"For Meta Phor Worse:Ethics of the Nurse/Client relationship and the use of language

Thunderwolf, MSN, RN · Jan 6, 2008

i read your post and understand that there has been much going on for you. i commend you in your effort for improved understanding when it comes to mental health issues, but am having difficullty with your post as i will point out.

been embroiled for the last 4 years in a legal conflict regarding safety to practice:

this must be a very frustrating thing for you to endure....especially after practicing for 40 years. i feel and understand this angst.

in an emergency situation .......when core services totally failed ..........i acted in good faith as a nurse in order to protect safety and save life....succeeding in my object.

however, this is the weak point of your post...it provides no pertinent information as what you provided or failed to provide in this event...enough for your licensing board to sanction you, placing you on suspension. and as such, members here are at a loss as to what you are trying to debate about in the first place. there is no direction. without this pertinent information, it makes the remainder of your post sound like a rant....but about what?....we have no idea.

as a result of my actions i was struck from the nz nurses register for one year for 'professional misconduct".
and
...constraints on my practice as a psychiatric nurse in new zealand.
and
i have remained under monthly professional supervision

without pertinent information provided here, the members are only left with "what actually did happen during that emergency?....what happened?...what did this member do or fail to do, requiring the board to take action?

presently i am fighting for reinstatement by council who still oppose my return to practice.

this we understand.

have also initiated a debate on the professional issues involved. the invitation to debate was extended to 36 prominent mental health nursing clinicians, academics, and other mental health professionals here in nz. also invited to contribute were 2 academics from the uk and 2 from australia.
four courageous folk from nz contributed. and 3 of the 4 from outside nz contributed.

without pertinent information, it leaves me wondering again....much has not been said....and what debate?...what are we debating about? i have no clue. i then have to wonder am i not alone....and then i see that many other professionals that you have invited for debate have declined the invite. again...debate what? we have no firm foundation to debate on as it pertains to you and your situation.

i believe the debate raises important concerns about language usage and metaphor in the relationship between client and mental health nurse: concepts of care that are relevant to mental health nursing internationally, particularly those of us with specialist training in the area of interpersonal skills.
the exploration of 'safe practice' and 'reality ethics' cannot progress in the climate of fear and suppression i presently experience here in nz nursing.
and
examine, and question the relationship between a truly "universal concept of what being mentally healthy"
and
...'mentally healthy caring society'

these are the only clues that are provided....but how is this relevant to you or your situation? we have no idea. the words in red i highlighted...all conceptual, lacking detail...which can be certainly debated back and forth as concepts....but then again, since the post starts regarding your situation....it pulls us back to you....again....we have no direction how this even applies to your situation, because we have no clue as to what your situation is about. as a result, all one can do is to formulate one's own reasons for your post. what happened during that event that is getting lost in all of the semantics?....although much is said here, much is left purposely unsaid. we could debate concepts, but this is not really the passion for the post....the passion is the perception of injustice.... but what injustice?, i have no idea. you provide no information regarding that event or you. i am left directionless as a result...not knowing how to be supportive to you. the only real clue that you provide regarding the event is that it involved a situation with you and a patient/client. something happened in a perceived emergency....we have no idea again what that event was and what it entailed. you intervened or failed to intervene....the licensing agency ruled misconduct or innappropriate behavior, then you were sanctioned. you felt this was unfair, enough to try to bring in many professionals around the world to champion your cause....but what cause? i and many professionals apparently have no clue. as it stands, the post (without pertinent information for a truly healthy debate) sounds more like an angry rant regarding perceived injustice...the true passion of the post. we can debate concepts to the end of time, especially the one's i highlighted in red. but, that is not what truly brought you here. i apologize for my tone in my post, for it is nothing more than my own personal frustration in my trying to be helpful to you. you leave me nothing really to debate in your post other than "what are you truly asking for?" and are there any personal mental health issues left unsaid?

presently my reinstatement hearing is schedule for 22nd february 2008.

i wish you the very best in this. i hope you find the answers that you seek. i hope you will eventually find some peace in this.

a gentle reminder to member and all members:

allnurses.com does not provide legal advice. this is not a legal advice board. per policy, all posts with legal advice or requesting legal advice are removed from the board.

Gendequitee · Jan 6, 2008

Thanks for your thoughts and time thunderwolf...

In my original post I gave the Website address: asking that readers review the debate on my site before they passed an opinion. Unfortunately this was instantly spotted by your moderator who removed the website address from the posting.( understandably as I was breaching TOS.) My blithe ignorance in oversubscribing contributed I'm sure to the trepidation of the moderators. I am not out to promote myself commercially as you will see. I hope that this accounts for most of the major deficits you describe.

