Aroha mai: nurses, nursing and mental illness

Abstract

This research takes an autoethnographical approach to exploring the connections between being a nurse, doing nursing work, and experiencing a mental illness. Data is comprised of autoethnographical stories from 18 nurses. Drawing on Lyotard’s (1988) postmodern philosophy of ‘regimes of phrases’ and ‘genres of discourse,’ the nurses’ stories yielded three motifs: Nursing, Tangata Whaiora (people seeking wellness) and Bullying. Motifs are recurring topical, emotional and contextual patterns which have been created in this research by means of the formation of collective stories from the content of the nurses’ stories, artwork, fictional vignettes and poetry. Interpretation of the motifs was undertaken by identifying and exploring connected or dissenting aspects within and between the motifs. Using Fine’s (1994) notion of hyphenated lives, the spaces between these aspects were conceptualised as hyphens. The Nursing motif revealed a hyphen between the notion of the nurses as selfless and tireless carers, and the mastery requirements of professionalism. The nurses’ hope for caring, belonging, expertise and ‘goodness’ were also features of the nursing motif. The Tangata Whaiora motif revealed the hyphen between being a compliant patient and a self-determined person seeking wellness, and also foreshadowed the notion that the nursing identity does not ‘permit’ the dual identities of nurse and tangata whaiora. This research has found that nurses who have experienced, or are vulnerable to, mental illness negotiate a nexus of hyphens between societal, professional and personal expectations of the nurse. Ongoing unsuccessful negotiation of their identities is exhausting and leads to enduring distress. At times, negotiation is not possible and the nurse is immobilised in a differend of silence and injustice. At such times, the only resolution possible for the nurse is to leave the nursing profession. Bullying surfaced as a feature of the hyphen between the nursing and tangata whaiora identities, as well as being a part of each identity as colonising, silencing and/or discriminatory acts. Successful negotiation between and among the nursing and tangata whaiora hyphens requires a radical restructuring of the nursing image and culture across the education, workplace and personal/clinical areas. Three strategies are proposed for the discipline of nursing to achieve this change: transformatory education, a conscientisation programme, and mandatory emancipatory clinical supervision.