Guest post by Dr Samantha Heath
We’ve probably all had the uncomfortable feeling of being the new person in the workplace, at the gym, or in a new social situation. For most of us, making relationships with co-workers and new acquaintances or friends is only temporarily awkward. Eventually, we become part of the furniture and for the most part learn the habits, ways, and culture of the ‘new’ place, eventually becoming the old hands. But did you ever stop to think about what changes about your behaviour? How you bend and flex to respond to the new?
Our students who undertake practical or clinical placements will tell you they are professionals in these situations: at fitting in; at learning the ropes of a place, adapting and adopting new attitudes and perspectives. This is their enculturation into a profession and is important for many good reasons. Yet, when the profession is mental-health nursing and the consequences of such enculturation influence the provision of healthcare, we might want to learn more.
This is exactly where Sarah Gray, Lecturer and Researcher at Unitec’s School of Healthcare and Social Practice focused her recently completed study examining the factors that influence staff members’ care of clients diagnosed with borderline personality disorder in one District Health Board. Sarah used the internationally validated ‘Attitude to Personality Disorder Questionnaire’ (Bowers & Allen, 2006), inviting all staff in adult mental-health services to participate. She found responses of the staff involved in community care were generally more positive, and differed from those of their colleagues providing inpatient care. Sarah indicates that this can be put down to the fact that inpatient staff see patients with borderline personality disorder when they are their worst, in acute distress, whereas colleagues in the community have the opportunity to see the whole person within context. However, this isn’t the whole story. Sarah also observed that the community mental-health nurses received more frequent professional supervision (on average every two months) than their colleagues working in inpatient settings.
Clinical supervision has an important role in many of the health and helping professions. It assists practitioners of all types to talk through difficult professional experiences, and to see them differently, perhaps reframing them more positively and supporting reflexive practice. Delivered by a range of health professionals including nurses and, for some, preferably by psychologists, the benefits of clinical supervision are enormous for practitioners and patients. Enabling deeper understanding of the patient condition, clinical supervision can lead to small adjustments in practitioners’ attitudes and changes in personal behaviour that positively impact on the therapeutic relationship. As the major provider of treatment for patients with borderline personality disorder, psychologists are also in demand from a patient perspective. New Zealand currently has only about 20% of the internationally recommended number of full-time psychologists. There is unlikely to be an immediate end to this crisis so, in using this work as a benchmark, Sarah is now preparing to undertake a PhD in which she will determine how early-career mental-health nurses can be supported to thrive at work. Her research is likely to influence the development of early-career behaviour and attitudes, and increase reflexivity and understanding of the patient condition; it is well worth the investment. The benefits of improved healthcare are obvious, but the career-long impact on the enculturation of future health professionals is potentially enormous.
