Nursing - Theses
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ItemHeartscapes: A new narrative for understanding the complex interplay of mental illness and cardiovascular health( 2021)People who live with serious mental illness such as schizophrenia and bipolar affective disorder are vulnerable to premature mortality. The leading cause of death is cardiovascular disease. Extensive research has produced important biomedical knowledge of this complex health problem. However, this knowledge has not translated into improvements in the cardiovascular health of people who live with mental illness. This PhD research project explored this real-world health problem through the stories and medical records of ten people living with mental illness. The research aimed to gain understanding of how living with mental illness influences cardiovascular health in everyday life. This study used critical realism and a realist qualitative design to frame a multi-method narrative inquiry. Data collection included clinical file reviews, semi-structured interviews, and narrative interviews. Visual methods were used to elicit experience and meaning making. Narrative analysis across the datasets produced a collection of ten illustrated core stories. Thematic analysis conducted within and across stories generated a metanarrative. In the metanarrative, a landscape metaphor was employed to explore how ten people who live with mental illness experienced and made meaning of their cardiovascular health in their everyday life. The metanarrative offers collective understandings of lived cardiovascular health. There are four key storylines: 1) Borderlands: Getting mental illness, switching on the complex interplay; 2) Entangled Lands: Living the complex interplay; 3) Heart Space: Uncovering the human hearts; and 4) Transformational Lands: Transforming vulnerable hearts. This approach generated a new narrative for understanding the complex relationship between mental illness and cardiovascular health. The new narrative affirms mental illness to be a powerful contributor to a complex array of interconnected cardiovascular risks. By shifting the critical realist explanatory lens from stories of illness to stories of transformation, this new narrative points to multidimensional connectedness as a fundamental precursor to whole heart health. Addressing the cardiovascular inequalities experienced by people who live with mental illness calls for whole of system transformation and the advancement of radical multileveled relational approaches to improving heart health.
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ItemSocial work in secure forensic mental health inpatient services: towards cultural competence( 2011)International migration has moved to the forefront of the global agenda and has become a challenge for governments around the world. According to the Department of Immigration and Citizenship [DIAC] (2007), Australia has become “one of the most culturally diverse societies of the 21st century” with more than six million migrants having arrived since 1945 (p.1). This is despite Australia’s history of racist immigration and indigenous policy, and continued social disadvantage and discrimination experienced by many indigenous and CALD (Culturally & Linguistically Diverse) Australians. Secure forensic mental health inpatient services, like many services, are not meeting the needs of the indigenous and CALD population. This paper will use a critical literature review, from a critical theory and social constructionist perspective, to answer three fundamental questions: What are the problems for indigenous and CALD patients in secure forensic mental health inpatient services? What factors contribute to, and sustain, these problems? What can social workers do about these problems? While cross-cultural forensic mental health research is scarce and often methodologically flawed, key themes emerge. Secure forensic mental health inpatient services are influenced by a complex, socially constructed tangle of institutions, policies and practices. The ‘caring’ mental health system and the ‘custodial’ criminal justice system often have conflicting goals and expectations. Furthermore, public and media perceptions of danger frame the policy context. This leaves patients commonly experiencing discrimination, disempowerment and social exclusion. However, patients from indigenous and CALD populations are further marginalised and have reduced ‘social quality’ (social inclusion, socio-economic security, social cohesion and empowerment) (Huxley & Thornicroft, 2003). The literature attributes this to factors including: discriminatory and reactive government policies, an ethnocentric mental health system that relies on culturally invalid classification systems, and culturally incompetent clinicians and organisations. Social workers have been implicit in these systemic failures through their lack of contribution to the literature and their lack of influence in forensic mental health. This is despite the compatibility of the social work person-in-environment perspective, and its focus on social justice and social quality, with good cross-cultural practice. Frequent references to ‘unexplored’ socio-cultural and environmental factors in the literature, and a mental health policy shift in Victoria towards social inclusion and community development, provide a timely opportunity for social work to assert itself. In this paper, my purpose is to demonstrate how social workers can affect structural change on a professional ecosystem that impedes culturally competent practice. Through this conceptual framework, I have developed Culturally Competent Guidelines for Social Workers in Secure Forensic Mental Health Inpatient Services. These guidelines aim to provide social workers with tools that might empower them to become more culturally competent clinicians, and in the process, enable them to strive for social justice by improving social quality and cultural competence at all levels.
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ItemWomen and their journals: navigating depression through consciousness-raising, resistance and action( 2009)Depression in women is a major mental health issue and social work practitioners can, at some stage in their careers, expect to work with women experiencing depression. Journal therapy, the use of writing for therapeutic purposes, is one example of support and intervention offered to women. The use of journal therapy and specifically the use of journalling by women in Women’s Journalling Groups were investigated in this research. Limited research had been undertaken in the area of journal therapy with women experiencing depression. The research was undertaken in four phases and used a modified form of grounded theory to develop the research design and to identify and articulate ideas about women’s use of journalling during depression. Phase one established the baseline knowledge for the research through a Co-operative Inquiry underpinned by feminist research principles. Findings from the Inquiry identified: Two key methods of journalling and women’s responses to depression: • The Considered Acknowledgement, Acceptance and Contemplation framework • The Proactive Resistance, Rehearsal, Agency and Action framework; Four key narratives that women had created about their journalling and their understanding of depression in women: • Identification and expression of emotions; • Identity, sense of self and self-value; • Structural and social roles, relationships and expectations; and • Transformative choices, opportunities and accomplishments; Phase two involved the conceptualising, formalising and transfer of this knowledge into the development of a Women’s Journalling Group program. Through the facilitation of two Women’s Journalling Groups in phase three, the journalling activities were found by women to be relevant and meaningful for them in assisting them to understand their depression and move toward recovery. Phase four included the final stage of knowledge utilisation and transfer. A most significant and new finding from this research was that journalling undertaken by the women was a form of action in response to their depression. Far from being a passive, ruminative, purposeless pastime, journalling was an evolving and sustaining action that enabled the women to gain insights and understandings into themselves and their depression. Journalling activities enabled women to identify and express the many feelings and thoughts that attached to their depression. In reaching clearer understandings of themselves and their depression and in gaining confidence in making choices about their future, women were engaged in processes of consciousness-raising and resistance. Resistance to social and structural expectations, roles and stereotypes was important for the women who could then redefine and redevelop their authentic sense of self and identity. Resistance could occur on an individual level in the journal and on a collective level within Women’s Journalling Groups. The major outcomes of this research have resulted in a model of journalling that has been used to develop a theoretically grounded Women’s Journalling Group program. Whist some further developmental work is required with the program, it nevertheless provides a tested therapeutic intervention that can be offered to women experiencing depression.