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By Sharon Lawlor
Photos by Elizabeth Phillips
Edited by Ann Greene
The origin of the quilt came in the fall of 1996, when I was nominated as Chair of Public Relations Committee for the Canadian Federation of Mental Health Nurses Board of Directors. Within a few months, the idea of relaying the story of our specialty throughout Canada via the route of a quilt depicting our goals and standards of practice was borne.
The Federation’s first goal as a national nursing interest group was to achieve status as a designated specialty with the Canadian Nurses Association. With that status, there was then established a credentialing examination for psychiatry and mental health nurses with the Canadian Nurses Association Testing Service. Nurses in Canada have had the opportunity to become certified in Psychiatric Mental Health Nursing since January 1995. Certified nurses are eligible to sign CPMHN(C) after their name and to wear the CNA specialty pin identifying the specialized body of knowledge.
In developing the testing for CNA, a committee was brought together to develop standards of practice, specific to psychiatric mental health nursing. The Canadian Standards of Psychiatric and Mental Health Nursing Practice provide direction to all nurses and to the public on acceptable practices of a psychiatric mental health nurse. This purpose is in accordance with the nursing professions obligation to the maintenance and improvement of the quality of nursing care. The quilt reflects the beliefs/values of the Federation and the seven CPMHN standards as interpreted by individual nurses and quilters from each province across Canada. Included here is a summary of each appliqué, which standard of practice or belief/value (Courage, Asylum, Hope and Justice) of the CFMHN and the province in which it was designed.
Starting with Newfoundland, this province did Standard #3 “The Administering and Monitoring of Therapeutic Intervention”. A blood pressure cuff, pill bottle and syringe represent this standard and some of the more task oriented activities of the PMH nurse. A consumer, who wishes to remain anonymous, completed the appliqué block.
Prince Edward Island chose to appliqué “Peace of Mind”, which is the official emblem for the Federation of Mental Health Nursing. Mrs. Annie Spears completed this piece. The Dove reflects “Peace” with the silhouette of the dove embedded in outline of the “Mind”.
Nova Scotia chose Standard #2 “The Diagnostic and Monitoring Function”. The quilter is unknown and their interpretation depicts effective diagnosis and monitoring that is dependent on knowledge of mental disorders, and psychiatric and mental health nursing principles. This knowledge, integrated with the nurses’ conceptual model of nursing practice, provides a framework for processing clinical and client information. Here we see a symbolic hourglass, outlined by faces, facing one another, representing the therapeutic nurse/client relationship, surrounded by the necessities of diagnosing and monitoring observation, examination, planning care, interpretation, and consultation. This appliqué includes tools used by nurses today, including a computer screen.
New Brunswick completed Standard #1 “The Helping Role”. This block is an accumulation of thoughts of a number of New Brunswick nurses, and many aspects of New Brunswick, including the New Brunswick tartan. The helping role is exemplified through the “art of being present”, which involves the relational elements of attending, listening, and observing. New Brunswick thanks Roberta Murray for her great appliqué savvy.
Quebec chose the element of “Justice”. Justice is depicted by the scales of justice and a blind owl, to convey the qualities of balance and fairness implicit in the concept of justice. The CFMHN believes that the qualities, balance and fairness, reflect the thinking of mental health nurses, as they strive to deal justly with the many faceted concerns they address in their work.
Ontario, given their size, was given two appliqués of the quilt to complete. A psychiatric nurse, Mary Conroy, also a quilter, worked on these tow blocks. The Ontario representative tells me that through many a night shift nurses discussed and participated in the interpretation of these designs. All were not members of CFMHN, however, all were psychiatric nurses and were enthusiastic, willing and knowledgeable team players. Mary’s first block was Standard #7 “Organizational and Work Role Competencies”. She has interpreted this by setting generic figures of men and women, (using red and white maple leaf material, which strengthens the image of Canada) around four blue hearts, symbolizing the caring aspect of nursing, which is at the central to the role of the nurse. Linking these are banners, on which are embroidered the four principles of this standard, and joining each of the banners is the dove, the emblem of the CFMHN.
The second block designed by Ontario, was that of “Courage”. Courage is symbolized by the universally recognized symbol of courage – the lion.
