Adversity as opportunity : living with schizophrenia and developing a resilient self

Approximately 1% of the population is diagnosed with schizophrenia, and despite longstanding critiques of the (bio)medical model, understanding of the disorder still arises primarily through (bio)medical explanations. In turn, causation, symptoms and treatments are increasingly sophisticated and well known while understanding of other aspects of the disorder, especially the intersubjective experience of people living with schizophrenia, remains fragmented. For this reason, the present study sought to understand how people experience schizophrenia. To do this, the stories of 19 people diagnosed with the disorder were hermeneutically interpreted. These stories appeared in The Schizophrenia Bulletin – a journal which publishes ‘first person accounts’, sometimes anonymously, of people’s experience of mental illness. Within the study context, the findings indicate that facing the adversity of schizophrenia means living: (i) wisely – understanding the nature of self-with schizophrenia and of life-with-schizophrenia; (ii) mindfully – keeping understandings in conscious thought; and (iii) purposefully – acting deliberately. Doing this results in a stable and meaningful life and in a different, more resilient self

Explicating practice knowledge: A hermeneutic inquiry into adolescent mental health nursing

Through this hermeneutic study I sought to explicate the practice knowledge of nursing on residential adolescent mental health units. I did this by seeking to understand what nurse's and adolescent's stories of nursing, or being nursed, revealed about the knowledge informing practice within that context. Seven nurses and seven young people shared their experiences. Taped and written stories, and survey material, provided texts for analysis and interpretation. As stories centred around specific nurse-adolescent interactions they pointed to the knowledge informing practice within those encounters. Thus, practice knowledge was explicated through interpretation of the actual experiences of nurses and adolescents. Study findings were conceptualised as sub-elements, elements and a meta-element of practice knowledge. Ninety one ""sub-elements of practice knowledge"" were identified and defined. These subelements illustrate how nurses work with adolescents. The subelements were grouped into four ""elements of practice knowledge"" and defined. The elements are: (I) engaging in therapeutic relationships, (2) providing a therapeutic milieu, (3) guiding the potential for change, and (4) facilitating positive outcomes. These elements point to the reasons behind nursing actions. Through examination of the sub-elements and elements the ""meta-element of practice knowledge"" was developed and defined. The meta -element ""fostering a functional self' describes the aim and outcomes of adolescent mental health nursing practice by noting the way nurses foster the adolescent's reintegration and wellness. A paucity of adolescent mental health nursing research has resulted in the knowledge informing practice within the specialty remaining virtually unknown.;The study findings are thus salient as they: (l) reveal the practice knowledge of adolescent mental health nursing, (2) identify theories used in practice, (3) provide a basis for theory testing research, (4) assist nurse education by noting the how, what and why of practice and the therapeutic outcomes from the use of practice knowledge, and (5) attest to the contribution adolescent mental health nurses make to adolescents, families and society

The experience of community mental health case management provided from an acute in-patient psychiatric unit

In Australia, case management is the cornerstone of mental health service delivery for seriously ill clients living in the community. In this study, case management was provided from an acute, inpatient psychiatric unit; a model thought to be unique. Findings from this qualitative study explicated the experience of case management from client and case manager (CM) perspectives. They note the nature, purpose, processes and outcomes of case management within that context. Findings were positive, suggesting clients and CM's develop a therapeutic alliance through which interventions are implemented and which result in clients experiencing personal (re) integration and enhanced well-being. These findings are discussed and they suggest an alternative model of service delivery well regarded by both clients and CM's