Psychiatric nursing or mental health nursing is the specialty of nursing that cares for people of all ages with mental illness or mental distress, such as schizophrenia, bipolar disorder, psychosis, depression or dementia. Nurses in this area receive more training in psychological therapies, building a therapeutic alliance, dealing with challenging behavior, and the administration of psychiatric medication.
Therapeutic relationship
As with other areas of nursing practice, psychiatric mental health nursing works within nursing models, utilizing nursing care plans, and seeks to care for the whole person. However, the emphasis of mental health nursing is on the development of a therapeutic relationship or alliance. In practice, this means that the nurse should seek to engage with the person in care in a positive and collaborative way that will empower the patient to draw on his or her inner resources in addition to any other treatment they may be receiving.
Therapeutic Relationship Aspects of Psychiatric Nursing
The most important duty of a psychiatric nurse is to maintain a positive therapeutic relationship with patients in a clinical setting. The fundamental elements of mental health care revolve around the interpersonal relations and interactions established between professionals and clients. Caring for people with mental illnesses demands an intensified presence and strong a desire to be supportive. Nurse practitioners, Fiona Dziopa, BPsyc, BSN, RN, and Kathy Ahern, Ph.D., RN, have identified nine critical mental health aspects of the psychiatric nursing practicum. These nine aspects include: understanding and empathy, individuality, providing support, being there/being available, being 'genuine', promoting equality, demonstrating respect, demonstrating clear boundaries, and demonstrating self awareness for the patient.
Understanding and Empathy
Understanding and empathy from psychiatric nurses reinforces a positive psychological balance for patients. Conveying an understanding is important because it provides patients with a sense of importance. The expression of thoughts and feelings should be encouraged without blaming, judging or belittling. Feeling important is significant to the lives of people who live in a structured society, who often stigmatize the mentally ill because of their disorder. Empowering patients with feelings of importance will bring them closer to the normality they had before the onset of their disorder. When subjected to fierce personal attacks, the psychiatric nurse retained the desire and ability to understand the patient. The ability to quickly empathize with unfortunate situations proves essential. Involvedness is also required when patients expect nursing staff to understand even when they are unable to express their needs verbally. When a psychiatric nurse gains understanding of the patient, the chances of improving overall treatment greatly increases.
Individuality
Individualized care becomes important when nurses need to get to know the patient. To obtain this knowledge the psychiatric nurse must see patients as individual people with lives beyond their mental illness. Seeing people as individuals with lives beyond their mental illness is imperative in making patients feel valued and respected In order to accept the patient as an individual, the psychiatric nurse must not be controlled by his or her own values, or by ideas and pre-understanding of mental health patients. Individual needs of patients are met by bending the rules of standard interventions and assessment. Psychiatric/mental health nurses spoke of the potential to 'bend the rules', which required an interpretation of the unit rules and the ability to evaluate the risks associated with bending them.
Providing Support
Successful therapeutic relationships between nurses and patients need to have positive support. Different methods of providing patients with support include many active responses. Minor activities such as shopping, reading the newspaper together, or taking lunch/dinner breaks with patients can improve the quality of support provided. Physical support may also be used and is manifested through the use of touch. Patients described feelings of connection when the psychiatric nurses hugged them or put a hand on their shoulder. Psychiatric/mental health nurses in Berg and Hallberg's study described an element of a working relationship as comforting through holding a patient's hand. Patients with depression described relief when the psychiatric nurse embraced them. Physical touch is intended to comfort and console patients who are willing to embrace these sensations and share mutual feelings with the psychiatric nurses.
Being There and Being Available
In order to make patients feel more comfortable, the patient care providers make themselves more approachable, therefore more readily open to multiple levels of personal connections. Such personal connections have the ability to uplift patients’ spirits and secure confidentiality. Utilization of the quality of time spent with the patient proves to be beneficial. By being available for a proper amount of time, patients open up and disclose personal stories, which enable psychiatric/mental health nurses to understand the meaning behind each story. The outcome results in nurses making every effort to attaining a non-biased point of view. A combination of being there and being available allows empirical connections to quell any negative feelings within patients.
