Remembering Mavis, who made the ordinary extraordinary

Back in 2004, one of my PhD student's successfully defended her thesis and was awarded her doctorate. She was a colleague, friend and a mental health nurse. Back in the day, she worked as a Community Psychiatric Nurse (CPN). I knew her from her university days. Sadly, after a battle with breast cancer, she is no longer with us. She came to mind this week, as I made my way back from spending a day interviewing, more of which later.

Mavis (not her real name) chose ethnomethodology as the way to undertake her research. Her study focussed on nurses working in acute mental health in-patient units. In true ethnographic style, Mavis spent many shifts, both as a participative and non-participative observer, in several mental health services across the North West of England.

Ethnomethodology, as an approach to sociological research, was first described by the American sociologist, Harold Garfinkel who explored how jury members used common sense, evidence and social position when determining whether someone was guilty or not. In his work, he was interested in understanding what the ‘social order of being’ might be in a particular setting.

For Mavis, this gave her a focus on how mental health nurses saw themselves as nurses, therapists and builders of therapeutic relationships with patients being cared for in an in-patient setting. What she succeeded in revealing was the often extraordinariness of what others (including the nurses) saw as ‘just’ being ordinary encounters.

So, helping a patient with their laundry doesn’t usually get described in nursing practice textbooks as a defined therapy. However, Mavis observed ordinary, everyday encounters like this and in so, doing witnessed either the development of a therapeutic relationship, or the nurturing and strengthening of an existing one. Over the 24-hour period, Mavis saw many such micro therapeutic interactions.

It was only in holding up the ethnomethodological mirror that the nurses were able to see the value in what many of them thought of as being routine, non-therapeutic encounters with the patients they cared for. It was a powerful message. Some 21 years later, it is still one that mental health nurses should not ignore.

Some of the work Mavis observed the nurses doing has since been ‘delegated’ to others. The development of the Support, Time and Recovery (STR) workforce is one such example. It is a contemporary example of what Mavis found within the mental health nursing workforce. STR colleagues provide what I think is a truly supportive service, and in many cases, the work they carry out enables a range of these micro-therapeutic opportunities. Over time, and with the appropriate support and training, such opportunities can be truly beneficial to patients. It is the little things that so often can be the really big things in people’s experiences of health care.

That interview that sparked my reflection? Well, the interview was for a new Chair at one of the mega group acute health care NHS Trusts. Being on the interview panel is one of the things I enjoy about my current role, and I recognise the great privilege I have to be involved at the start of something new, and something exciting. The interview last week was one of these opportunities. It was the second time I had been involved with this Trust; the first time they were unable to appoint. This time round, they did. I wish the successful candidate well; they have a tough job ahead of them. It felt like a good day, but of course, the unsuccessful candidates might not have seen it that way.

On my way home from the interview and being stuck (which feels almost inevitable these days) on the M6, I reflected on the day. I thought about the folk I had been sitting around the table with over the course of the day. Every one of them, including the candidates, were in different ways, ‘extraordinary’. Yet, you wouldn’t know this, if you sat beside them on the ubiquitous Manchester omnibus (younger readers think Tram). They were all good people. In their own way, each was making an extraordinary contribution to the mental health and wellbeing of others. In a highly troubled world, I felt sure Mavis would have approved.