I beg your forbearance and ask that you further explore the issues

I raise by first of all reading the debate. It may authenticate me a little to tell you that one contributor is a former Chairperson of the Nursing Council of New Zealand.

I feel confident that you will then fully understand my situation, and the significance of the same to Mental health Nursing practice

Thankyou for your time and effort so far. It is my hope that I can further stimulate your professional interest, and that of the membership.

Kiora

Gendequity

llg, PhD, RN · Jan 6, 2008

Thanks for your thoughts and time thunderwolf...
I beg your forbearance and ask that you further explore the issues
I raise by first of all reading the debate.

Without a link to go to your website ... we are left to consider only what you told us in your post here. Your post does not give us enough to consider. You are going to have to summarize the key points here in order for us to have the information we need to consider the issues.

Thunderwolf, MSN, RN · Jan 6, 2008

Sorry and yes, llg. Personal website addresses are not permitted on the open board, only in the public profile. Yes....he may provide some of his key points here in order to initiate a debate. He may direct members to debate and discuss psychiatric nursing issues here in this forum, without referring to a personal website of his own for the debate itself.

Thank you for the interest and the post.

PsychNurseWannaBe, BSN, RN · Jan 6, 2008

I have read quite a bit on your website. I must say I am at a loss for words. Mostly because this is involving the practice of nursing in a different country. I am not familiar with nursing in NZ.

Your situation is very complex and there are many dynamics involved. So many that I can't help but think it is not appropriate for this board, especially the legality. However, there are concepts that could be discussed.

n Building rapport

n Therapeutic communication

n Confidentiality

n Professionalism

n Crisis prevention and management

It is hard for me to equate what is acceptable in nursing in NZ compared to the US. In all honesty, should a nurse in the US act in the manner you did, I would expect that nurse to be called in front of the BON. I am not judging what you did as right or wrong, I would just expect the BON to inquire.

So let us know what you want to discuss and debate.

~Psych

Thunderwolf, MSN, RN · Jan 6, 2008

Excellent post, PsychNurseWannaBe. I think you hit the nail on the head.

Gendequitee · Jan 6, 2008

Ok ...I'm catching on here...

Is it not the right of the client to decide if he has been threatened and abused?

Is it not the right of the client to voice his experience of the interaction?

In my case the client has never been formally consulted/interviewed about his experience.. in fact in the transcripts of my disciplinary hearing he is specifically quoted as saying he had no wish to make a complaint of any description.

There is also an issue of gender: Is it appropriate for five women to sit in judgement upon a prolonged interaction between 2 men? 2 men who have formed a unique relationship and have shared a unique culture?

How can such people make a judgement about what is or is not a threat or abuse? What place metaphor?

Shouldn't such an interaction be judged within the societal context of the event and within the context of the 'bigger picture'...?

Is it not totally inappropriate to adopt a reductionist, deontological approach, isolating a small fraction of a prolonged conversation.. putting it under the microscope and assuming that it represent the whole interaction?

I suggest to you that such deontologism has no place in Mental health Nursing. I suggest that such an approach reflects the beliefs and attitudes of those that judge, NOT the experience and reality of the client?

Client-centred care? Collaborative care?

I suggest to you that such an approach is representative of a system centred model of care, not a client-centred approach.

Mental health nurses invariably work within multi-disciplinary teams..how can quality care be client focussed when professional boundaries and ethics not only differ but conflict?

The client becomes the pawn of professional politics, not the entire focus of therapy...

The sworn testimony of both Consultant Psychiatrist (and Former Deputy Director of NZ mental health services) and the Commander of the Armed Offenders Squad at the scene, supported and endorsed my actions. The two Nurses who testified did not, whilst the person who should be the judge, who is CENTRAL to the whole issue,and whose rights to be heard are enshrined in our laws has been actively ignored for 4yrs. Is this not an abuse of his Rights?

I hope I have furnished you with material for debate.

I truly hope that I have stayed within the rules with this post...I do not wish to earn more demerit points...

Love and Peace

Gendequity

Thunderwolf, MSN, RN · Jan 6, 2008

Thank you for answering my question regarding what the surrounding circumstances are regarding what happened as you see them. I did ask for this. Lots of questions...lots of issues....which simply can not be addressed in a single thread. As it sits here, it tends to ramble...and tends to lean possibly into the debate of legalities....which we as members will not debate on. We are a nursing board...not a legal debate board.

I would suggest you reread PsychNurseWannaBe's post....this IS appropriate for discussion here. Another suggestion is to present one item of debateable psych nursing related material for a thread of discussion so that it can be debated or discussed properly....not multiple items like this. This doesn't have to be complex, but the manner in which this is posted makes it so. Lastly, step back for awhile. Rethink what could or needs to be discussed that would be helpful and useful....then come back with a fresh start.

As this thread goes, I am closing it.