How does the current culture of mental health services, support or hinder the mental health nurse’s ability to facilitate spiritual care for individuals with a severe mental illness who are facing death?

Author: Sharon Picot

Picot, Sharon, 2021 How does the current culture of mental health services, support or hinder the mental health nurse’s ability to facilitate spiritual care for individuals with a severe mental illness who are facing death?, Flinders University, College of Nursing and Health Sciences

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Due to poor physical health, people with severe mental illness are dying up to thirty years earlier than the general population. The limited literature on their experience of dying indicates that that they often suffer from structural vulnerability in relation to equity and access to healthcare services and what care they do receive is frequently poor. It is also known that living with both a mental illness and facing death can engender spiritual concerns. Studies have shown that dying at a younger age is a risk factor for existential or spiritual despair. Hence, addressing spiritual concerns can be an important dimension in their nursing care. This study seeks to determine if the current culture of the mental health service in South Australia assists mental health nurses to facilitate spiritual care for individuals with an enduring mental illness who are facing death from a life limiting illness.

The combined methodologies of focused ethnography and autoethnography were used to identify the organisational cultural issues that affected Mental Health Nurses’ ability to facilitate spiritual care. A group of Palliative Care Nurses were also included to provide a comparative organisational context. Data from the focused ethnography was collected from 11 Mental Health Nurses and 6 Palliative Care Nurses through semi structured interviews. The data from the autoethnography was based on the researcher’s (my) clinical experience as a Mental Health Nurse Practitioner with a primary focus in palliative care. Both methodologies also used data from government documents.

A theoretical framework for the data analysis was used based on the work of nursing theorists. This was predominantly the work of Joyce Travelbee (1926-1973). Results indicated that the culture of the mental health service was in crisis at the time of data collection. Further, the power dynamics within the service privileged the corporate biomedical paradigm. Mental Health Nurses reported that they felt disempowered and some senior nurses felt reluctant or unable to articulate their nursing practice. Hence, their spiritual care and the unique needs of the person facing death became invisible. Both similar and contrasting data from the Palliative Care Nurses offered insights into the professional culture of mental health nursing. These data suggested that despite a lack of organisational support for spiritual care, the skills, knowledge and values of mental health nursing culture underpinned the nurse’s ability to provide spiritual care to this highly marginalised and vulnerable population. Recommendations will be suggested to improve organisational support for spiritual care through nursing leadership and policy change. A strongly held professional culture with an emphasis on person-centred care would counter a culture of disempowerment. This professional culture can be further developed through education at both an undergraduate level and within organisational development programmes.

Keywords: Spiritual care, mental illness, endof life care, mental health nursing, therapeutic realtionship

Subject: Nursing thesis

Thesis type: Doctor of Philosophy
Completed: 2021
School: College of Nursing and Health Sciences
Supervisor: Dr Ann Harrington