Out of the institution?: exploring the culture of community psychiatric nurses.

Abstract

The literature shows that there is a lack of knowledge about the practice of the relatively new profession of community psychiatric nurse who initially train in hospitals and then move to the community. The research undertaken for this thesis is designed to address this lack of knowledge by exploring the views of community psychiatric nurses practicing in South Durham. Using a Weberian perspective, it was proposed that the collective cultural beliefs of the CPNs would reflect perceived differences between hospital and community psychiatric nursing. The culture was explored through 30 semi-structured interviews with the CPNs working for South Durham Mental Health Trust in 1996/7.A series of cultural beliefs (categorised as "themes") were found which described views about the differences between psychiatric nursing in hospital and the community, in the disorders found in each patient group, relationships with consultants psychiatrists and general practitioners, relationships with other health and social care professionals and what constituted a "good" community psychiatric nurse. There was also a theme which related to all the others, which concerned threats to their professional identity, as seen by the CPNs, in terms of their status as a distinct group of health care workers. The findings show that the CPNs provide care for a wider range of disorders than found in hospital patients. There is no mandatory training which leads to a variety of strategies by which they learn to treat unfamiliar disorders. Relationships with medical staff, and other professionals, have to be re-negotiated when moving from hospital to community. It also appeared that the CPNs perceived a threat to their professional identity as a consequence of the changes in mental health care which were occurring at the time of field work, involving both the NHS and social care agencies.