practice"

            The editors cautiously nod their agreement, push their chairs back from the table, and, with an encouraging wave, they exit, murmuring quietly together over a sheaf of papers.

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