Nurses’ Unacknowledged Vulnerability: Burdensome Feelings
We are now featuring the article titled “Exposed to an Accumulation of Burdensome Feelings: Mental Health Nurses’ Vulnerability in Everyday Encounters With Seriously Ill Inpatients” by Solfrid Vatne, PhD, RN. This article has important implications for practice, and provides insight into the knowledge and wisdom necessary for nursing practice. The article is available for download at no cost while it is featured! Here is a message from Dr. Vatne about her work:
Understanding and developing nursing practice has been my focus for teaching and area of research since the beginning of my career in education of nurses in 1980’s. The theory-practice gap in mental health nursing has been especially intriguing to me. I began questioning the students’ lack of reflection concerning dominating nursing practices, and wondering about how tacit knowledge seemed to oversteer therapeutic ideals in nursing actions such as building trusting relationships with patients.
An example of the theory-practice gap can be found in my master project that described the contradictions between having user cooperation as an ideal for practice and limit-setting actions directed towards controlling patients’ deviant behavior. My PhD-project explored the relationship between tacit and theoretical ideals further through an Action science design, based on a field study with observations, interviews, and reflection-groups, which searched for nurses’ rationality in limit-setting actions. The main finding was that nurses’ rationality was emotionally based and connected to a variation of unpleasant feelings in situations with patients whose behavior was experienced as unforeseen, deviant and sometimes dangerous. The patients experienced limit-setting as tortuous, which in turn could escalate their unforeseen behavior and hinder the nurses reaching their goal of controlling the patients’ behavior.
The possibility that both patients and nurses could be regarded as vulnerable struck me, and I became curious about shedding a new light on my data to try to understand nurses’ vulnerability in their relationships to severely mentally ill patients more deeply. This article suggests that such nurse-patient relationships could be viewed as vulnerable in themselves.
This is a well-documented exploration of vulnerability which then leads to a moral injury, acting against ones own or professional norms. In the US seclusion and restraint have been declared non-therapeutic by SAMHSA, and is traumatic in itself. Yet these practices continue. The gap between ideals and practice is greatest in mental health. This is largely due to problems in communication with patients. Perhaps we need to try harder to comprehend the subjective experiences of the patients, rather than distancing behind the need for “order”.
I agree that shame and a sense of failure is (unfortunately) imputed when an incident occurs. I was fascinated to see that even in Norway, the nurses are mostly women and the unskilled aides are men. Where did this model come from, and why do we continue to construct services like this? It seems to encourage “acting out .”