This article reviews student mental health nurses’ narratives of working with service users with mental health problems and HIV. It is an explorative study including two student narratives reviewing their experiences. This study could be replicated on a larger scale to further explore students’ experiences of working with this service user grou

Jones, Emma

Jones, M

Kennedy, N

Meek, James

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ArticleAn exploration of student mental health nurses’ narratives about working with service users living with HIVMeek, James, Jones, Emma, Kennedy, N and Jones, MAvailable at http://clok.uclan.ac.uk/17467/Meek, James, Jones, Emma, Kennedy, N and Jones, M (2016) An exploration of student mental health nurses’ narratives about working with service users living with HIV. HIV Nursing, 16 (3). pp. 73-75. ISSN 1474-7359  It is advisable to refer to the publisher’s version if you intend to cite from the work.For more information about UCLan’s research in this area go to http://www.uclan.ac.uk/researchgroups/ and search for <name of research Group>.For information about Research generally at UCLan please go to http://www.uclan.ac.uk/research/ All outputs in CLoK are protected by Intellectual Property Rights law, includingCopyright law.  Copyright, IPR and Moral Rights for the works on this site are retained by the individual authors and/or other copyright owners. Terms and conditions for use of this material are defined in the http://clok.uclan.ac.uk/policies/CLoKCentral Lancashire online Knowledgewww.clok.uclan.ac.ukAn exploration of student mental healthnurses’ narratives about working withservice users living with HIVJames Meek1, Emma Jones1, Nicola Kennedy2 and Martin Jones21Senior Lecturer, University of Central Lancashire; 2Student Mental Health Nurse, University of Central LancashireBackgroundWorking in collaboration, we (Emma Jonesand James Meek) have developed ashared interest in the intertwining natureof HIV and mental health, despite coming from verydifferent clinical nursing backgrounds before makingthe switch to academia as lecturers at the Universityof Central Lancashire. Emma Jones is a RegisteredMental Health Nurse and has worked in mental healthservices, particularly in forensic services, with serviceusers with personality disorders. James Meek is aRegistered Adult Nurse and worked in acute medicineprior to moving into sexual health services, particularlyHIV and contraceptive care. There is a shared interestin student learning and narrative research. Wethought it would be useful to conduct an experimentaland explorative piece of narrative researchinvestigating student nurses’ experiences of caring forpeople living with HIV.Narrative research is broad and encompasses avariety of stories told by individuals such as serviceusers, their carers or clinical staff. Data gathered areanalysed and themed to find common meanings ofan individual’s experiences. The research is generallypresented from one of these two perspectives [1]:1. Narrative is a human sense-making process whichis essential for configuring lived experience.2. Narrative is a tool of social construction; reality andmeaning are configured through telling andsharing stories using the medium of language.We thought it would be beneficial to understand storiesfrom mental health student nurses about theirexperiences of caring for an individual living with HIV.Student nurses are often involved in research atacademic institutions or clinical placements, workingalongside research teams. They also undertake theirown research; however, this is predominantlysecondary research or literature reviews, althoughsome academic institutions offer student nurses theopportunity to undertake primary research throughtheir dissertation or final academic piece of work. Ithas been noted that student education should be aresearch-based profession through the Nursing andMidwifery Council’s Code [2]. However, it has beenacknowledged that the large number of studentnurses, and the need to ensure patient safety whenresearch is undertaken, may present a challenge fornursing students wishing to become involved inresearch [3]. Student nurses may also find themselves‘being researched’, and this article encompassesstudents being involved in research with theiracademic staff, and writing their own narrativereflections.After conducting an initial review of the literatureusing the database CINAHL Complete, Booleanterminology and truncation [4] of HIV ‘AND’ Narrative*were searched, and 74 articles were identified. Mostarticles were patient narrative articles from key groupssuch as ‘men who have sex with men’ or ‘African menor women’. These articles tell stories directly frompatients of their experiences of living with HIV andthen are themed to find common understanding fromthe research. It appears that student narratives havenot been explored.Student nurses were emailed and asked if they hadcared for a patient living with HIV in the UK andwould like to write a short reflective piece for an article.They were advised not to use a model of reflectionbut to write a ‘page or so’ on their experience. Weleft the options very open to students and made sureit was very much led by the students in their response.The two reflections below were received and providetwo very interesting stories direct from student nursesabout their own individual experiences. This reviewof student reflections could lead to a wider