Development of professional knowledge in action: experiences from an action science design focusing on acknowledging communication in mental health.

This article reports a multi-professional development project that was based on an action science design. The purpose was to develop 'acknowledging communication' in a psychiatric department for young people, and the objective to study the staffs' experiences of participating in the project. The professional part of the project has its foundation in Schibbye's treatment theory of inter-subjective understanding of relationships, and involves three main approaches from her theory: self-reflection, self-delimitation and emotional presence. The article presents the specific action design used, where reflection processes were developed in three different arenas: multidisciplinary Reflection groups, a Leader support group for the group leaders of the Reflection groups and collective Project seminars for all employees. A formal study programme designed to increase professional expertise, 15 European Credit Transfer System (ECTS), was also offered. The research methods included the researcher's process notes taken during the process, field notes from participating in the Leader support group, and qualitative interviews of eight informants participating in the various reflection arenas. The article presents and discusses the experiences evolved from the methods that were developed during the professional action science project: reflection on specific situations of interaction with patients in the form of oral/written narratives and the development of video presentations in combination with 'reflective teams'. The study showed that to facilitate change in the role of staff members, it is important to combine several reflection arenas where theoretical principles can be converted into practical action. By drawing data from only one study site, the study has a limited transferability, but should be of interest for professionals working with clinical change processes.

Acknowledging communication: a milieu-therapeutic approach in mental health care.

AIM: This paper is a report of a study to develop milieu therapists' acknowledging communication in their relationships with patients. BACKGROUND: Gunderson's therapeutic processes in milieu therapy have come into use in a broad range of mental health contexts in many countries. Research in nursing indicates that validation needs a more concrete development for use in clinical work. METHODS: Schibbye's theory, 'Intersubjective relational understanding', formed the theoretical foundation for a participatory action research project in 2004-2005. The data comprised the researcher's process notes written during participation in the group of group leaders every second week over a period of 18 months, clinical narratives presented by participants in the same group, and eight qualitative interviews of members of the reflection group. FINDINGS: The core concept in acknowledging communication, mutuality, was described as inter-subjective sharing of feelings and beliefs in a respectful way. Participants presented their process of development as a movement from knowing what was best for the patient (acknowledging patients as competent persons, a milieu-therapy culture based on conformity), to appreciating diversity and stubborn talk, to reflective wondering questions. Misunderstanding of acknowledgement occurred, for instance, in the form of always being supportive and affirmative towards patients. CONCLUSION: The concrete approaches in acknowledging communication presented in this article could be a fruitful basis for educating in and developing milieu therapy, both for nursing and in a multi-professional approach in clinical practice and educational institutions. Future research should focus on broader development of various areas of acknowledging communication in practice, and should also include patients' experiences of such approaches.