Manitoba did Standard #4 “Effective management of Rapidly Changing Situations”. This square depicts the response of the whole province to a community disaster. In 1997, Manitoba experienced the “Flood of the Century”. During that time, all Manitobans worked together to protect their communities in the most adverse of conditions. This quilt square reflects, in an abstract way, what was experienced at that time. Through the middle of the square runs the grey, swirling waters of the Red River. The brick and black fabrics represent the dykes of sand bags and mud, which were built up on either side in an attempt to curtail the raging waters and prevent devastation to the land along the banks. At the height of the flood, a winter blizzard with heavy snowfall created additional concern, as depicted by the snow against the green of the trees. The blue fabric represents the often-blue skies, but also reflects the heavy snows, which fell. Lastly, the four hands represent the people of all colours and creeds, who worked together throughout the province. The quilter for Manitoba was Susan Earl, who is a nurse and a quilter.
Saskatchewan did Standard #4 “Teaching-Coaching Function”. The CFMHN Regional Representative from Saskatchewan, Floralyn Wessel, in collaboration with quilter, Pat Sargent, designed this quilt piece. The teaching-coaching function focuses on promoting self-reliance and self-determination in assisting consumers and families to attain greater facility in living with the effects of mental illness. Teaching and coaching provide nurses with the opportunity to make a difference by serving as an important resource and guide in a mutually supportive role to both consumers and their families. The open hands are in an uplifting position, to symbolize the supportive role with the teaching-coaching function. Support involves the process of listening, asking questions, setting mutual goals, guiding, providing information and options, reinforcing decisions and encouraging active choices. The open book symbolizes the theory-based practice used in the teaching-coaching function. Nurses use theory to critically reflect and examine situations from a variety of perspectives in order to assess consumers to make modifications, and in evaluation and choosing alternatives. In turn, practice informs theory, and provides new ideas, meanings and fuller understandings. The text descriptions of powerlessness, helplessness and hopelessness are presented to illustrate that the teaching-coaching function can impact these feelings in a positive way. Nurses help to instill hope and feelings of power as they promote self-determination, self-reliance, and assist consumers and families to manage, cope and live with the effects of mental illness.
Alberta did the element of “Hope”, which is one of the beliefs/values of the CFMHN. The quilter is Theresa Turner. Hope is depicted by Alberta’s floral emblem, the Wild Rose.
British Columbia did Standard #6 “Monitoring and Ensuring the Quality of Health Care Practice”. The quilter was Ceci Lam and was designed in collaboration with Ann Greene, the BC Representative to the CFMHN. This standard was depicted by the symbolism of an “eye on the practice”, in the “hands” of the caring, monitoring body. The nurse has the responsibility to advocate for the clients’ right to receive the least restrictive form of care, and to respect and affirm the client’s right to pursue individual goals of equality and justice.
British Columbia also covered the belief/value of “Asylum”. Asylum can have a negative connotation, however, Webster’s Dictionary defines asylum as a “sanctuary or place of refuge – any place of retreat and security”. To reflect this theme and the west coast of Canada, a First Nation’s artist, Cecil Dawson, offered his interpretation of what asylum means to the west coast native Indians. The quilter, Vivi Morton, appliquéd his sketch. It depicts what sanctuary means to the coastal Indians of BC. Settlements were established in geographically ideal coves, which provided safety for the entire village. At the beginning of the century, several families would live in the “big house”, all sharing in the experiences, wealth or specific needs of each member.
I cannot end the story of this quilt without giving my heartfelt thanks to Barb Grimster and Edie Zakem, both of Charlottetown, PEI. I did not know Barb before I started this project. I introduced myself to her, as I had learned of her reputation with a previous quilt project. She assisted me greatly with enthusiasm and suppo rt from the beginning of this project, and has followed the development of this qu ilt th rough from its origin. Barb introduced me to Edie when I needed someone to pull the surfa ce of the quilt together. Again, with enthusiasm, Edie designed and independently quilted this entire quilt to what we see today. Not only myself, personally, offers Edie heartfelt thanks, so does the Board of the Canadian Federation of Psychiatric and Mental Health Nurses. This quilt will now travel* across Canada, through small villages, towns and cities, depicting and telling the story of the specialty of psychiatric mental health nursing and why psychiatric mental health nursing is needed as a specialty!
The quilt was completed in 1997 and has been available to PMH nursing groups across the country since that time. To request display of the quilt at an event in your area, please contact the CFMHN at firstname.lastname@example.org