A qualitative exploration of environmental and relational factors affecting service user involvement from the perspective of community mental health nurses : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Nursing at Massey University, Palmerston North Campus, New Zealand

Abstract

Mental health policy and clinical guidelines require service user involvement principles within clinical practice and service provision, yet few national studies exist to examine Mental Health Nurse’s (MHNs) viewpoints about its implementation. This qualitative research project asks the question ‘What are the environmental and relational factors which affect service user involvement in community mental health team settings from the perspectives of community MHNs?’ The research aims were: (1) Explore how the practice environment supports service user involvement; (2) Explore how they include, or not, service users in the provision of care; and, (3) To discuss how the group of community MHNs recognise and describe service user involvement. Central ethics approval was gained and eight community MHNs in two District Health Board’s (DHBs) with over 5 years experience were interviewed. Participant’s discussion was audio taped, transcribed and then analysed utilising a thematic analysis approach.

From this analysis, two predominant themes arose. Theme one highlights the ‘relationship dynamics of practice’ through exploration of concepts of historical changes; conflicting relationships, influential attitudes and powerlessness. Theme two explores ‘strength based approaches’ from the participants perspectives and includes recovery; inclusive practices; challenging stigma and beliefs towards service user involvement. Mutual agreement about the benefits of service user involvement was identified. However, changes to funding, hierarchical mental health organisations, nurses’ education, stigmatising attitudes and lack of nursing identity have impacted on the implementation and support of service user involvement. Recommendations for further research and suggestions for nursing practice are offered through building nursing capacity, capability, quality and strengthening the profession.