Interpreting and responding to expressions of mental pain: the inner and outer dialogues of the mental health nurse

The experience and expression of mental pain can be interpreted in various ways by the mental health nurse and the client during therapeutic interaction. This chapter explores how meanings of mental distress are configured through dialogue between and within the mental health nurse and the person in care. Here, the authors follow Bahktin’s (1981) thesis that meaning making is a dialogical activity, arrived at through engagement with one’s own internal voices and available dialogues and discouses in the surrounding context. Thus the nurses’s understanding or sense making of expressions of mental pain emerges from the interaction between inner (personal, embodied) and outer (professional / therapeutic, social) dialogues. These internal and external ‘voices’ inevitably influence the nurse’s engagement with the client; where these are unquestioned and congruent, the nurse enters into therapeutic engagement with a sense of clarity and purpose and when these dialogues are at variance, the nurse encounters confusion as s / he struggles to find a meaningful interpretation of events so that s / he can engage purposefully with the person in care. The authors ague that while congruent dialogues may facilitate spontaneous knowing and acting, unquestioned interpretations can become habituated knowledge constructions, employing and sustaining professional monologues that dominate the communication process and suppress possible alternative voicings of mental distress. In this chapter we are interested in troubling dialogues in mental health interactions and interventions. We suggest that when inner / outer voices that are perhaps conflictual and somewhat confusing, are met with open curiosity, this approach can promote opportunities for new and transformational dialogue. Further, using vignettes from teaching and research contexts, we offer two interlinked strategies for purposefully engaging with contending dialogues and developing communication about mental pain, thereby enhancing the therapeutic relationship between the nurse and person in care

Making an exhibition of ourselves : using narrative and arts-based inquiry with student nurses

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The Baby Hearts Study – A case-control protocol with data linkage to evaluate risk and protective factors for congenital heart disease

Introduction The Baby Hearts study aimed to investigate risk and protective factors for congenital heart disease (CHD), and to investigate the health behaviours of a representative sample of pregnant women in Northern Ireland. Objectives We describe and evaluate the population-based case-control design enhanced with data linkage to administrative health data. Methods Cases (mothers of babies with CHD, n=286) were recruited following diagnosis prenatally or postnatally. Controls (mothers of babies without CHD, n=966) were recruited at 18-22 weeks gestation, from all women attending each maternity unit during a designated month. Hybrid data collection methods were used, including a self-administered iPad/postal questionnaire, and linkage to maternity and prescription records. Results Refusal rates were low (8%). iPad questionnaire completion at clinic or home visit had high acceptability whereas postal questionnaires were poorly returned leading to a further 9-10% loss of eligible cases/controls. In total, 61% of eligible cases and 68% of eligible controls were recruited, closely representative of the Northern Ireland population, with no evidence of selection bias. Of those recruited, 97% gave consent for linkage to medical records. Thirty-three percent of women had an unplanned pregnancy and 76% suspected they were pregnant by 5 weeks gestation, with no significant differences between cases and controls. There was considerable discordance between self-report, maternity and prescription records regarding medications obtained/taken in the first trimester, but no evidence of differences between cases and controls that would indicate substantial recall bias. Although there was high concordance between self-report and maternity records regarding folic acid supplementation, cases had significantly lower concordance than controls. Conclusions Our results suggest hybrid data collection approaches are a useful way forward for aetiological studies to reduce responder burden and address and estimate recall bias, and that the Baby Hearts study protocol is suitable for replication in other populations, modified to the local context

The Northern Ireland Baby Hearts Study: A Case-Control study using a hybrid data linkage method

Background The Northern Ireland (NI) Baby Hearts study aimed to investigate risk factors for congenital heart defects (CHD), and to investigate the health behaviours of a representative sample of NI pregnant women. Methods We performed a case-control study with hybrid data collection methods, including self-administered iPad questionnaire or postal questionnaire, information held in maternity records and linkage to prescription records. Cases (n=286) were recruited following diagnosis prenatally or postnatally, controls (n=966) were recruited during recruitment months in each maternity unit at 18-20 weeks gestation. Findings Refusal rates for questionnaire completion were low (7-8%). Among those recruited, consent for access and linkage to medical records was high (98%). Recruitment of both cases and controls was closely representative of the NI population in terms of age, area of residence and deprivation. There was considerable discordance between self-report questionnaires, maternity records and prescription records regarding medications taken in the first trimester, and between self-report questionnaires and maternity records regarding behaviours such as preconceptional folic acid, pregnancy planning, and smoking. However, there were no differences between cases and controls that would indicate recall bias. Conclusions Our results suggest that hybrid data collection approaches are a useful way forward for aetiological studies

