Therapist responses to requests for disclosure of therapeutic records: an introductory study

This paper describes a questionnaire survey of therapists in the UK who have been subject to requests for disclosure of client records as part of a legal process. Therapist responses are outlined in terms of the perceived effect of such disclosure on the client, therapist and the therapeutic relationship. Negative effects included the experience of exposure of sensitive client material in an adversarial legal system, of powerful emotional responses by therapists, and a sense of feeling professionally de-skilled in an unfamiliar and often challenging legal environment. Positive effects for the client included the achievement of valued outcomes such as compensation, and, for the therapist, the facilitation of support for the client in this process. These findings are discussed in terms of a contrast between therapist perceptions of consensual and contested disclosure. In the former, therapist and client are in agreement about the restorative value and outcome of disclosure. In contested disclosure, the process is experienced as disrupting therapeutic privacy, undermining professional self-confidence and introducing an unwelcome element of critical re-evaluation of client motives for undertaking therapy

Inclusive learning, diversity and nurse education

Students embarking on undergraduate nursing programmes face many challenges. They must adapt to raised academic expectations, learn a bewildering new range of skills, values and behaviours, and begin to negotiate complex and emotionally demanding practice environments and relationships. In addition to practicalities such as moving away from support networks, constrained finances and perhaps being in a work environment for the first time, nursing students must incorporate changes into their personal identities and form a professional sense of self. How well students are supported to respond to these expectations via their own networks and through engagement and connection with their new profession and programme can shape their potential for achievement. The nursing profession advocates for non-discriminatory inclusive care for all, as well as advocating for a wider diversity of care professionals. This means actively promoting inclusion in programme recruitment and development strategies. However, these aims are hindered by student attrition which is a significant issue throughout higher education in Britain including nurse education. Data published by the Higher Education Statistics Agency (HESA) in 2016/17 indicates that students facing multiple disadvantage are more likely to leave university in their first year than their peers. As well as being a clear example of social injustice, unequal completion rates reduce the projected workforce and disrupt supply and planning. Discounting gender disparities, nursing has a strong record for recruiting and training a broad range of students, but completion rates emerge as lower than for other subjects. An influencing factor here may be that as the professional demands of nursing have intensified, so has the academic rigour required to deliver corresponding competency requirements. Nurse educators need to be creative and flexible to enable students to engage with complex learning which ranges from higher order thinking skills, and philosophical and ethical understandings, to intricate physical tasks. This creates challenges for inclusive curriculum design as well as needing to effectively facilitate it, it must be accessible to a diverse body of nursing students who may have strengths in terms of life experience but who present across the range of academic competence and confidence. Inclusive learning and teaching is advocated as best practice in providing a response to these issues. However, inclusivity is a contested concept, with varied uptake and it sits within a higher education context of financial restrictions, larger class sizes and a push for more online provision. What is clear though is that academic outcomes across student groups are unacceptably varied with significant attainment gaps for those with multiple disadvantages. A key question for nurse educators is how best to develop an evidence base for the pedagogical approaches that are most likely to enable the completion of successful student nurse journeys for all, regardless of their starting point