Variables y operacionalización

research related to the skilled use of ethical imagination within a mental health nursing context.

7.5 Final insights

IPA is a reflective process, which is iterative and typically non-linear. These reflections are constantly interacting with each other, however, for the purpose of writing this study these reflections are separated out and identified. This does not mean at this juncture this reflective process stops, even now as I am writing this section reflective insights are springing into my consciousness. Yet, I am mindful there is a need to capture these reflections as learning, which will hopefully improve the way mental health nurses practise. Wanting to improve mental health nursing practice is shaped by my continuing experiences as a registered mental health nurse. This wanting or drive is grounded by the pragmatic reality of this study – the findings.

In the recommendations of this study there is an emphasis on the steps that can be taken to improve the practise of both prequalifying and post-qualifying mental health nurses. These steps emphasise the importance of developing ‘good ethical habits’ combined with the use of an ‘ethical imagination’. Good ethical habits and an ethical imagination are not added extras. All of the participants demonstrated the use of good ethical habits, which were accrued through years of mental health nursing practise. The informal and formal learning the participants undertook, including participating in reflective activities, shaped these good ethical habits. It is important to recognise the development of these good ethical habits are part of a mental health nurse’s lifelong learning journey – ‘cradle to grave’. Whereas the use of an ethical imagination is contextualised and directly developed through the mental health nurse’s practise experiences. In addition, ethical imagination is potentially an undiscovered part of the mental health nurse as an artist. It also has synergies with the notion of practical wisdom or phronesis.

The original aim of this study was to ‘explore how mental health nurses who within their practice have used sanctioned coercion make ‘ethical’ sense of their experiences’. In effect, the intention was to address a knowledge gap related to the ethical reasoning experiences of mental health nurses using coercive strategies. Due to this study, what do we now know that we did not know prior to this study? Of course, methodologically we have to be cautious, as this learning may not be generalisable. However, we now know that coercion is disliked irrespective of its justification, this includes changing the term ‘coercion’ to something less sinister like ‘persuasion’. The use of coercion is grounded within the values and empathetic intention of the mental health nurse - ‘I would not like this being done to me’. Knowing when to apply coercion is not just about pattern recognition it is about personal knowing. This type of knowing is embedded within the therapeutic relationship; it also constantly interacts with other types of knowing. Being ethical within a coercive context is underpinned by rules, theories, etc. The most important ingredient is ‘common sense’, having good ethical habits and a good ethical imagination (expert nurse).

Appendices

Appendix 1 - ethical clearance

With reference to your application for Ethical approval:

12/HEA/042 - Overriding the choices of mental health service users’; a study examining the acute mental health nurses perspective

Liverpool John Moores University Research Ethics Committee (REC) has reviewed the above application by Chairs action and I am happy to inform you that the Committee are content to give a favourable ethical opinion and recruitment to the study can now commence. Approval is given on the understanding that:

· any adverse reactions/events which take place during the course of the project will be reported to the Committee immediately;

· any unforeseen ethical issues arising during the course of the project will be reported to the Committee immediately;

· any substantive amendments to the protocol will be reported to the Committee immediately. · the LJMU logo is used for all documentation relating to participant recruitment and participation eg poster, information sheets, consent forms, questionnaires. The JMU logo can be accessed at http://www.ljmu.ac.uk/corporatecommunications/60486.htm. For details on how to report adverse events or amendments please refer to the information provided at

http://www.ljmu.ac.uk/RGSO/RGSO_Docs/EC8Adverse.pdf. Please note that ethical approval is

given for a period of five years from the date granted and therefore the expiry date for this project will be August 2017. An application for extension of approval must be submitted if the project continues after this date.

Yours sincerely

Mandy Williams

Research Support Officer

Liverpool John Moores University Research Support Office

4th Floor, Kingsway House Hatton Garden

Appendix 2 – participant email

Invitation to participate in the research

Dear reader

Call for participants:

I would like to invite you to participate in my research focusing on the experiences of acute mental health nurse who have used coercive strategies to control mental health users such as the use of restraint, special observations, the law, psychological interventions and risk management approaches. If you are a registered mental health who is currently practicing and has recent experience within acute mental health services, you can participate. Participation will entail 3 separate 45-60 minute face to face interviews, which will be recorded and transcribed for analysis. All interviews will remain confidential, and the research material will only be shared with my supervisors at Liverpool John Moores University. All research material will be anonymised to protect the identity of participants. Participants can choose to withdraw at any time, at which point their material will be destroyed. This research study has been granted ethical approval through Liverpool John Moores University as part of my Doctorate studies, and will be supervised by Rose Khatri ([email protected]) and Dr Susan Giles ([email protected]) at the University.

If you would like to discuss this research and perhaps would consider participating, please send me a reply by email.

Kind regards,

Grahame Smith

Principal Lecturer

Faculty of Health and Applied Social Sciences Henry Cotton Campus

Room 3.55 - 3rd Floor 15-21 Webster Street Liverpool, L3 2ET

t: 01512314115 m: 07929999495 e: [email protected]

Appendix 3 – participant information sheet

Project Title: ‘Overriding the choices of mental health service users’; a study examining the acute mental health nurses perspective

Researcher: Grahame Smith – Faculty of Health & Applied Social Sciences

You are being invited to take part in this research study. Before you decide whether or not you wish to participate in this study, it is important for you to understand why the research is being done and what it will involve. Please take the time to read the following information carefully and discuss it with others if you wish.