Nurses' perceptions of boundaries with service users in acute mental health inpatient settings : a grounded theory study

This thesis explores mental health nurses’ perceptions of boundaries with service users in acute mental health inpatient settings. This is against a backdrop of notions of recovery implying a relaxation of boundaries, but with an increasing dominance of concerns with risk. This thesis is divided into two sections, with the first part containing a journal paper that is ready for submission. The second section, an extended paper, is required to be read alongside the journal paper. The extended paper contains more detailed information that could not be presented within the journal paper. The journal paper concentrates on the main literature about recovery approaches and service users’ views about the relaxation of boundaries as part of their recovery, alongside barriers to the relaxation of boundaries within the acute mental health inpatient setting. It highlights the gap in the current literature which the thesis aims to address. In order to build a theory about what mental health nurses within the acute psychiatric setting perceive as boundaries with service users, a grounded theory methodology was used. This was used to analyse transcripts of semi structured interviews carried out with the mental health nurses. Three descriptive categories were constructed from the analysis relating to how mental health nurses perceive boundaries: the socially constructed nature of boundaries; the perceived need for boundaries; and enacting boundaries. Theoretical categories were constructed to embed the analysis in the broader cultural setting. The extended paper sets the research against a broader background about recovery approaches and the dominance of the discourse about risk aversion. It specifically explores boundaries in relation to recovery principles and risk, as well as factors that may hinder the relaxation of boundaries, such as stigma and othering. It offers additional information about the methodology and analyses of the data. It has a detailed reflection and memos about the research process. The results section concentrates on factors that impact on mental health nurses perceptions of boundaries. The theoretical categories are presented which aim to account for the data gained, rather than to just describe it.