Nurses' Discourses of Challenging Behaviour in Inpatient Mental Health Services

Mellow, Amy Louise (2018) Nurses' Discourses of Challenging Behaviour in Inpatient Mental Health Services. DClinPsy thesis, University of Lincoln.

Nurses' Discourses of Challenging Behaviour in Inpatient Mental Health Services
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Item Type:Thesis (DClinPsy)
Item Status:Live Archive


Nurses working in acute mental health services are vulnerable to occupational stress. One main stressor identified has been the challenging behaviour of some service-users (Jenkins & Elliott, 2004). The impact of challenging behaviour is far reaching. It affects the health and safety of staff, service-users and carers, negatively impacts the overall experience of care (Beech & Leather, 2005; NICE, 2014; 2015) and can increase risk of abuse, isolation and neglect of service-users and increase stress and strain amongst caregivers (Emerson, Robertson, Gregory, Hatton, Kessissoglou, Hallam, & Hillery, 2000; Rose, Nelson, & Hardiman, 2016). Challenging behaviours, in particular incidents of violence and aggression, are a complex manifestation of a combination of characteristics. Challenging behaviour has been found to be the term most often cited as the reason for the use of restrictive interventions on incident forms (Ryan & Bowers, 2006). The use of unnecessary restrictive interventions has been widely criticised, particularly following the Winterbourne View Inquest (DoH, 2012) and national guidance states that it should only be used as a last resort to manage imminent risk (NICE, 2015a). A number of political drivers have attempted to end the use of unnecessary restrictive interventions (Mind, 2013). However, a Freedom Of Information request (FOI) made by Norman Lamb MP has found that the use of physical restraint on inpatient wards remains high. The central aim of this research was to explore how qualified mental health nurses construct the challenging behaviours they experience on the wards, and how they talk about its management.
A number of studies have explored how staff account for their treatment decisions and have shown how dominant practices are enabled and maintained through language (Harper, 1995; Parker, Gergaaca, Harper, McLoughlin & Stowell-Smith, 1995).
This research is informed by a critical realist stance. Semi-structured interviews were used to elicit talk about challenging behaviour and its management with seven voluntary participants, all inpatient mental health nurses recruited from the acute and PICU Wards of two NHS mental health hospitals. Interviews were analysed using discourse analysis, informed by both discursive psychology (Potter & Wetherell, 1995) and Foucauldian discourse analysis (Foucault, 1979) approaches.
It was found that staff drew on a dominant biomedical discourse which acted to legitimise restrictive interventions and marginalise psychosocial and emotional constructs and approaches. Systemic discourses were also drawn on to both justify and criticise the use of coercive approaches and to position both staff and service-users as disempowered. Thus, challenging behaviour and restrictive interventions could be argued to represent tools for both groups to recover control.

Keywords:Nurses, Challenging Behaviour, Mental Health Services
Subjects:C Biological Sciences > C840 Clinical Psychology
Divisions:College of Social Science > School of Psychology
ID Code:34667
Deposited On:01 Feb 2019 15:26

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