Psychiatric mental health nursing is a specialized field of nursing that is dedicated to promotion of mental health via the evaluation, diagnosis and treatment of psychiatric disorders and mental health problems. Psychiatric psychological health professionals offer inclusive patient centered psychiatric care and mental health and outcome assessment in a wide range of situations across the whole range of care. The notion of partnership between the nurse and the patient is vital to psychiatric mental health nursing practice. It is based on mutual support, collaboration and trust which promote decision making, informed choice and empowerment of both the psychiatric nurse and the client (Barker 2003).
An experience of partnership caring and how my contribution impacted psychiatric nursing practice
From my experiences as a mental health nurse, mental health nursing practice is mainly about establishment of good human relations and partnership. The primary goal of psychiatric nursing is to create therapeutic human relationships. Psychiatric nurses are required to create a caring mindset so as to take good care of their patients. According to Fitzpatrick (2005), the theoretical and historical foundation of psychiatric nursing stresses the significance of intrapersonal and interpersonal skills that are fundamental for developing curative relationships. A caring approach is at the core of these relationships, which is usually communication to individuals you work with via the utilization of basic intrapersonal and interpersonal skills.
Client-nurse relationships are highly significant in psychiatric psychological health nursing. Both outpatient and inpatient nursing involves the capability of the nurse to engage the patient in interpersonal interrelations. A psychiatric psychological health nurse practicing within the community set-up deals with persistently ill patients both in disastrous situations and long-term curative relationships. Under this set-up, communication skills are greatly significant since trust requires to be created within a comparatively short duration of time. The psychiatric nurse employing crisis intervention utilizes utmost assessment skills and creates trust to make a client confide crucial information (Barker 2003).
Understanding is a crucial element in creation of a therapeutic or healing relationship in mental health psychiatric nursing. Expressing understanding is significant because it gives a patient the feeling of importance. Lynch and Trenoweth (2008) argue that feeling valued is important to the life of an individual who resides in a community, which often stigmatizes him due to his mental illness. When a nurse understands and knows the clients, he is able to help the clients to understand and appreciate themselves, thus giving them the power to influence their healing. Subsequently, understanding the client facilitates individualized care. Active listening is at the core of a good partnership between the nurse and the client. It is also regarded to be a vital aspect of understanding. To completely employ listening to express understanding, the psychiatric nurse must listen to the patient and also be attentive. When psychiatric nurses offer appropriate attention and appear interested in listening to the patient, the clients feel understood. In addition, communication and interpersonal techniques like clarifying, reflecting, summarizing and offering eye contact are vital to understanding and relating to the client (Lynch & Trenoweth 2008).
In order to promote listening to understand the needs and problems of the client accurately, a psychiatric nurse is supposed to appreciate unique communication, situation and problem of the client. To fully understand the distinctiveness of every situation, the psychiatric nurse is supposed to surpass what is anticipated of majority of other health expertise to gain an in-depth individual understanding of the client. Other than merely acting out and testing behavior, the psychological health doctor is supposed to look far beyond the palpable and endeavor to comprehend and assign meaning to the particular kind of behavior being displayed by the patient. The in-depth analysis is needed to create this degree of understanding. Besides, it needs skills and time to understand the patient. More importantly, the personal experience of the patient is worthy and should thus be accorded the deepest respect. The psychiatric nurse is needed to treat the personal experience of the patient as a reward brought to the relationship between the patient and the nurse (Chan & Leung 2002).
The conveyance of feelings and thoughts must be encouraged without belittling, judging or blaming the patient. The manner in which a psychiatric nurse reacts to a client’s disclosure of horrible information can impede or promote the relationship. Rydon (2005) notes that when psychiatric nurses develop skills to be capable to react to horrible information disclosed by a patient without revulsion or shock, the patient feels a sense of appreciation and understanding as well as a feeling of being a normal human being. Fundamentally, through relating to a client as an individual, the psychiatric nurse enhances the client’s sense of understanding. In order to promote this form of understanding, the psychiatric nurse should interrelate principally as a human being, talk to the client as a friend or neighbor and not as an expert or counselor. Additionally, the sharing or universal experiences like mutual adversities and identical backgrounds also assist the client to unite with the psychiatric nurse and feel appreciated (Welch 2005).
