Reviewing the literature constructing the field: Accounting for the CPN in practice and research

Abstract

Making health practice and policy 'evidence-based' politicises clinical research, by making proof of 'effectiveness' the key to resources. In this paper we revisit a literature review of clinical effectiveness in psychiatric nursing in order to demonstrate how, in a multi-professional health system, scientific publications can also function as claims in the competition for resources. We consider the rhetorical dimension both of the literature reviewed, and of the act of literaturereviewing itself. Each genre comprising 'the literature' constructs a version of the field of mental health care and a version of the CPN within the field. Each genre thereby constructs 'effectiveness' differently. We therefore recast the problem of determining the effectiveness of Community Psychiatric Nurses (CPNs) as the problem of determining how the problem of CPN effectiveness is constructed as a problem in different discursive contexts, i.e. by different professional and non-professional discourse communities. In reconstructing the problem of effectiveness as one part of the wider struggle for definition of the field of mental health care, the genres we consider are: • care studies, in which CPNs report on their own work; • qualitative studies related to CPN effectiveness; • users' reports on their mental health experiences; • the 'hidden CPN'- loss of information in studies of services; • the 'disappearing CPN'- loss of role specificity in community psychiatric projects. Concluding with a case study of the literature as political remote control (negotiating the CPN as a resource in community mental health care), we show how, if the field can be seen as a field of interests, sometimes openly displayed, sometimes not, a basic game being played in the literature is that of differently placed social groups seeking control of mental health services in the community through the production of legitimating accounts of practice.