Being Genuine
The act of being genuine must come from within and be expressed by nurses without reluctancy. Genuineness requires the psychiatric/mental health nurse to be natural or authentic in their interactions with the patient. In his article about pivotal moments in therapeutic relationships, Welch found that psychiatric nurses must be in accordance with their values and beliefs. Along with the previous concept, O’brien concluded that being consistent and reliable in both punctuality and character makes for genuinity. Schafer and Peternelj-Taylor believe that a psychiatric/mental health nurse's 'genuineness' is determined through the level of consistency displayed between their verbal and non-verbal behavior. Similarly, Scanlon found that genuineness was expressed by fulfilling intended tasks. Self disclosure proves to be the key to being open and honest. Self-disclosure involves the psychiatric/mental health nurse sharing life experiences. Self-disclosure is also essential to therapeutic relationship development because as the relationship grows patients are reluctant to give any more information if they feel the relationship is too one sided. Multiple authors found genuine emotion, such as tearfulness, blunt feedback, and straight talk facilitated the therapeutic relationship in the pursuit of being open and honest The friendship of a therapeutic relationship is different to a sociable friendship because the therapeutic relationship friendship is asymmetrical in nature. The basic concept of genuineness is centered on being true to one’s word. Patients would not trust nurses who fail in complying with what they say or promise.
Promoting Equality
For a successful therapeutic relationship to form, a beneficial co-dependency between the nurse and patient must be established. A derogatory view of the patient’s role in the clinical setting dilapidates a therapeutic alliance. While patients need psychiatric/mental health nurses to support their recovery, psychiatric/mental health nurses need patients to develop skills and experience. Psychiatric nurses convey themselves as team members or facilitators of the relationship, rather than the leaders. By empowering the patient with a sense of control and involvement, psychiatric nurses encourage the patient's independence. Sole control of certain situations should not be embedded in the nurse. Equal interactions are established when psychiatric nurses talk to patients one-on-one. Participating in activities that do not make one person more dominant over the other, such as talking about a mutual interest or getting lunch together strengthen the levels of equality shared between professionals and patients. This can also create the "illusion of choice"; giving the patient options, even if limited or confined within structure.
Demonstrating Respect
To develop a quality therapeutic relationship psychiatric/mental health nurses need to make patients feel respected and important. Accepting patient faults and problems is vital to convey respect; helping the patient see themselves as worthy and worthwhile.
Demonstrating Clear Boundaries
Boundaries are essential for protecting both the patient and the psychiatric/mental health nurse and maintaining a functional therapeutic relationship. Limit setting helps to shield the patient from embarrassing behavior and instills the patient with feelings of safety and containment. Limit setting also protects the psychiatric/mental health nurse from "burnout” preserving personal stability; thus promoting a quality relationship.
Demonstrating Self-Awareness
Psychiatric nurses recognize personal vulnerability in order to develop professionally. Required knowledge on humanistic, basic human values and self knowledge improves the depth of understanding the self. Different personalities affect the way psychiatric nurses respond to their patients. The more self aware, the more knowledge on how to approach interactions with patients. Interpersonal are skills needed to form relationships with patients were acquired through learning about oneself. Clinical supervision was found to provide the opportunity for nurses to reflect on patient relationships, to improve clinical skills and to help repair difficult relationships The reflections articulated by psychiatric nurses through clinical supervision help foster self awareness.
Therapeutic relationship
As with other areas of nursing practice, psychiatric mental health nursing works within nursing models, utilizing nursing care plans, and seeks to care for the whole person. However, the emphasis of mental health nursing is on the development of a therapeutic relationship or alliance. In practice, this means that the nurse should seek to engage with the person in care in a positive and collaborative way that will empower the patient to draw on his or her inner resources in addition to any other treatment they may be receiving.
