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Values in everyday mental health nursing

Research

Summary report: Using photography with mental health nursing students to explore issues of culture and values

What do we already know about this topic?
A values-based practice (VBP) approach informs the national educational and practice curriculum of English mental health nurses and aims to re-examine and restate personal, professional and societal values, as ultimately, it will be practitioners’ understandings of these values which influence and impact on the experiences, actions and relationships within all health care encounters. A VBP approach explicitly acknowledges emotions, conflict and ambivalence ‘up front,’ as part of the expected response to discussions of culture and difference.

The VBP module (NJ256) is a pre-registration diploma mental health nursing module in the School of Nursing and Midwifery. The premise of the module is that mental health practitioners’ values underpin every encounter in healthcare and students need to learn to make explicit their own values and explore the uncertainties and complexities this creates in order to work with others. It aims to offer a critical and political approach to culture and diversity by working with an understanding of culture and diversity that attempts to avoid fixed or static notions of culture, or culture as a pathologising description or set of ‘exotically’ different attributes belonging to ‘others’. Rather, the focus is on the cultures we all inhabit and the implications of this for mental health mental nursing and service users’ experiences of care but also of discrimination and stigma.

Why did we want to evaluate the use of photography in this module?
The use of the humanities and arts in medical and nursing education and training is an approach known to promote and encourage health practitioners to become more compassionate and empathetic in their everyday practice. Visual methods are known to increase students’ observational skills, their awareness of dealing with health needs across cultures and are said to strengthen students’ confidence in and abilities to provide care.

During this module, students work in small groups and actively participate in explorations of their own culture, by taking photos they feel describe, represent or illuminate this. The small groups are required to present their photos to the whole group and discuss the reasons for their choice and the values, norms and beliefs they identified, those they shared and those found to be different. The guidance for the task encourages them to think critically and interrogate their own understandings and assumptions.

In the feedback session we ask students to offer their own understandings (photo elicitation), while those facilitating the session draw attention to the content and themes present in the analysis and presentations overall. During the past three years the presentations and discussions have raised important questions about power and knowledge and understandings and constructions of norms and difference. But to date the assessment of photography, and its relevance for learning has been limited to the overall module evaluation, which has always been positive. However, we had questions:

  • We wanted to know whether taking one and half days out from a total of five days module is worthwhile?
  • Whether anything more significant is learnt?
  • Whether what is learnt could be taught differently, more conventionally?
  • Whether we need to rethink the exercise and use different art based teaching methods?
  • And finally, whether this type of learning is memorable or sustainable?

What did we find and what does the project research add?
Prior to the module, students had ideas about culture and values but these were sometimes difficult to articulate or identify. Following the module, students were surprised to find they sometimes held strong values; they more clearly recognised the complexity and difficulty of responding to and dealing with conflicting values; they found listening to others challenging but helpful, and for some, they could more clearly identify their own values and culture.

During the fieldwork, we observed good interpersonal and group work skills, interesting but sometimes challenging debates and discussions, a great support and encouragement of each other, and fun learning from and about each other.

In the group feedback and presentations, students actively participated in their learning; selecting, creating and producing images, and articulating their own understandings and meanings. Further discussion and analysis revealed students’ own readings of the photos and together in the group, other cultural signs and symbols, notions of power and knowledge and dominant discourses, identities and the cultural gaze provide alternative readings and understandings of culture and diversity.

In the follow up interviews we found student enjoyed going outside to learn, they found listening to and learning from each other valuable, they enjoyed taking photos to observe same and different values and aspects of culture, they felt photography provoked a different type and level of discussion and dialogue than in classroom based learning, and that taking photos were maybe not so important in themselves, but acted more as a means to an end. Most remembered the day more than any other session in the module and claimed to have more awareness of the complexity and importance of values in practice.

What do we still need to find out?
We still need to find out whether this type of learning promotes a reflexivity of self and practice that lasts, and whether it has any impact in practice for service users, and whether other creative methods would do the job as well.