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Title: Carrying on together : making embodied skills and practices within mental health care visible
Author: Dryden, Tracy
ISNI:       0000 0004 2724 5681
Awarding Body: Lancaster University
Current Institution: Lancaster University
Date of Award: 2010
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Foreword Tracy Dryden was a mental health nurse deeply concerned that the value of nursing practice - and patient care - was being undermined by policies that constrained colleagues to work in a rigid manner. Tracy's doctoral thesis explored in painstaking detail the insecurity which threatens to destabilise mental health nursing expertise and the risks for service users which restrictive and exclusive use of 'evidence-based' resources can incur. In doing so she found a way to trace, make visible and give value to mental health nurses' skills. Her tragic and untimely death means that this work is unfinished. Tracy died only a few months before the expected submission of this thesis, therefore, we as her supervisors have collated the drafts of each chapter and present them here for examination. We have given these drafts only a cursory edit to improve the presentation of her ideas. We have purposely refrained from developing these ideas in any way. There are sections which Tracy had highlighted as requiring development or clarification. These notes to herself, and the accompanying sections of text, we have left unchanged so as to allow the examiners further insight into the level at which Tracy was working. The argument of the thesis may lack the finesse it would have attained in the final revisions, as Tracy worked with the thesis as a whole, but we believe that even as it stands, it is strong and coherent. We would like to see Tracy's work published in the near future, and available to those she writes so passionately and thoughtfully about. We would welcome the examiners thoughts on this matter. Although it is impossible for us to write Tracy's acknowledgements, we know without question that she would have wanted to express her deepest thanks to her family - her children Lee and Owen, and her mum, dad and sister - without whose love, help, unfaltering support and understanding, she could not have even attempted this work. Dawn Goodwin and Maggie Mort Preface I walk into the large open-plan nurses' office at the community mental health resource centre, one week before I am due to return to work as a community mental health nurse (CMHN). It has been three years since I left to take a career break in order to pursue my Ph. D. Lynda, one of my colleagues (who has worked as a CMHN with this team for over ten years) greets me enthusiastically with a smile and asks me if I am returning to work. She then informs me that she is leaving her position shortly. She has secured a place on the Behavioural Therapy IAPT (insert explanation of this) course Cognitive Behavioural Therapy (CBT) training course. This course will enable her to gain a position as a CBT specialist. I ask her whether she will return to the CMHN team. She replies: Don't be silly, Tracy, I am through with all this stuff we receive as nurses. I want to do something that is ... She searches for a word but fails to find the right one. Instead, she holds up her hands as if trying to make the shape of something tangible. She continues: ... And something that I can say what it is that I am doing. It's ridiculous. What on earth have you been doing for the last three years that only brings you back to this? I can't believe you're coming back. There must be something better you want to do! We both laugh. But I am sad: Lynda has always been a valued member of staff within the community mental health nursing team. However, I remember how she, alongside other nursing colleagues used to express frustration and anger inferring that, as nurses they were always given what I often heard described as the 'dirty work'. In one sense it is shameful to describe it this way; clients do not chose to have problems and needs that do not fit into well-defined, 'clean' categories. However, I think that these nurses mean it more in the sense that it is the work that their multi disciplinary mental health colleagues, for example psychologists (who may specialise in art, drama and psychodynamic therapies) and clinicians that specialise in specific therapies (such as, cognitive behavioural or solution focussed approaches), will not accept - the leftovers. These nurses perceive the psychologists and other specialists as taking all the 'clean' and 'tidy' work that can be neatly categorised into their specialist protocols. The untidy work that remains - the clients that are referred to the nursing team - have complex issues that cannot easily be categorised. These clients are often vulnerable, they may be at risk to themselves and others, they sometimes have a history of committing crimes, and many have a number of 'working diagnoses' as opposed to one confirmed diagnosis. That is, a client is thought to be depressed and so the clinician works towards treating this, yet it is questionable as to whether they may have another disorder such as a personality disorder.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available