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Part One: Literature Review Purpose: To explore current knowledge about the psychological impact of psychiatric hospitalisation. Method: A Computerised literature search was completed using six publication databases. Relevant papers were identified and reference list and prospective citation searches were conducted. Particular inclusion and exclusion criteria were employed. Results: Very little literature has explicitly investigated the psychological impact of psychiatric hospitalisation. However, findings around psychological concepts such as identity, stigma, coercion and trauma have started to indicate the nature and extent of psychological responses. The majority of studies are atheoretical in nature and lack methodological rigour. Conclusions: Further research is needed to incorporate psychological theory into an understanding of the experience of psychiatric inpatients. Future research should include rigorous empirical studies within acute adult populations and exploratory qualitative studies with other age/client groups. Part Two: Research Report Objectives: To explore adolescents’ experiences of psychiatric hospitalisation, including the psychological impact of the experience and coping mechanisms. Method: The data from semi-structured interviews with ten adolescents was analysed using the grounded theory method (Glaser & Strauss, 1967). Results: A process model was developed around the core category ‘Living in an Alternative Reality’. Contributory categories highlighted the possible impact of hospitalisation and outcome categories suggested the ways in which adolescents coped. Discussion/Conclusions: The results suggest that the experiences of adolescent inpatients may be similar to adult experiences. The clinical implications of the findings, such as the need to maintain connections with family and friends and foster supportive relationships within the ward environment, highlight the need to prioritise the service-user perspective in clinical settings and future research. Part Three: Critical Appraisal A reflection on the overall research process is provided. Practical and theoretical issues of interest are discussed, including the influence of the self in qualitative research, the editing process, and power and control.

The study is a narrative analysis of the accounts of five British Asian men aged between 23 and 42 years of age, who were inpatients with diagnoses of a mental illness. The aim of the research was to gain a better understanding of the psychological impact of an admission to an inpatient psychiatric service upon South Asian men and their families. Data was derived through flexible use of a semi-structured interview schedule. Participants spoke of their life and circumstances prior to their hospital admission, including the nature of their family relationships, their experiences of being a patient, and their hopes for the future post discharge from hospital. A summary of each participant's story is presented. The case study analysis of each account presents the core narrative, tone, notion of self construct, self in relation to others and genre within each narrative. Cross analysis of all the accounts showed similarities and differences present in the participants' stories. The findings are discussed in relation to an overarching genre 'Journeys of potential reparation and new beginnings', which captured the meta-narrative across the participants' accounts. It relates to participants' future hopes and plans for recovery and in some cases, an understanding of the fragility of these plans. Genres of participants' individual accounts seemed to fit with this ,overall sub-genre " ... it's going to be a fight ...". Participants anticipated struggles continuing post-discharge in relation to their psychological care and recovery, re-building their identities and lives, maintaining or re-building meaningful family relationships and having a sense of belonging in their family, cultural community and/or wider society. Implications for theoretical, clinical, training and development for professionals and service provision are discussed. Finally, strengths and limitations of the study, ideas for future research, the conclusion, and my final reflections are discussed.

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This thesis describes a series of studies that examine how nurses who work with people with intellectual disability make clinical decisions in practice. Current research offers evidence and guidance to support clinical decision making for nurses working within mainstream healthcare services. However, the available reviews of intellectual disability nursing research have identified that evidence to support intellectual disability nursing practice is sparse. Consequently, little is known about how and what decisions intellectual disability nurses make in practice; and the types and sources of evidence they use to support their practice. In the context of intellectual disability nursing and in light of a review of the literature (Chapter 1 and 2), three studies were conducted. The aim of this thesis was to use mixed methods (Chapter 3) to explore the process of clinical decision making in intellectual disability nursing. In Study 1 (Chapter 4), Interpretative Phenomenological Analysis was used to explore how twelve intellectual disability nurses made decisions in practice and how their decisions were influenced by evidence. Four key themes emerged : 1) getting to know the person, 2) working as a team, 3) evidence to support decision making, and 4) understanding of evidence based practice. An all Wales survey (Study 2) of nurses employed by the National Health Service intellectual disability nursing service in Wales was conducted. The survey determined the types and sources of evidence nurses used to make decisions in practice; further identifying the demographic and cognitive characteristics that influenced the use of evidence (see Chapter 5). Study 3 explored how individuals with intellectual disability perceive the role of intellectual disability nurses (Chapter 6). Seven participants engaged in semi structured interviews and the analysis of the data was guided by Foucault's concepts of dividing practice, scientific classification and subjectification. Two discursive themes emerged from the analysis: (1) Inclusion: empowering and supportive healthcare practice; and (2) Exclusion : challenges and practices that resist healthcare involvement.

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