Database of New Zealand mental health research

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Principal contact
Name	Dr Chris Walsh
Email	dr.christine.walsh@gmail.com
The research
Summary	This thesis uses licensed narrative to explore the complexities of nurses’ self disclosure. The findings revealed that nurses’ personal experiences in becoming and being lesbian were closely linked to their professional identity as a nurse. This research advances knowledge and understanding of whether disclosure of sexual identity to clients is appropriate and will assist other health professionals in their practice.
Objectives	The overall aim of this study was to explore the experiences of lesbian nurses working in psychiatric mental health nursing. Two questions frame this study: • What is the experience of lesbian nurses who work in psychiatric mental health nursing? • How does identifying as lesbian influence the practice of psychiatric mental health nurses?
Study design	The methodology used for this research thesis is narrative inquiry. Narrative inquiry provides a framework for understanding experiences through story. Fifteen lesbian psychiatric mental health nurses living in New Zealand have shared their experiences in two interviews- one face to face and the other by telephone.
Methods	Qualitative
Results	The first key finding is articulating the relationship between how the ‘who’ participants are as lesbian psychiatric mental health nurses contributes to the ‘how’ they practice. In the beginning of this thesis I noted the intensity of the debate around articulating the ‘what’ and’ why’ and ‘how’ of psychiatric mental health nursing practice. My hope was that this thesis would contribute to understandings about how the ‘who’ we are makes a difference to the person in mental distress. I believe that this has been revealed through participant’s descriptions of becoming and being lesbian in the socio-political and mental health nursing contexts that are New Zealand. The second key finding is the notion of being authentic in practice. I began this study with the idea that lesbian nurses working in mental health needed to self-disclose their lesbian identity in order to remain honest and genuine in their interactions with people in mental distress. The key narrative themes identified in Chapter Five capture the significance and complexities of this self-disclosure. Specifically, the interface between personal identity disclosure and lesbian identity disclosure in the professional setting clearly demonstrates that the lesbian nurse cannot separate her personal experiences in becoming and being lesbian from her professional identity as a nurse. The three narrative sub-themes, making choices, tackling tensions and mediating boundaries are features of the decision making process throughout the personal and professional lives and identities of the participants. Findings from this research suggest that the nurse remains authentic whether she self-discloses her lesbian identity or not. The negotiation of self-disclosure of their lesbian identity as expressed by the participants adds a new layer to the ongoing questions about ‘how’ psychiatric mental health nurses actually think about and make choices about what is appropriate self disclosure. The complexities of this decision are so embedded in context and time that revealing them through the licensed narratives has helped to make more transparent the depth and process of thinking required to work therapeutically and authentically with clients.
Conclusions	So what are some of the implications and applications of findings for lesbian psychiatric mental health nurses in practice? First, as I stated at the outset, no study has investigated the practice of lesbian psychiatric mental health nurses nationally or internationally. Nor has much attention been given to how the nurse’s sexual identity influences her practice, particularly in the therapeutic relationship. This study therefore offers a beginning point to be built on and developed. There needs to be more narrative research about how lesbian identity influences their practice as nurses working in mental health settings in order to understand more about how their identity shapes their practice and practice shapes their identity. Because this is the first study of its kind, there was no evidence in the literature that addressed the impact that lesbian identity has on the therapeutic relationship in psychiatric mental health nursing. It is important to articulate the ‘self’ particularly with respect to sexual identity in the therapeutic engagement with the person in mental distress and this study shows that being who we are makes a difference to how we practice. Nurses who identify as heterosexual might like to examine how their sexual identity influences their practice and therefore the relationships they have with clients. Lesbian authenticity and therapeutic authenticity are features of the therapeutic engagement and revealing the complexity of this engagement is part of the contribution this study makes to psychiatric mental health nursing. Second, this study has been focussed on lesbian nurses who work in mental health. All of the participants worked in the community. But what of those lesbian nurses who work in in-patient units, in much more controlled areas of mental health nursing where clients are more often acutely distressed? What shape would the therapeutic relationship take given that it is more likely that the lesbian nurse would be ‘outed’ unexpectedly and having some control over this seems to help lesbian nurses in their practice? The participants in this study have described their experiences ‘doing their time’ in acute in-patient units. These were often highly distressing times for them particularly facing homophobia from acutely unwell patients. They had few strategies for dealing with this. To counter this we need to share our stories with other nurses and also with mental health consumers about the contribution that lesbian psychiatric mental health nurses’ make to nursing practice in the mental health setting. This topic lends itself to a collaborative research study involving both lesbian psychiatric mental health nurses and lesbian mental health consumers. Third, what are the issues for lesbian clients who have worked with lesbian psychiatric mental health nurses? Has their therapeutic engagement with the nurse been better because of the nurse being lesbian? What expectations might the lesbian client have knowing that the nurse identifies as lesbian and how did the nurse reveal/conceal her identity? If these issues are explored it can lead to more understanding about how lesbian clients might benefit from working with lesbian nurses or in fact why they might prefer heterosexual nurses. An argument could be made for lesbian clients to have access to lesbian nurses as a preferential choice. Fourth, how do heterosexual nurses working in mental health view their lesbian colleagues? Because this is the first study of its kind, there is no evidence in the literature that addresses this relationship. This question requires further investigation. Fifth, further investigation is needed into homophobic attitudes by heterosexual nurses working in mental health. Although participants felt accepted by their heterosexual nursing colleagues, they expressed concerns about underlying homophobia. Also, while work colleagues appeared accepting of the lesbian nurse this study revealed examples of homophobic attitudes to lesbian and gay male patients. Finally, how might nurse educators especially at an undergraduate level teach about the therapeutic use of self, being authentic, and appropriate self disclosure given the findings in this thesis? One of the positive spin-offs of these findings is the material in this thesis which offers a way of educating heterosexual nursing students about the intricacies of the therapeutic relationship. Lesbian nursing students may identify with the findings and the participants stories and feel more confident in their lesbian identity. Using material in this thesis offers further opportunities for educators to illustrate how heterosexist and homophobic attitudes impact on the lives of lesbians, both as nurses and consumers of mental health services.
Key Descriptors	Clinical Practice
Disciplines	Nursing
Settings	Other
Diagnostic Categories	Other
Populations	Female, General Population
Other Keywords	lesbian, mental health nurse, narrative inquiry, therapeutic relationship.
Ethics approval	Yes
Academic led	Yes
Service led	No
How were service users involved	No involvement
Publication in peer review journal	No
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Page last updated: 7 November 2008