Los rasgos de individuación en los inicios del Oratorio

The findings from this project have been an epiphany for me. In seeking to determine MHNs skills and training needs, I was probably unconsciously leaning towards the professional (biological science and clinical care) nursing aspects of this. Therefore, themes of clinical skills, knowledge and confidence came more to the fore. It was only when I examined MHNs education and skills needs from a MHSU perspective that I found a wholly different emphasis on the subject. MHSUs did find knowledge and skills important but they felt that stigma, negative attitudes, diagnostic overshadowing and splitting physical and mental health care needs as more important to them. To paraphrase one participant, “why teach these skills if they don’t believe me when I tell them I am unwell?”

This is the first time that I have used mixed methods research as a method of investigation. I found the pragmatic aspect of using what works attractive and indeed, in this area it proved to be more suitable than a mono-method. However, I feel that I may have been too caught up in the epistemological debate especially about the quality aspects of the study. I think it will take another few mixed methods projects before I can reconcile the pragmatism of the approach with my own epistemological doubts.

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A lot is written about critical reflection in nursing. This project has re-taught me the value of critical reflection in my academic career. This should move beyond the confines of learning outcomes and the student learning experience in the classroom and into the experiences of MHSUs on the receiving end of care in their living room. I will examine this further in the recommendations and products of the research that follow this section.

I found exploring MHNs education and skills needs from the MHSU perspective very challenging professionally. I must admit to a sense of disappointment that the participant’s experiences were negative. However, when I was reflecting on this I really came to appreciate the power of stigma and how we can be unwittingly affected by it. Therefore in my own academic work and writing I have taken more of a focus on stigma and diagnostic overshadowing in MHN learning and practice in this area. While MHNs expressed a need for education and skills in the conventional aspects of diabetes care e.g. risk factors such as diet, lifestyle, adverse drug reactions and sedentary lifestyle, I have begun to highlight unconventional risk factors such as stigma and how this can affect MHSUs physical health.

Eraut (2003:1) states that,

“...the most dangerous assumption in the professions is that being qualified implies that one is competent”, further suggesting “that organisations usually claim that employees possess prerequisite occupational skills”.

These assumptions have been key motivating factors and drivers for this project. There appears to be an assumption that MHNs, because they are nurses, have the prerequisite skills to take on and sustain the physical care agenda in mental health. The results of this project would suggest that there is a variable level of occupational skills and equally important, confidence. The findings would seem to

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suggest that there is a lack of contemporary and up to date occupational knowledge and skills given the length of time training had occurred. However, there is certainly a lot of motivation on behalf of MHNs to learn more about diabetes care as their current knowledge and skill levels are low and do require improvement. It also shows that this can have an impact on the care that MHSUs have, which this study has found to be patchy, to say the least. These assumptions should not be a restraining force in NHS organisations critically examining the preparedness of MHNs to take on and sustain the physical health agenda, especially in complex areas such as diabetes care.

This research would concur with Jordan and Reid (1997) regarding the context in which MHNs are taught biological sciences and physical care skills. These are very important if under-appreciated areas of MHN curricula. For example at undergraduate level such teaching is usually undertaken from a general adult perspective which might lead to a depreciation of importance for MHNs as they may not see the benefits of this knowledge to them. Furthermore this study would amplify Jordan and Reid’s point to include mental health specific contexts such as stigma and negative attitudes and how these might act as barriers to appropriate care for MHSUs and barriers to MHNs actually using the physical care skills and biological sciences knowledge that they are being taught.

Stiles (1999), suggests the use of reflexive validity – did the research outcomes change the investigator's understanding or the theory – as a criterion of validity. I have found the input and experience of working with MHSUs to be very valuable and a challenge to my own practice. Their experiences have added a unique insight to the realities of living with a mental health problem and how this can affect physical health needs. There is an inference in Higgins et al (2011) study that MHSU input into curriculum would be seen as a low-level type of involvement, akin to tokenism. This research would take a contrary view of this as without the MHSU specific input the curriculum would be heavily weighted to professional education needs and not MHSU needs. This work would emphasise the point that

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involvement in curriculum planning would make for a fundamentally sound curriculum that other, more visible aspects of MHSU involvement, could be facilitated e.g. teaching or assessment.