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Keywords:

  • confession;
  • Foucault;
  • governance;
  • risk;
  • self-regulation;
  • supervision

Accessible summary

  • Mental health nursing has a long tradition of ‘monitoring and managing’ how nurses behave, this has not always benefitted either service users or nurses.

  • Nurses are professionally required to seek guidance from more experienced colleagues to reflect, examine and improve on their practice.

  • Formal and informal guidance, known as supervision, often reinforces traditional values and practices that do not challenge the status quo.

  • To improve outcomes for service users and empower mental health nurses it is important that nurses adopt much more critical forms of reflection.

Abstract

Mental health nurses frequently draw on self-disclosure practices within their working relationships. These ‘confessional’ acts can in turn be predicated on traditional assumptions of moral authority exercised by more senior colleagues. More broadly, attention has been drawn to the increasing significance of ‘technologies of the self’ inside neo-liberal regimes of governance. Through various forms of self-disclosure people are obliged ‘to speak the truth about themselves’. By publically declaring themselves as ‘fit for purpose’ nurses are required to be reflexive, self-monitoring individuals, capable of constructing their own identities and biographies, and guided by expert knowledges. In this way, risk becomes a form of governance, as the individuals continually find themselves balancing risks and opportunities. Foucault's insights into the importance of ‘care of the self’ and ‘surveillance of the self’ to systems of social order and governance, such as mental health services, are significant in identifying nursing as a potential form of confessional practice. ‘Reflective practice’ and ‘clinical supervision’ are therefore ‘technologies’, functioning as ‘modes of surveillance’, and as ‘confessional practices’. So ‘clinical supervision’ may be understood as part of a process of ‘governance’ that does not necessarily empower nurses, but can act to guide, correct and modify ways in which they conduct themselves.