Caring for adolescents with acute and complex mental health
needs in hospital settings : conceptualising and enabling nursing
identity, task and intervention

Foster, C

Abstract

Background: Adolescent psychiatric intensive care units (PICU) play a significant role in child and adolescent mental health care pathways, not just in the UK but across Europe. Prior to the papers included in this thesis, there was no primary research in the field of adolescent PICU nursing. This thesis presents a series of five papers that directly address this gap and make a unique contribution to knowledge and understanding in the field of adolescent inpatient mental health nursing.

Research Objectives:
1. Investigate the role of psychodynamic theory in understanding the interplay between mentally distressed adolescents, nursing staff, and the inpatient care context.
2. Investigate the nature of adolescent mental health nursing and nursing intervention, in a previously unexamined area of child and adolescent nursing practice; adolescent PICU.
3. Conceptualise a model of mental health nursing within adolescent PICU settings.
4. Use this new conceptual understanding to develop and test a novel intervention, to support and enable adolescent mental health nurses to articulate, enhance and sustain the therapeutic tasks of their work.
5. Evaluate the impact of this intervention on staff experience of their work and care provision.

Method: The research is situated within a transdisciplinary psycho-social research framework. Psychodynamic praxis is integrated into systematic qualitative and quantitative research methods, to develop an original methodology to achieve the research objectives through a process of co-production with participants. Developmental object-relations and attachment theory are used as a lens, through which the detail of adolescent mental health nursing work can be seen.

Outcomes: A new model of adolescent PICU nursing is proposed. The process by which the mutually constitutive relationship between the young people’s developmental and mental health needs, the PICU care context, and the nursing task, manifests as a series of interlocking and unresolvable tensions, is elaborated. It is proposed that these tensions are the space in which unique nursing interventions are produced. Adolescent PICU nursing is conceptualised as an intersubjective process analogous to the good-enough carer-infant relationship, in which a rigorous and technical form of love, is elaborated as the key method of intervention. Key to the implementation of ‘love as method’ are the concepts of the container-contained relationship, projective identification and reverie, alongside a willingness to continuously occupy unresolvable tensions as demanding but productive spaces.
The emotional and psychological impact of continuously residing in a state of tension and of maintaining close physical and relational proximity to highly disturbed young people, means that the factors that enhance and impede the therapeutic task of nursing in adolescent PICU are two sides of the same coin, mediated by the process of projective identification.

Conclusions: An evidence-based case is made for detailed, faithful and receptive observation of mental health nursing approaches that parallel, acknowledge and re-centre the place of a specific and disciplined form of love, as the method for creating the interpersonal conditions for recovery from acute and complex mental distress, especially when these manifest in young people.
A critical appraisal of the methodology used in the thesis demonstrates the suitability and validity of psychoanalytically informed research methods, for investigating invisible or hidden relational elements of adolescent mental health inpatient practice. However, care must be taken to limit replication of power
dynamics that have historically left mental health nurses in epistemically disadvantaged positions.

Implications: The implications for adolescent mental health nursing praxis, education, management and policy are highlighted, and recommendations for further research are made.

Citation

identity, task and intervention. (Thesis). University of Salford

• Thesis Type: Thesis
• Deposit Date: Feb 5, 2021
• Publicly Available Date: Feb 5, 2021
• Award Date: Oct 16, 2020