Trauma-informed care through the lifeworld of mental health nurses employed in hospital-based mental health settings

Allyson Wilson

doi:10.25918/thesis.435

Introduction: Trauma-informed care (TIC) has been positioned as a key approach to eliminating coercive practices in acute mental health settings, with international governmental support for its implementation (Azeem et al., 2017; Homes & Grandison, 2021; Law et al., 2021; Public Health Agency of Canada, 2018; Productivity Commission, 2020). Some research highlights the potential for TIC decrease seclusion and restraint, improve consumer experiences, reduce staff injuries, and minimise trauma and re-traumatisation in mental health settings (Azeem et al., 2011; Bryson et al., 2017). However, research exploring TIC from the perspective of mental health nurses (MHNs) remains limited (Wilson et al., 2017). Background: MHNs play an important role in supporting people experiencing mental health challenges. They offer a diverse skillset encompassing physical healthcare, recovery-oriented approaches, person-centred care, and specialised psychotherapy (Hurley & Lakeman, 2021; Hurley, Lakeman et al., 2022). Despite this, MHNs face significant challenges, including systemic issues like poor organisational cultures, high absenteeism, job dissatisfaction, burnout, and limited career advancement opportunities, particularly in Australia (Alenezi et al., 2019; Delgado et al., 2021; Hasan et al., 2018; Phiri et al., 2022), that create significant barriers to attracting and retaining qualified nurses. Acute mental health settings, typically hospital-based environments, represent the largest employer of nurses and the primary location where MHNs work in Australia (Australian Institute of Health and Welfare, 2019a). However, inherent challenges exist within these environments. The use of enforced care and treatment, involuntary admissions, and the prevalence of coercive practices, including seclusion and restraint, can create iatrogenic harm for both consumers and MHNs (Berring & Georgaca, 2023; Burrin et al., 2021). Aim: This study aimed to explore TIC through the lifeworld of MHNs working in acute mental health settings. Methods: The study employed a qualitative, phenomenological approach to investigate the lived experiences of MHNs. The research involved 29 nurses employed in hospital-based settings in Australia. Data collection involved in-depth interviews, exploring MHNs’ perspectives on TIC in their daily practice. Data analysis focused on identifying themes and patterns using van Manen’s (1990) phenomenological approach. Findings: The study revealed a notable gap in research and a lack of critical understanding regarding how TIC intersects with the daily practices and realities of MHNs in these environments. The findings highlighted the persistent tension between TIC and the coercive practices inherent in MHN care within these settings. The environments were characterised by MHN experiences of post-traumatic stress, heightened vigilance, and self-preservation, conflicting with TIC. The dominance of the medical model in modern MHN care created a paradox where MHNs have limited freedom to prioritise the relational dynamics needed for TIC over task-oriented practices. Conclusion: There is an urgent need to deconstruct the organisational and environmental influences on MHN practice in acute mental health settings. Through this critical deconstruction, MHNs may be afforded the opportunity to transform their practice and to challenge the system that emphasises control and coercion. Recognising the therapeutic potential of MHNs is central to TIC. Acknowledging this centrality may afford MHNs with the opportunity to regain agency in their practice and work towards a system that truly integrates healing, recovery, and TIC.

Trauma-informed care through the lifeworld of mental health nurses employed in hospital-based mental health settings

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Trauma-informed care through the lifeworld of mental health nurses employed in hospital-based mental health settings

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