The book, the stories, the people: an ongoing dialogic narrative inquiry study combining a practice development project. Part 2: the practice development context.

This paper is the second part of a two-article practice development report. It builds on the first part by introducing and discussing a Writing for Recovery practice development project, conducted at two UK sites. The paper begins by briefly describing the project within the context of helping mental health users, carers and survivors develop skills in creative writing in order to engage in the process of narrative re-storying in line with preferred identity. A selective overview of broad and focal background literature relevant to the project is then provided in order to position it within a values-based mental health nursing practice. Following this, the specific plan for running the project is briefly summarized, covering actual and anticipated ethical issues. The paper ends with a discussion of dissemination aims.

The book, the stories, the people: an ongoing dialogic narrative inquiry study combining a practice development project. Part 1: the research context.

This paper, part one of a two paper report, describes key aspects of the research context of an ongoing practice development project, conducted on two UK sites. The paper begins with a discussion of the project's origins within a community of people working in the recovery paradigm, including the contributory strand of the first author's recovery and survivor writing. The discussion then turns to three inter-related areas within which the research component sits and which provide it with philosophical, theoretical and conceptual coherence. Each area will be unpacked and its significance explained. This will provide a platform for discussing the focus, methodology and methods of the research, and related assumptions governing both data collection and analysis. The paper concludes with a research commitment to a mental health nursing practice allied to recovery as narrative healing. Links are made to the second paper which describes the context and specifics of a Writing for Recovery project for users, survivors and carers. This shares with, and builds on, the overall project's research context and its assumptions.

Nietzsche's Genealogy of Morality and the changing boundaries of medicine, psychiatry and psychiatric and mental health nursing practice: a slave revolt?

The main constructions in Nietzsche's On the Genealogy of Morality (1994) are employed in order to explore the changes in mental health care that have been recently taking place. Characterized by boundaries that define the objectivity of scientific method, the biological stratum or the area of concern (disease and the disembodied being) and the professional distance that is maintained in the healthcare encounter, the noble morality of contemporary allopathic (Western) mental health care practice appears to be being challenged, in an act of ressentiment, by the slave morality of society, inverting values and beliefs that have previously been held. Mental health care paternalism may be in the process of giving way to consumer sovereignty, patient participation in decision making and the re-discovery of the embodied being at the centre of the healthcare encounter. Nietzsche warns that the dominance of slave morality and the inversion of moral values (what was a quality that was held by the nobles and regarded as good) - that is, objectivity and mental health care paternalism - becomes bad; and what was a quality held by the slaves and regarded as bad - subjectivity - becomes good, may ultimately be detrimental to the advancement of society.

All this happened, more or less: thoughts on 'truth', the role of fiction and its potential application in mental health and psychiatric nursing research.

Fundamental differences in the philosophy of history as an academic discipline are briefly explored, primarily from two perspectives. The traditional psychiatric and mental health nursing historian objectively uses primary sources in order to be able to make 'truth' claims about the past. The post-modern psychiatric nursing historian, on the other hand, constructs truth claims, rather than discovers them, and in the process of doing so creates historical discourses that are different from the past. To the postmodern psychiatric nursing historian, all histories are fictions, created with the use of imagination, and have characteristics that are similar to the literary constructions that are more traditionally identified as fiction. A variety of literature is used in order to explore such claims, and the conclusion is drawn that, with caution and careful attention to the rigorous use of historical method, fiction can be used as a valid source for historical research in psychiatric and mental health nursing.

Lifeworld, the arts and mental health nursing.

Various manifestations of the arts have been employed in mental health care as successful diversional and therapeutic interventions, and as an adjunct to mental healthcare professional education. There is now a current groundswell of the use of the arts and humanities in both the practice of research and the representation and dissemination of findings. Here, we first point to the potential ability of the arts that can be used to re-humanize the world of health and social care and its underpinning sciences. Second, we highlight the nature and relevance of this more aesthetic movement and its potential to enable meaningful engagement with people in order to facilitate shared understandings of concretely lived experiences. Finally, we use a long-standing philosophical framework, the 'lifeworld', as an exemplar to demonstrate how the wholeness and essence of human being can be revealed or shown through art. In doing so, we make the tentative suggestion that phenomenology and the lifeworld approach may be a useful philosophical framework for underpinning the use of arts in mental health nursing.

Therapeutic touch for anxiety disorders.

