Religion, assessment and the problem of ‘normative uncertainty’ for mental health student nurses: a critical incident‐informed qualitative interview study

Accessible summary What is known about the subject? There is very minimal research available on mental health (MH) student nurse perceptions of cultural phenomenon – specifically, the ways in which they differentiate between ‘normal’ and ‘psychopathological’ beliefs related to culture and religion. Work in cultural psychiatry suggests that other MH professionals struggle with identifying whether beliefs or experiences indicate ‘psychosis’ or are ‘typical’ of a person's religious and cultural background. One research study with nurses suggests that they can sometimes also struggle to differentiate between religious and ‘psychotic’ beliefs and experiences.What this paper adds to existing knowledge: This research adds to the literature through analysing and demonstrating student nurses' experience with witnessing and accurately determining the clinical significance and relevance of people's religious beliefs and experiences. To our knowledge, this is the first study to use clinical practice to reflect on cultural issues in student MH nurses in this way, rather than using vignettes. These problems were attributed to a lack of religion‐specific knowledge both in our study and within wider MH and anthropology research.What are the implications for practice? This study highlights the potential practice implications resulting from the risk of misinterpretation of beliefs and experiences. We propose ways in which this can be addressed through using different models of belief systems, and suggestions for approaching the issue in MH nurse education.Abstract There is limited research around how mental health ( MH ) student nurses interpret and differentiate between people's religious and cultural beliefs and the existence of psychopathological symptomatology and experiences. Here we focus on one cultural issue that arose from research exploring how MH student nurses approach and interpret religion and culture in their practice – that is, the difficulties in determining the clinical significance of the religious beliefs and experiences expressed by the people they care for. While problems with establishing the cultural boundaries of normality in clinical assessments are an important area of debate in cultural psychiatry, it remains a peripheral issue in MH nurse education. An anthropologically informed qualitative research design underpinned ‘critical incident’ ( CI )‐focused ethnographic interviews with 36 second and third‐year MH nursing field students and seven undergraduate MH branch lecturers. Follow up focus groups were also carried out. Interview transcripts were subject to thematic analysis. Four subthemes were identified under the broad theme of the clinical significance of religious‐type expression and experience: (1) identifying the difference between delusions and religious belief; (2) identifying whether an experience was hallucination or religious experience; (3) the clinical implications of such challenges; and (4) applying religion‐specific knowledge. There are clinical implications that may result from the difficulties with assessing the clinical significance of religious beliefs and experiences, identified in both our research and within international cultural psychiatry literature and research. Misinterpretation and therefore wrongly assessing someone's experience as pathological is a significant concern. It is suggested that CI analysis could be adapted to help nurses, nursing students and nurse educators recognize the religious dimensions of mental distress, particularly those that then potentially impact upon the accuracy and person centeredness of clinical assessment. Further research is proposed to investigate the clinical assessment and training needs of nurses in the area of religion and mental distress.