A co-operative inquiry : participation of mental health service users in the clinical practice decisions of mental health student nurses
This is a study about participation of mental health service users in the clinical practice decisions of mental health student nurses undertaking their nurse training. The research was undertaken with students, recruited from a higher education institution, in collaboration with mental health service users, recruited from mental health service user organisations, and was conducted over a period of eighteen months. Mental health service users have long been calling for greater involvement in the clinical decisions which affect their lives. Involvement in this context means decisions made collaboratively with service users where there is determined effort, on the part of the nurse, to share decisional power. Concern has also been expressed that current theory used to inform practice is derived predominantly from professional academics rather then those who use services. In order to address these issues, a co-operative inquiry design was adopted which engaged all participants as co-researchers, as well as co-subjects, and involved repeated cycles of action and reflection, using recorded group meetings as the means to collect the data. The aims of the study were to identify strategies for increasing user participation in decisions, to develop a model of good practice and to explore the value of co-operative inquiry as a vehicle for bringing about increased participation. The outcomes of the inquiry have been to identify, from a service user perspective, professional values, behaviours and actions and cultural aspects within organisations which inhibit or enable the sharing of power and participation in decisions. In addition the inquiry has developed the ‘time for change’ model which it is proposed could be used to evaluate aspects of participation within the clinical practice and education environment. The inquiry concludes by demonstrating the potential benefits and challenges of conducting meaningful participatory research. It also reflects on the value of the co-operative inquiry process as a vehicle for developing the students’ practice and moral development, which, it is argued, has wider utility in higher education and the practice learning environment. Finally the inquiry emphasises the need for an organisational culture in which the practice of participation can evolve and be nurtured, in order to overcome the systematic exclusion, or what has been termed ‘institutional userism’, which was a common experience for the inquiry participants.