Psychiatric Nursing: Partnership in Caring
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Background & Purpose
The practice of Psychiatric Nursing primarily requires vast and in depth knowledge about the technical aspects of and the display of efficient, necessary, and qualifying skills in health care. However, excellence in the field of Nursing also requires the application of holistic approaches in health care, which is ideally a combination not only of cognitive and physical capabilities, but also including emotive, perhaps even spiritual faculties. The emotional aspect of Nursing includes a health care worker’s ability to establish a caring and supportive relationship with a patient – partnership in caring. Based on a survey conducted at the Central Mental Hospital, health care workers believe and understand that part of their responsibility is not only to assess and aid therapy, but also to establish good communication and develop a therapeutic environment based on support and compassion (Timmons 2010: 636). The concept of “partnership in caring” will be further explored in the succeeding discussion, considering actual experiences and examples observed in an acute mental health ward. Moreover, the following discussion will also focus on how learning experiences could be applied in future practice. A pseudonym will be used to protect the privacy of the individual who will be mentioned throughout the discussion.
Partnership in Caring: A Humanistic Approach
Establishing partnership between client and nurse is highly important in the field of psychiatric nursing. Partnership is often observed in the health care setting through the incorporation of the Patient-Centered Approach. The patient-centered approach follows the concept of humanistic and existential psychology introduced by Carl Rogers, which focuses on the personal growth of the client. According to Butts and Rich (2005: 166), a person-centered approach involves the following conditions: “(1) genuiness or realness, (2) acceptance, caring or prizing, and (3) empathic understanding.” Therefore, a mental health nurse should be able to display genuine care or concern and express empathy towards the client. According to Elder, Evans, and Nizette (2009: 5), “empathy involves an attempt to understand the client’s predicament… the nurse makes a conscious attempt to discuss with the client their current and past experiences.” Davies and Janosik (1991: 44), on the other hand, define empathic communication as a nurse’s attempt to, “actively concentrate on the client’s messages, verbal and nonverbal… formulate an answer that accurately responds to the intensity of the client’s message.” Overall, clients find empathic nurses more valuable because they are naturally interested and compassionate, and thus, more capable of understanding their individual situations. The introduction of a person-centered approach in mental health underscores the psychosocial aspect of the practice (MacNeela, et al. 2010: 339) and its value in therapy and recovery.
Relationship development between client and nurse relates to the establishment of an effective therapeutic environment and interaction between them. To achieve desirable and satisfactory results, the nurse must aim to meet five components of partnership, which includes building trust, establishing rapport, and showing respect, genuineness, and empathy. According to White, Duncan, and Baumle (2010: 584), trust is “the ability to rely on an individual’s character and ability” and it is important in partnership between the client and nurse because the former must be able to trust the latter to establish an open and confident relationship. Establishing trust consequently develops rapport, since it is “a bond or connection between two people that is based on mutual trust” (White, Duncan, and Baumle 2010: 584). In addition, “Nurses establish rapport through interpersonal warmth, a nonjudgmental attitude and a demonstration of understanding” (Austin & Boyd 2010: 128). Like trust and rapport, respect, genuineness, and empathy also go hand in hand. An empathic nurse shows genuine respect towards the client’s judgment or decision, behavior, and interests, and therefore, opens an opportunity for trust and relationship building.
The importance of applying a patient-centered approach, which manifests through the establishment of a good client-nurse relationship based on trust, rapport, genuineness, respect, and empathy, is validated by various cases of successful therapy because of the kind of relationship between the client and the nurse. According to Lakeman (2012: 225), the focus of mental health nursing changed in the last decade due to the changes on the views and perspectives of psychiatry and health care. Furthermore, mental health facilities, like in Cork City (Ireland), are beginning to apply person-centered approaches in their health care services by fostering collaboration and social inclusion (McCarthy, Kerrish, & Gijbels 2012: 21). Health policies implemented by the local government, especially in Northern Ireland, focus on involvement because interaction and responsive health care is valuable (Heenan 2009: 451; Higgins, et al. 2011: 519) and the Mental Health Commission in the country is prioritizing “the development of more effective teamworking within mental health services” (Byrne & Onyett 2010). Nowadays, efficient nursing performance in mental health is measured through a health care worker’s values. To prove the importance of affective skills in mental health nursing, Lakeman conducted a research study, surveying Irish nurses to determine their definition of “good mental health nursing.” The results of Lakeman’s study revealed that the Irish nurses who participated in the study consider the quality of interpersonal relationship between them and their clients to be pivotal in the results of therapy. Overall, the Irish nurses value care, empathy, and insight as indicators of good mental health nursing practice (Lakeman 2012: 225).
