An interpretive hermeneutic phenomenological exploration of patients’ and student mental health nurses’ lived experiences of the time they share together on secure personality disorder units for men

Abstract

Background: Unlike more general consideration of caring relationships, the important experience of the time patients and students share together in mental health services has not been specifically explored before. This study was focused on student nurses within medium secure personality disorder placements for men. Students represent the present and future of nursing, often having greater patient contact than registered nurses, and this is appreciated by patients.

Methodology: Interpretive Hermeneutic Phenomenology was the underpinning philosophy of this research, woven throughout; with the aim of exploring the participants’ lived experiences and illuminating present phenomenon/s, with reflexivity central to the process. National Health Service and university ethical approval was granted. Seven patients and five student mental health nurses participated in unstructured interviews.

Findings: Three themes were illuminated. Everyday stuff with three subthemes; ‘Just being around’; ‘Having a laugh’; and ‘The way you speak to people is important’. Balance with three subthemes; Recognition: ‘We’re just people’ and they’re the same as us; Identities: ‘More like us’; and Weathering the ride: ‘Sponges’ to holder of keys. The third overarching theme Impact has three subthemes; Time; Having value and feeling valued: ‘Damn well not useless now’ and The landscape.

The findings illuminate that when students and patients shared time together they were being-with in their own time and space, where they shared an experience of togetherness, enabling them to feel that they were ‘just people’ and valued, which had lasting impact. Interpersonal connections created a bubble, despite experiences of thrownness into the world and landscape, or the bearing of diagnostic labels. Together, the participants engaged in the mundane everyday, sharing activities, connecting over common interests and having a laugh. Reciprocal identities of teacher and learner were obtained within shared experiences of being assessed. The time students and patients shared together was a gift, powerfully impacting on their sense of humanness, value and worth.

Students experienced a balance between therapeuticness (leaping-ahead) and professionalism (leaping-in). Therapeuticness involved an all-encompassing, supportive and humane approach via everyday being-with, creating a bubble and enabling recognition. Professionalism encompassed risk aversion, restricting identities and roles, and power constructs. A balance was struck through innovative practices and patient involvement.

The landscapes of secure settings, housed the pivotal panoptical eye of the staff office, sucking in staff and blowing patients away. Students were immune to the vacuum of the office and were viewed as ‘sponges’. Students were available, had time, were learners and not paid; elements not fully present for other staff due to set roles. Students can become holder of keys on becoming staff, however, can ‘weather the ride’ by focusing on the everyday mundane, being-with and connecting with patients to create bubbles.

Conclusion: This study is a call to all to foster the mundane, the everyday and recognise the humanity in others. Student nurses can balance therapeuticness and professionalism, be themselves, have a laugh with patients, connect over shared interests and make bubbles. This study is a message of hope for people residing in often dehumanising settings, who may have experienced thrownness, trauma and othering, that they can experience humanity and have worth and value.