BACKGROUND: Anxiety disorders are a common occurrence in today's society. There is interest from the community in the use of complementary therapies for anxiety disorders. This review examined the currently available evidence supporting the use of therapeutic touch in treating anxiety disorders. OBJECTIVES: To examine the efficacy and adverse effects of therapeutic touch for anxiety disorders. SEARCH STRATEGY: We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTR-Studies and CCDANCTR-References) (search date 13/01/06), the Controlled Trials website and Dissertation Abstracts International. Searches of reference lists of retrieved papers were also carried out and experts in the field were contacted. SELECTION CRITERIA: Inclusion criteria included all published and unpublished randomised and quasi-randomised controlled trials comparing therapeutic touch with sham (mimic) TT, pharmacological therapy, psychological treatment, other treatment or no treatment /waiting list. The participants included adults with an anxiety disorder defined by the Diagnostic and Statistical Manual (DSM-IV),the International Classification of Diseases (ICD-10), validated diagnostic instruments, or other validated clinician or self-report instruments. DATA COLLECTION AND ANALYSIS: Two review authors independently applied inclusion criteria. Further information was sought from trialists where papers contained insufficient information to make a decision about eligibility. MAIN RESULTS: No randomised or quasi-randomised controlled trials of therapeutic touch for anxiety disorders were identified. AUTHORS' CONCLUSIONS: Given the high prevalence of anxiety disorders and the current paucity of evidence on therapeutic touch in this population, there is a need for well conducted randomised controlled trials to examine the effectiveness of therapeutic touch for anxiety disorders.

Thoughts on the therapeutic use of narrative in the promotion of coping in cancer care.

When a life is struck by cancer the very foundations of that life are shaken. The safety of 'everydayness' is replaced with a fear and uncertainty of tomorrow and the human need to make sense of life is the driving force behind coping. After initial diagnosis patients must begin to piece together their lives and build new and stronger foundations. This paper identifies a growing awareness of the role that narratives can play in helping cancer patients cope with their illness. Narratives can be used to objectify and distance oneself from problems in order to gain understanding, establish meaning, develop greater self-knowledge and decrease emotional distress. This review concludes that narratives can help patients cope with their cancer and urges nurses to incorporate the use of narratives into their practice.

"Attempting to say something without saying it ...": writing haiku in health care education.

Over a number of years the authors have been running short haiku writing workshops and have been using haiku as an evaluation tool. This paper describes those experiences and uses the haiku generated in these workshops to illustrate how this poetic form can be used as-for example, part of the process of reflection, to explore emotional and practical issues related to clinical health care practice, to refine writing skills and precision and, it is hoped, to convey to others the essence of the experience of health care provision, education and, perhaps, health, illness, and disease.

Phantom bladder sensations: a new concern for stoma care workers.

The phenomena of phantom limb pain and sensations are well recognized in the medical literature. However, historically, there has been little more than passing reference to phantom pain and sensations of visceral organs. In particular, phantom bladder pain has been barely recognized. This article describes the result of a small survey of urostomists (n=50) who experienced bladder pain and sensations that were described by the respondents as being a perpetuation of the pain and sensations that they experienced before cystectomy or urinary bladder diversion surgery. Respondents reported a varied frequency of sensations, unhelpful healthcare professional responses and a range of strategies that they employed to deal successfully with the pain and sensations. The findings of this study are important because they have identified significant issues for stoma care patients that need to be addressed by those involved in stoma care and which could lead to significant quality of life improvements. This research has shown that stoma care workers need to include the possibility of the occurrence of phantom bladder sensations in preoperative counselling, acknowledge and support postoperative patients by confirming the validity of their experience and by using interventions, identified in this study, that can minimize the effects.

Utilizing the mythical and folkloric power of trees in the modern hospital environment.

The Department of Health, under the auspices of the Government of the United Kingdom, has recently been encouraging hospital management boards to plant trees for the benefit of patients and staff. Although there is little scientific evidence to support such an edict, there are thousands of years of mythical and folkloric evidence to support such an initiative. This evidence is briefly reviewed, paying particular attention to the supposed powers often ascribed to oak, rowan, yew, hawthorn, ash and beech trees. Recommendations for arboreal tree planting schemes in hospitals are made based on this evidence.

Making sense of problem-based learning: the perceptions and experiences of undergraduate nursing students.

This paper reports the findings of one stage of an ongoing project to evaluate a problem-based learning (PBL) curriculum. Focusing on the students themselves, the ethnographic study explored how undergraduate nursing students (n=17) managed and made sense of a PBL programme. Fieldwork and ethnographic interviews revealed the students' perceptions of the purpose of PBL and further issues that were of concern were identified and labelled the uncertainty of functioning without a clearly delineated educational structure, perceptions of knowledge acquisition, understanding of group interaction processes, and the role of the facilitator. These findings and the implications that arise as a result are discussed.