explorationof student experience, and ethical approval could begained for a narrative study. Confidentiality has beenAbstractThis article reviews student mental health nurses’narratives of working with service users with mentalhealth problems and HIV. It is an explorative studyincluding two student narratives reviewing theirexperiences. This study could be replicated on a largerscale to further explore students’ experiences ofworking with this service user group.HIV Nursing 2016; 16: 73–75 Feature73respected and all names and areas have beenremoved [2].Student reflection 1Whilst on a community placement, I worked with apatient who was HIV positive. This patient reportednot being allowed to register with a GP as he hadpreviously assaulted a member of staff whilst aninpatient, so had to attend whilst supervised, andwas understandably reluctant to do so. He had notbeen to see his doctor for over a year and had notbeen to have his blood tests for a similar amount oftime. He was quite open in discussing his HIV withmy mentor and me and agreed to us makingappointments with the doctor and at the sexual healthclinic to have his blood tests taken. I telephoned andmade his appointment for him and we escorted himto his appointments due to his level of anxiety. Thereason he did not want to go for the blood tests wasthat he was terrified that his infection would havegot worse and he would require medication. He feltthat he could cope with having HIV as long as itdid not require medication, but would not be ableto live with the additional pressures of takingmedication for it.This patient had a very open and honest relationshipwith my mentor, and whilst I was on placement healso got in to a new relationship with another residentand service user in his supported accommodation.Due to his poor compliance with monitoring of his HIVstatus, we discussed with him the importance ofpracticing safe sex in this relationship. He assured usthat because he was infected by a man who knewhe had the illness, but did not use protection, he wouldnever do that to another person.Working with this patient provoked a range ofemotions for me. Initially I was a little afraid as I wasaware of his previous history of assaulting a memberof staff and this was my first placement, makingeverything a little bit frightening. As I got to knowthe patient I became angry at the poor care he wasreceiving in relation to his HIV and GP care, as hewas a vulnerable individual who had acted violentlywhilst unwell in hospital but I did not really feel heposed a risk to professionals whilst his mental healthwas being well managed. In effect he was fallingthrough the cracks in the system, and this very seriouscondition was not being monitored for him in the sameway that other patients would be, purely becauseof his mental health. I had a lot of admiration for hishonesty when talking about HIV and his attitudetowards infecting other people, but I was upset thathe had been infected by somebody who haddeliberately ignored the risk. Working with this patientimproved my confidence in discussing sexual healthwith men, and also made me more aware of theimportance of educating vulnerable patients.Student reflection 2On placement as a student nurse within an acuteinpatient unit, I worked closely with a gentleman whohad been diagnosed as HIV positive. He was arelatively young man, who described himself as gay.He reported being sexually assaulted following beinggiven Rohypnol in a nightclub. The young manreported that this incident had resulted in himcontracting HIV. As a result of this he had becomevery low in mood and was admitted to the mentalhealth unit as he had stated that he had plannedintent of ending his own life, and had been treatedin hospital following a medication overdose.The service user also lived with diabetes, and neededdaily samples taken through the extraction of bloodfrom the finger tips. People were wary of this, but assomeone who reads around physical health issues,I was aware that with correct personal protectiveequipment (PPE; such as gloves) that risk could beminimised. I was advised that I had to be verydisciplined around this, as I suffer from psoriasis andoften have broken skin on my hands and fingers,therefore contact with blood could be particularlyhazardous if precautions were not taken. However,I was transparent and had open discussions aroundthis prior to treatment with the service user. Wediscussed why I felt I had to use PPE, which heunderstood, and I was aware that I should have thisconversation with him beforehand so that there wereno surprises. He would not feel like I was undulycautious or that I may have prejudices around hiscondition. We were able to find that if we spokeopenly and frankly about this that we could work welltogether.As the HIV and trauma of the sexual assault werethe main factors in his current mental state, it wasdifficult to instil hope, as the HIV would not be goingaway any time soon; we had to work aroundresearching living with HIV and the management ofit, in that people living with HIV can lead relativelynormal lives when medicated appropriately. He hadconcerns around having to tell future sexual partners,and suffered self-esteem issues as a result, which hewas having psychological input for. All the while,through his admission, he said that he had plannedintent for suicide for when he left the ward, so riskwas high.Another issue we had to discuss was although wewere not known to one another