How does stigma influence mental health nursing identities? An ethnographic study of the meaning of stigma for nursing role identities in two Belgian Psychiatric Hospitals

Background: Stigma constitutes a threat for professionals who work in mental health care, through their association with mental illness as a discrediting attribute. Together with nurses' unclear self-perception, recent insights suggest that stigma may inform the apparent identity crisis within the mental health nursing profession. Objective: This article explores how stigma may give meaning to mental health nursing identities. The nursing role is built upon official labels, a prime trigger of stigma. Therefore, due to nurses' ambiguous relation with the psychiatric/medical care and their own stigma experiences due to their association with mental health problems, they can be considered as a stigmatizing, de-stigmatizing and stigmatized group. Dynamics which inform this intricate relation between stigma and mental health nursing identity are the focus of this article. Accordingly, this article points to the importance of including stigma in the overall study of mental health nursing identity. Design, settings and participants: This research uses a qualitative case-study design. Ethnographic data were gathered from 33 nurses in 4 wards in two psychiatric hospitals in the region of Ghent (Belgium). Methods: Participant observation and semi-structured interviews were combined to access the meaning of being a mental health nurse in these specific care contexts and its possible interference with mental health stigma. Results: The findings suggest that tackling stigma is a particularly important personal motive for nurses to work in mental health care. The meaning of stigma is closely entangled with nurses' troublesome relationship with the medical model of care. Variations between hospitals regarding the extent to which stigma informs the professional role constructs and identity of nurses are found to be related to the degree of formalization of the nursing roles in these different hospitals. Conclusion: The present study points to the relevance of the integration of stigma in mental health nursing identity research. Furthermore, the focus on stigma may offer an opportunity to link contexts of illness and care, and nurses' identity constructs.