Risk Factors for Congenital Heart Disease: the Baby Hearts Study, a population-based case-control study

We investigated the role of maternal environmental factors in the aetiology of congenital heart disease (CHD). A population-based case-control study (242 CHD cases, 966 controls) was conducted using an iPad questionnaire for mother with linkage to maternity and first trimester prescription records. Risk of CHD was associated with low maternal education (OR adjusted for confounders 1.59; 95% confidence interval [CI], 1.02-2.49), pregestational diabetes (OR 4.04; 95% CI 1.00-16.28), self-reported maternal clotting disorders (adjOR 8.55, 95%CI 1.51-48.44), prescriptions for the anticlotting medication enoxaparin (adjOR 3.22, 95%CI 1.01-10.22) and self-reported vaginal infections (adjOR 1.69, 95%CI 1.01-2.80). There was no strong support for the hypothesis that periconceptional folic acid supplements have a protective effect, but there was a protective effect of frequent consumption of folate rich fruits (adjOR 0.64, 95%CI 0.47-0.89). Compared to the most common pre-pregnancy dietary pattern, CHD risk was associated with a poor diet low in fruit and vegetables (adjOR 1.56, 95%CI 1.05-2.34). Mothers of cases reported more pregnancy related stress (adjOR 1.69; 95% CI 1.22-2.34) and multiple stressors (adjOR 1.94, 95%CI 0.83-4.53). We found no supportive evidence for CHD risk being associated with obesity, smoking, depression or antidepressant use in this population. Our findings add to the previous evidence base to show potential for public health approaches to help prevent CHD in future by modifying environmental factors. Independent confirmation should be sought regarding elevated CHD risk associated with maternal blood clotting disorders and their treatment, since we are the first to report this

Interpreting and responding to expressions of mental pain: the inner and outer dialogues of the mental health nurse

The experience and expression of mental pain can be interpreted in various ways by the mental health nurse and the client during therapeutic interaction. This chapter explores how meanings of mental distress are configured through dialogue between and within the mental health nurse and the person in care. Here, the authors follow Bahktin’s (1981) thesis that meaning making is a dialogical activity, arrived at through engagement with one’s own internal voices and available dialogues and discouses in the surrounding context. Thus the nurses’s understanding or sense making of expressions of mental pain emerges from the interaction between inner (personal, embodied) and outer (professional / therapeutic, social) dialogues. These internal and external ‘voices’ inevitably influence the nurse’s engagement with the client; where these are unquestioned and congruent, the nurse enters into therapeutic engagement with a sense of clarity and purpose and when these dialogues are at variance, the nurse encounters confusion as s / he struggles to find a meaningful interpretation of events so that s / he can engage purposefully with the person in care. The authors ague that while congruent dialogues may facilitate spontaneous knowing and acting, unquestioned interpretations can become habituated knowledge constructions, employing and sustaining professional monologues that dominate the communication process and suppress possible alternative voicings of mental distress. In this chapter we are interested in troubling dialogues in mental health interactions and interventions. We suggest that when inner / outer voices that are perhaps conflictual and somewhat confusing, are met with open curiosity, this approach can promote opportunities for new and transformational dialogue. Further, using vignettes from teaching and research contexts, we offer two interlinked strategies for purposefully engaging with contending dialogues and developing communication about mental pain, thereby enhancing the therapeutic relationship between the nurse and person in care

Reflections On An In-House Academic Writing Retreat

This paper outlines some of the contemporary challenges and opportunities facing lecturers in third level education in Ireland in the area of academic writing.  It is argued that nurse academics in particular are charged with the imperative to write and publish in order to foster academic development of what has traditionally been regarded as a practice driven vocation.  Some of the challenges to academic writing as identified in the literature are discussed as well as measures undertaken to support Faculty writing and publishing. An account is provided as to how a group of academics in one third level School are attempting to overcome personal inhibitions and resource limitations through the use of a self devised writing support group and an in-house writers retreat.  Reflections on the establishment and effects of these initiatives are presented and subsequent conclusions and recommendations are made