Partnership in Caring: Personal Experiences and Examples
Cleary and Dowling (2009: 539) conducted a study to determine the capabilities and attitudes of mental health workers in Ireland towards mental health and recovery. In the study, Cleary and Dowling administered a survey among 153 health care professionals in the country. Based on the responses, the participants believe that the development of a safe, supportive, and caring environment is essential in the recovery of mental health patients. The respondents both consider the relationship between client and nurse as a standard procedure or approach, as well as a likely or desirable behavior – a combination of knowledge and behavior – towards mental health recovery. The results of the study reveal that today, nurses especially in Ireland, are aware of the importance of developing strong affective relationships between clients and nurses as a means to improve therapy practices and consequently, the recovery of patients. Barker (2001: 233) also conducted research to underscore the importance of implementing person-centered approach in mental health nursing in the United Kingdom. Using the Tidal Model, Barker emphasizes the importance of placing “interpersonal relationship” as the center of client-nurse interaction. Based on the Tidal Model, the person-centered approach in mental health nursing empowers not only the nurse, but also the client, and therefore leads to faster and more efficient recovery (Barker 2001: 233).
Rice, et al. (2007: 516) also developed a series of guidelines to inform mental health practitioners in Northern Ireland about best practices in the field. In the research, Rice, et al. acknowledged the challenging and difficult job of mental health nurses, but also emphasized that despite those challenges, nurses should also acknowledge their responsibilities and duties towards their clients. Best practices in mental health nursing, according to Rice, et al., include self-awareness, genuine self-expression, and the capacity to display care and compassion towards clients. Bord Altranais also reports the importance of partnership not only in the actual mental health care practice, but also in the education of future nurses in the field of psychiatry. According to Bord Altrainais, the educational training of future mental health practitioners changes based on current trends in the field. Therefore, the educational board also incorporated theories and concepts in empathic nursing on educational programs in the country (Bord Altranais 2009: 6).
Aside from academic and literary references that emphasize the importance of client-nurse relationship, personal experiences at an acute hostel setting for service users also prove the important role of partnership in the practice of mental health nursing. In the ward, I worked with a client, Bobby (not the client’s real name), who has bipolar disorder. Bobby does not take medications despite his frequent feelings of depression. At first, the client kept to himself and avoided interacting with other people. He often exhibited negative attitude, which affected the mood or atmosphere in the ward. However, over time, the client learned to interact and although he would still feel depressed, Bobby has learned how to overcome or handle his depression through communication. Through my personal interactions with Bobby, I learned many things about his personal life, especially the numerous reasons or sources of his depression and melancholy.
Bobby grew up in a dysfunctional family and throughout school and career life, he felt unsupported by his family and friends. He always felt detached or different from his peers and he often feels like no one understands him. He finds it difficult to relate to other people due to different beliefs, opinions and interests. Without a support system, Bobby feels alone and his loneliness often leads to depression. Because of his depression, he does not perform well at work and as a result, he does not receive sufficient salary to pay for his medicine. Bobby’s inability to buy medicine for his depression worsens his situation. At first, Bobby was hesitant in sharing his personal life with me. However, he began opening up when I showed genuine interest towards his situation. I asked the questions first and asked them repeatedly even if his answers were short. I also talked to Bobby regularly and after a few sessions, he started opening up about his family, social, and professional life. Through my interactions with Bobby, I also learned important specific cues that foster good and open communication, such as repeating and remembering the client’s story, initiating the conversation with a familiar topic, using verbal and nonverbal cues (light touch of assurances, eye contact, thoughtful expression, etc.), and sharing personal information too. Thus, based on my own experience, I believe that establishing mutual trust requires effort and consistency. Communicating with the client may appear intrusive at first, however, through the application of proper techniques and approaches, the client will eventually warm up to the nurse. Relationship building takes and time and will require patience on the part of the nurse.
Overall, research and personal experience underscore the importance of partnership in mental health care. Empathy and communication do not only foster interaction, but also allows the health care practitioner to determine what steps or approaches to take when it comes to therapy and facilitating recovery because understanding the situation of the client reveals what kind of approach is appropriate to deal with his or problems or situation. However, relationship building and partnership requires hard work, and therefore, should be part of a mental health care practitioner’s education and training. Early on, mental health nurses should understand that their responsibilities span beyond the technicalities of psychiatry and extend to the expression of affective faculties. Based on this knowledge and my experiences, I plan to improve my craft as a future professional in the field of mental health by taking into consideration the importance of building a relationship with the client, understanding that clients are human beings too, and implementing a holistic, client-centered approach in my practice.