Resilience in mental health nurses working in secure environments

This study explored aspects of resilience as experienced by mental health nurses in a high secure service. The aim of this research was to explore resilience for the participants and to develop a concept analysis of resilience in settings of this kind. There have been many studies on the occupational challenges for nurses (Sabo 2006, Van Den Tooren and De Jonge 2008, Riahi 2011) although relatively few have focussed exclusively on mental health nurses (Jones et al 1987, Dunn and Ritter 1995, Nihiwatiwa 2001, Gilbody et al 2006). Several studies have noted distinct features of the work which are particular to mental health nurses: the intense nature of the interactions with patients (Cronin-Stubbs and Brophy 1985); the regular confrontation of difficult and challenging behaviours (Sullivan 1993); violence and threats from patients and relatives (Tillett 2003); and resources and staffing (Alexander et al 1998). Caring for patients with a personality disorder is noted in the literature as being particularly challenging and demanding for mental health nurses (Murphy and McVey 2003, Bowers 2002, Wright, Haigh and McKeown 2007, Westwood and Baker 2010, Bodner et al 2015, Dickens et al 2015, Dickens et al 2016. Mixed methodology was used to profile nurses’ resilience in this environment, using a validated questionnaire. In-depth semi-structured interviews were analysed using Interpretative Phenomenological Analysis (IPA). A concept analysis of resilience in this environment was developed using the data gathered in this way, synthesised with existing literature. The profile of resilience demonstrated that that the majority of the respondents felt in control, enjoy a challenge, work to achieve goals and take pride in their achievements. The characteristics of ‘hardiness’, ‘bounce back’ and ‘cognitive appraisal’ emerged as key characteristics associated with resilience. Four superordinate themes emerged from the analysis of the staff interviews: management of emotions, teamwork, understanding and work-life balance. The theme of management of emotions highlighted that boundaries were necessary, and it was essential not to get caught up in the patients’ emotions. ‘Giving care’ rather than caring personally was felt to be important. Team work emerged as a key issue, and involved the need to talk things over with trusted colleagues, the expectation that team members and managers would notice and intervene when someone appeared to be in need of support; and having managers who were approachable and available. The theme of understanding included an awareness of the nature of personality disorders and the effect this can have on interactions; and a need for reflection, supervision and coping with interpersonal challenges was highlighted. All of the participants spoke of the need for a work-life balance, making a conscious effort to keep the worlds of work and home separate, keeping physically healthy, and spending time with family and friends. This was embodied in the phrase ‘leaving it at the gate’ which was used to characterise the separation of the two worlds. A concept analysis of resilience was developed by synthesising new empirical data along with existing literature. The study developed a practice-based definition of resilience in the context of working with personality disordered patients in a secure environment, together with the identification of characteristics of the workplace environment that can assist with and facilitate the capacity for ‘bouncing back’. The three main findings of the study were that the constituents of resilience in this staff group are hardiness, bounce back and cognitive appraisal. This adds new perspectives about what helps staff to work positively with challenging patients in mental health nursing. These new contributions to knowledge and practice can be used by organisations to develop targeted interventions in promoting wellbeing at work, reducing work related stress, and aiding recruitment and retention. In secure environments mental health nurses need organisational support and assistance with developing ways of managing difficult experiences with patients, systems that promote recovery, and the educational and supervisory support to help understand and process the effects on them.