Abstract
We need research not only to measure the effects of our interventions but also to understand how to implement or improve healthcare measures. Qualitative research considering the point of view of patients and caregivers is especially useful for this perspective. This research, following a thorough presentation of the Kenyan situation, uses a clearly presented qualitative grounded theory methodology, with in-depth interviews with mental health nurses in Kenya, and underlines the importance of environment as an intervening condition for the quality of nursing practice in mental health and not only as a health determinant for the patient. ‘Environment emerged as the intervening condition that influences interventions.’ Environment has to be considered as ‘a total context’ in a systemic vision, where the conditions of work and resources of caregivers have to be taken into account, ensuring ‘safety for nurses and their patients’. The intrapersonal environment is discussed as well as interpersonal interactions, even if this point is only suggested in verbatims. We have not only to consider a patient’s, but also a caregiver’s intrapersonal environment, both influencing interpersonal interactions with the patient – patient’s centredness – and quality of care. ‘Unfavourable work environments influence mental health nursing care negatively.’ The authors describe such environments as hostile, where people suffer from stigmatisation, discrimination, rejection, neglect, disrespect and unmet basic needs. Hostile environments impact on caregivers and on patients together.
This research needs further research questions: how to transform a hostile environment into a homely one? Probably mental health nurses have some ideas about the causes of the problem and the solutions they are using every day. What can they do? Intrapersonal or the inner world of nurses is also important to explore. What is the impact of a hostile environment on their personal feelings? Is it a cause of professional exhaustion or burn-out? What are the consequences of burn-out? What is the interaction of nurses with other healthcare professions, social workers, doctors, etc.? How can this interprofessional context impact on the care environment? How can education create tools for future nurses facing hostile environments? Conceptual models are of course very important, permitting the nurse ‘to plan interventions based on rationale and not routines’. This research allows us to refine the conceptual model starting directly from the point of view of nurses. Pedagogically, theory or models are not sufficient for practice; we also need reflectivity to appreciate our intrapersonal environment when we face the patient. This is particularly true for mental health professionals. How do nurses use this reflectivity and when? Many health professionals around the world are complaining there is no space for exchange during or after the working; how is it in Kenya?
With all those questions we see that this research opens many doors for future qualitative research, as well as those for quantitative comparative studies in order to evaluate clinical outputs of different environments, as suggested by the authors.