Mental Health Nursing

202 Acute Mental Health Nursing
states that one of the main themes providing a base to normalisation is that
of role expectancy. He argues that the way society reacts towards a person
with a label such as mental illness often determines the behaviour and
characteristics of that person. For example, a person with a diagnosis of
schizophrenia may be less likely to succeed in gaining employment, and
repeated failures at job seeking may convince the person that they are not
capable of working. O’Brien and Tyne (1981) have described this as
‘vicious circles’. Mental health services and professionals have been shown
to interpret a person’s behaviour differently because of any label applied
to them. This was highlighted in a study by Rosenhan (1975) who found
that once a person becomes labelled as mentally ill everyday behaviours
such as diary writing can be interpreted as confirmation of that label. In
this case keeping a diary was described as ‘obsessive writing behaviour’ by
nursing staff.
A normalising rationale and the stress vulnerability model are important
in acute settings for two reasons. First, normalising a person’s
experience will help to develop the therapeutic nursing relationship.
Engagement and rapport building are the essential first steps when working
with people with serious mental illness and are profoundly difficult
(Drury, 2000). Chadwick and Birchwood (1996) have suggested some
factors which may prevent engagement with clients who are experiencing
serious mental illness. They include, amongst others, the patient’s view of
the effects of discussing their symptoms (for example, does this prevent
discharge from hospital or result in an increase in medication) and an
inability on the part of the nurse to empathise with the patient’s experience
of their symptoms because the symptoms are outside the realm of the
nurse’s experience. Work by Tien (1991) demonstrated that 2.3% of the
normal general population experience auditory hallucinations, and discussing
this with patients is extremely useful.
Many people can recall a time when they have experienced some type
of psychotic phenomena (hearing their name called when they are very
tired, for example) and any personal disclosure of this nature may be helpful,
especially focusing on any feelings or anxiety experienced. However,
it is not necessary to have experienced psychosis in order to understand
how frightening the consequences might be; i.e., it is not necessary to
have experienced a thought that someone is trying to kill you to understand
that this thought, if you believed it, would be very frightening.
Second, it is important to consider the stress vulnerability model when
one considers the environment of an acute in-patient ward. The model
assumes that in psychosis, stress in the environment interacts with a person’s
genetic vulnerability resulting in the production of, or an increase in,
symptoms of psychosis. It is generally accepted that acute wards are
stressful places in which to work, often resulting in low morale and high