previously, there wasa good chance we may cross paths in the future. Thiswas, of course, a source of anxiety for him. We talkedopenly and transparently about this, and agreed thatif we did happen to see each other that I would notacknowledge him and he would not acknowledgeme, therefore minimising any stigma orembarrassment, although this would have beenimpossible to remove as he would naturally feelanxious if he were to see me. Incidentally, we haveHIV Nursing 2016; 16: 73–75Feature74seen each other since he was discharged andadhered to the agreed plan, although I can onlyimagine what this must feel like for him – he was bynature a private and intelligent individual, so havingpeople he may see know about his situation mustprovoke anxiety and challenge his mood significantly.I was off duty when he was discharged so neveractually got to say goodbye, but I was glad that wehad had such open discussion, as it taught me a lotabout his physical health, as well as allowing us tocome to agreement over what we should do in theevent of seeing each other again.DiscussionThese two articles provide an interesting insight intostudent nurses and their experiences of caring for apatient livingwithHIV.Whilst this is only two reflections,and it would be difficult to analyse these data anddraw any detailed conclusions from them, it does tellus a few things. Student nurses are supporting patientsliving with HIV and both articles explored the angleof mental health and the impact of this.Student nurses need to learn about HIV in both theoryand practical situations. With over 100,000 peopleliving with HIV [5] in the UK it is likely that most nurseswill at some point in their career care for a patientliving with HIV. Whilst nurse education is varied, andlearning on one particular topic alone is difficult, itwould be beneficial to learn about HIV.Service users with a mental disorder are at anincreased risk of contracting HIV, and service userswith HIV are at an increased risk of developing amental disorder [6], demonstrating the interlinkednature of the two areas. Having both a mentaldisorder and HIV can impact heavily on prognosisof both conditions [6]. A further interesting area thatis relevant to both service users with HIV and serviceusers with a mental disorder is the impact of stigma,which can significantly impact on their quality of life[7], especially if a service user experiences both ofthese conditions. The two areas are intrinsically linkedand should therefore be explored. Students are thefuture workforce; it is important to explore theirthoughts and experiences of working with service userswith HIV and mental health problems, understandthem and therefore consider them within thedevelopment of nursing programmes.A key element when working with people withmental health problems is the therapeutic relationshipand developing trust [8], as discussed in the students’narratives above. By being open and transparent theywere able to build good relationships with theirservices users and support them while in mentalhealth services. As educators it is vital that weencourage our students to work in this open andtransparent way, thus supporting our service usersin gaining the best quality of life they can.ConclusionThis article has demonstrated the importance ofgaining student nurses’ narratives to begin tounderstand their experiences of working with serviceusers with mental health problems and HIV. Furthernarratives would enhance the development ofknowledge in this area and this explorative paperhas shown that this could be explored in more depthwith a higher number of students’ narratives.References1. Casey B, Proudfoot D, Corbally M. Narrative in nursing research:an overview of three approaches. J Adv Nurs, 2016, 72(5),1203–1215.2. Nursing and Midwifery Council. The Code: Professional standardsof practice and behaviour for nurses and midwives, 2015.Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf (accessed June2016).3. Smith J. Should undergraduate student nurses undertake research?BMJ Blogs, 2013. Available at: http://blogs.bmj.com/ebn/2013/09/10/should-undergraduate-student-nurses-undertake-research/ (accessed June 2016).4. Cottrell S. The Study Skills Handbook (4th Edn). Palgrave Macmillan,2013.5. Public Health England. HIV in the UK – Situation Report 2015:Incidence, prevalence, and prevention, 2015. Available at:https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/477702/HIV_in_the_UK_2015_report.pdf(accessed June 2016).6. Schadé A, van Grootheest G, Smit JH. HIV-infected mental healthpatients: characteristics and comparison with HIV-infected patientsfrom the general population and non-infected mental healthpatients. BMC Psychiatry, 2013, 13, 1–10.7. Bogart LM, Wagner GJ, Galvan FH et al. Perceived discriminationand mental health symptoms among Black men with HIV. CulturDivers Ethnic Minor Psychol, 2011, 17, 295–302.8. Jones ES, Wright KM. ‘They’re really PD today’: An explorationof mental health nursing students’ perceptions of developing atherapeutic relationship with patients with a diagnosis of antisocialpersonality disorder. Int J Offender Ther Comp Criminol, 2015,Epub ahead of print, PMID: 26169569.Correspondence: James Meekjmeek@uclan.ac.ukor Emma Jonesejones14@uclan.ac.ukHIV Nursing 2016; 16: 73–75 Feature75

An exploration of student mental health nurses’ narratives about working with service users living with HIV

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