Document Type

Dissertation

Degree

Doctor of Philosophy

Major

Nursing

Date of Defense

4-10-2024

Graduate Advisor

Julie Bertram, Ph.D.

Committee

Roxanne Vandermause, Ph.D.

Wilma Calvert, Ph.D.

Anne Fish, Ph.D.

Abstract

The nursing profession experiences caring for patients suffering psychosis and managing crises events in a way that is unique to all other healthcare providers. A gap in research and literature exists related to this phenomenon. The purpose of this study was to examine the lived experiences of nurses caring for patients experiencing psychosis or some other severe mental health issue. By analyzing the common expressions and behaviors of nurses in situations involving care of psychosis, the meaning of the care giving experience and thus, an understanding of the interactions involved with caregivers in psychosis was revealed. Participants provided experiential, firsthand data on the interventive process as it shows itself in everyday practice. This research was undertaken to address the following questions:

1. How do nurses experience psychotic manifestations of confusion, aggression, and violence in patients they encounter?

2. How do nurses express their experiences and preparation when they must intervene with patients manifesting psychosis or other severe mental health issue?

A Heideggerian hermeneutic phenomenological approach was utilized to answer these questions. Ten nurses of varying ages and years of clinical experience at the bedside were interviewed. Their narratives gave experience rich accounts to the dataset and contributed to three major patterns and eight sub-themes that were identified from analysis.

The three patterns were Being in an Environment of Sudden Chaos, Guiding the Intervention for Security, and Needing to Prepare for the Unexpected. The eight subthemes were: Facing the Crisis, Deciding the Course, Bearing the Weight, Ensuring Safety, Communicating Therapeutically, Getting Invasive, Beginning Unequipped, and Gaining Experience.

Results from analysis found that educational institutions and employers are doing an inadequate job of preparing nurses to intervene in mental health emergencies. Clinical experience and years in direct patient care made nurses better equipped. Along with better education and training, the processes of adapting interventions for psychosis and other severe mental health conditions needs greater methodological research, rigor, and clarity. Employers and healthcare institutions must do their part to ensure nurses feel supported and safe while they develop the nursing skills necessary to effectively manage these crises events.

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