The impact of the beat generation and popular culture on the development of Martha Rogers's Theory of the Science of Unitary Beings.

In the 1940s and 1950s, Greenwich Village, and New York City in general, were places that were participating in great change. Beat Generation writers, pop artists and contemporary musicians were redefining their crafts. In the midst of all this lived Martha Rogers, who was redefining her craft, nursing. In this paper the author argues, in what could be defined as a beginning and informal hermeneutic analysis, that in order to fully understand the Science of Unitary Human Beings it is necessary to understand the social context in which the theoretical framework was developed. Implications arising from the insights that emerge from this brief exploration of the social context in which the Science of Unitary Human Beings developed, which concentrates on the writing of the Beat Generation, are discussed.

Following the forsaken: a procedural description of a problem-based learning program in a school of nursing studies.

This paper reports the findings of one stage in an ongoing project to evaluate, from the students' perspectives, a student-centered problem-based learning (PBL) program in a School of Nursing Studies. We begin by making a comparison between teacher-centered education and religious devotion, and liken PBL to a congregation without a priest. A topographical account of the setting follows, describing the typical activities and events that characterize the program. Throughout the course of this account, a number of issues arise: the role of the facilitator, group dynamics, mutual responsibility and motivation for learning. These are touched on briefly, but we do not attempt to make a substantive theoretical contribution. Despite the widespread popularity of PBL in nursing schools, there have been few empirical studies conducted and, consequently, the adoption of PBL in nursing has been dependent upon the research of the very different discipline of medicine and medical education.

Creating tension: undergraduate student nurses' responses to a problem-based learning curriculum.

Qualitative data were collected from undergraduate student nurses (n = 45) who were participating in a problem-based learning programme of education. Data analysis, using a modified grounded theory method, revealed that although it was perceived that there were considerable benefits to be gained from problem-based learning, there were also some disadvantages. A category that was labelled 'creating tension', which consisted of two sub-categories, namely 'making the transition' and 'remembering the aims' emerged from the data. Making the transition highlighted the difficulty in moving to problem-based learning from more traditional methods of education, whilst remembering the aims described an emphasis on the importance that students place on knowledge acquisition. A number of recommendations for educational practice and research are made as a result of these findings.

An exploration of the potential benefits of pet-facilitated therapy.

There is mounting evidence to suggest that those who keep pets are likely to benefit from various improvements in health. Despite founders of nursing such as Florence Nightingale advocating the importance of animals within the care environment, their integration into hospitals and other health care settings has been slow. The literature on animal-induced health benefits is reviewed and the conclusion is drawn that the potential benefits of pet therapy are considerable. It is suggested that nurses can assume an active role in advocating ward pet or pet-visiting schemes.

Trends in nursing and midwifery research and the need for change in complementary therapy research.

In recent years there has been a change in nursing and midwifery research. Whilst many of the subjects being studied remain the same, nurses and midwives have started to employ a range of data collection methods that are relatively new to the profession. Predominantly quantitative research, which concentrates on reduction, objectivity, manipulation, categorization, passivity, control, prediction, causality and generalizability (Munhall & Oiler 1986), is starting to be replaced by other approaches perhaps more congruent with nursing, midwifery and caring. As Moody (1990) stated, 'the 1980s ushered in an array of diverse, sophisticated research methods...' with other authors adding that 'nursing is just beginning to authenticate new territory that incorporates a plurality of methods' (Nagle & Mitchell 1991). The following is an exploration of the recent apparent shift away from a focus on quantitative research in nursing and midwifery towards the use of qualitative methods which emphasize a greater degree of individuality, humanism, participation and interaction. It is suggested that the traditional quantitative research paradigm still exists in the field of complementary therapy research and that the shift that has taken place in nursing and midwifery research needs to be considered more seriously in the field of research in complementary therapies.

Exploring the potential of problem-based learning in nurse education.

It could be argued that the role of the nurse is beginning to change from that of a medical assistant to one of a more research-aware, reflective professional. As a result, the education of nursing students has needed to adapt. This paper explores how problem-based learning (PBL) may be an appropriate means of achieving an educational preparation that can respond to changing needs. Particular attention is paid to the theoretical underpinnings of PBL, especially the concepts of adult education, cognitive processes and learning in context. Some of the relevant empirical studies are reviewed, and the authors attempt to identify the gaps in the literature, concluding by recommending a course of action to expand the existing levels of understanding and evidence that supports, or otherwise, the use of PBL.