Individualized care is very vital in psychiatric nursing. It is interceded via knowing the client. To attain this knowledge, a psychiatric nurse is required to view a patient as an individual with a life beyond his or her mental illness. Moyle (2003) notes that viewing a patient, as an individual with his life beyond his mental disease, is very important in making the client feel respected and valued. Acceptance of individuality is significant, because discrimination can happen when a client is stereotyped. Therefore, psychiatric nurses must not view their roles as mangers of sicknesses but as supporters of the clients to manage their personal lives in the face of the illness. Moreover, so as to accept the client as an individual, a psychiatric nurse shouldn’t be regulated by her or his personal ideas, values and prior understanding of patients with mental illnesses. For therapeutic relationship between the patient and the psychiatric nurse to develop, the patient should feel comfortable and safe (Moyle 2003)
Feeling comfortable and safe takes place via a supportive atmosphere developed by the psychiatric nurse. Johansson and Eklund (2003) argue that the most common methods that offer clients with support entail active responses like offering feedback and suggestions, expressing hope, offering a patient a reassurance and reflecting the concern in an individual voice. Doing certain things with and for the client, such as accompanying the patient to shop or taking a cup of coffee together is very important in demonstrating support. Provision of support in psychiatric nursing practice also includes physical support which is manifested via the utilization of touch. Majority of patients feel connected when a psychiatric nurse hugs them or puts a hand on the patient’s shoulder. In the same way, a psychiatric nurse views the aspect of the working relationship as consoling by holding the hand of the patient. Patients with depression get relieved when a psychiatric nurse embraces them (Johansson & Eklund 2003).
How I can apply the evidence to my future nursing practice
After interacting with my client, I have identified that the relationship between the nurse and the client is therapeutic and professional. It makes sure that the needs of the client are foremost. This kind of relationship exists in psychiatric nursing to meet client’s needs and not the nurse’s needs. It is usually the responsibility of the nurse to establish and maintain boundaries with patients, in spite of the way the client behaves. There are five major components to client-nurse relationship namely respect, empathy, power trust and professional intimacy. In spite of the content, the length or interrelation and whether the psychiatric nurse provides secondary primary care, these five components are at all times present (Rydon 2005).
The relationship between the nurse and the client is professional one that establishes to meet the client’s needs. It’s the responsibility of the psychiatric nurse to establish and sustain a professional relationship with a client. According to Hem and Heggen (2003), when the nurse understands a client via the personal relationship, it might be hard to maintain adequate subjectivity of the client. To understand the professional relationship between the nurse and the client that is based upon the acknowledgement that the client is in a better position to decide on his personal life when he is an informed and active participant in the process of decision making. The client-nurse relationship must not have a negative impact on meeting the therapeutic needs of the client or interfere with the right of the client to get competent, ethical and safe mental care (Welch 2005).
According to Frank (2004), there always exists a power imbalance in the client- nurse relationship. The psychiatric nurse is usually in a position of authority and the dependent client is less powerful. The nurse possesses a wide range of competencies that patients require entailing authority, knowledge, access and influence to client’s confidential information. It is the obligation of the psychiatric nurse to be conscious of power disparity, to identify the probability of the patient to feel threatened and to develop a curative relationship. This kind of awareness is a requirement to establishment and maintenance of suitable boundaries. It is the responsibility of the nurse to maintain integrity of boundary with the patient (Frank 2004).
The proper utilization of power in client-nurse relationship will ensure that the needs of the client are foremost and his susceptibility is protected. In order to enhance parity in therapeutic relationship, it is important to recognize the relationship between the client and nurse is mutually valuable. McGuire and Priebe (2001) note that this mutuality is based on the belief, that the role of the patient is as significant as the role of the psychiatric nurses. This implies that whilst clients require nurses to support them in recovering from their illnesses, psychiatric nurses require clients to develop experience and skills. Therefore, nurses must be team members and facilitators of relationship other than being leaders that ultimately empowers the client with a feeling of involvement and control. Psychiatric nurses promote the independence of patients by providing suggestion proposals without taking full control (Scanlon 2006).
According to An Bord Altranais (2000), numerous behaviors are not acceptable in client-nurse relationship and clearly are violation of standards. Improper behaviors entail physical, emotional or verbal neglect and abuse. Abuse occurs due to treachery of trust or misuse of power imbalance between the client and psychiatric nurse. Psychiatric nursing practice entails touching as a show of support to the patient. Supportive touch is utilized to offer encouragement or comfort and when effectively used, it has a therapeutic and calming effect on the patient. Whilst it is a caring, human and therapeutic reaction to several situations, physical contact can be misinterpreted by susceptible patients. The amount, location and type of touch vary. Therefore, nurses are required to carefully evaluate every situation and establish whether supportive touch will be appropriate and welcomed by the client or not. They are required to be conscious of the patient’s perception of meaning of touch (An Bord Altranais 2001).
The concept of partnership between the client and the nurse is of great importance in psychiatric nursing practice. The major goal of psychiatric nursing is to build therapeutic human relationships. A good client- nurse relationship promotes good communication between the patient and the nurse and ensures the needs of the clients are foremost. Through a good relationship, trust, mutual support, and understanding are created which makes the patient feel respected and appreciated. Good communication and understanding makes the patients have a feeling of involvement and control of their lives.