Therapeutic Relationship Aspects of Psychiatric Nursing
The most important duty of a psychiatric nurse is to maintain a positive therapeutic relationship with patients in a clinical setting. The fundamental elements of mental health care revolve around the interpersonal relations and interactions established between professionals and clients. Caring for people with mental illnesses demands an intensified presence and strong a desire to be supportive. Nurse practitioners, Fiona Dziopa, BPsyc, BSN, RN, and Kathy Ahern, Ph.D., RN, have identified nine critical mental health aspects of the psychiatric nursing practicum. These nine aspects include: understanding and empathy, individuality, providing support, being there/being available, being 'genuine', promoting equality, demonstrating respect, demonstrating clear boundaries, and demonstrating self awareness for the patient.
Understanding and Empathy
Understanding and empathy from psychiatric nurses reinforces a positive psychological balance for patients. Conveying an understanding is important because it provides patients with a sense of importance. The expression of thoughts and feelings should be encouraged without blaming, judging or belittling. Feeling important is significant to the lives of people who live in a structured society, who often stigmatize the mentally ill because of their disorder. Empowering patients with feelings of importance will bring them closer to the normality they had before the onset of their disorder. When subjected to fierce personal attacks, the psychiatric nurse retained the desire and ability to understand the patient. The ability to quickly empathize with unfortunate situations proves essential. Involvedness is also required when patients expect nursing staff to understand even when they are unable to express their needs verbally. When a psychiatric nurse gains understanding of the patient, the chances of improving overall treatment greatly increases.
Individuality
Individualized care becomes important when nurses need to get to know the patient. To obtain this knowledge the psychiatric nurse must see patients as individual people with lives beyond their mental illness. Seeing people as individuals with lives beyond their mental illness is imperative in making patients feel valued and respected In order to accept the patient as an individual, the psychiatric nurse must not be controlled by his or her own values, or by ideas and pre-understanding of mental health patients. Individual needs of patients are met by bending the rules of standard interventions and assessment. Psychiatric/mental health nurses spoke of the potential to 'bend the rules', which required an interpretation of the unit rules and the ability to evaluate the risks associated with bending them.
Providing Support
Successful therapeutic relationships between nurses and patients need to have positive support. Different methods of providing patients with support include many active responses. Minor activities such as shopping, reading the newspaper together, or taking lunch/dinner breaks with patients can improve the quality of support provided. Physical support may also be used and is manifested through the use of touch. Patients described feelings of connection when the psychiatric nurses hugged them or put a hand on their shoulder. Psychiatric/mental health nurses in Berg and Hallberg's study described an element of a working relationship as comforting through holding a patient's hand. Patients with depression described relief when the psychiatric nurse embraced them. Physical touch is intended to comfort and console patients who are willing to embrace these sensations and share mutual feelings with the psychiatric nurses.
Being There and Being Available
In order to make patients feel more comfortable, the patient care providers make themselves more approachable, therefore more readily open to multiple levels of personal connections. Such personal connections have the ability to uplift patients’ spirits and secure confidentiality. Utilization of the quality of time spent with the patient proves to be beneficial. By being available for a proper amount of time, patients open up and disclose personal stories, which enable psychiatric/mental health nurses to understand the meaning behind each story. The outcome results in nurses making every effort to attaining a non-biased point of view. A combination of being there and being available allows empirical connections to quell any negative feelings within patients.
Being Genuine
The act of being genuine must come from within and be expressed by nurses without reluctancy. Genuineness requires the psychiatric/mental health nurse to be natural or authentic in their interactions with the patient. In his article about pivotal moments in therapeutic relationships, Welch found that psychiatric nurses must be in accordance with their values and beliefs. Along with the previous concept, O’brien concluded that being consistent and reliable in both punctuality and character makes for genuinity. Schafer and Peternelj-Taylor believe that a psychiatric/mental health nurse's 'genuineness' is determined through the level of consistency displayed between their verbal and non-verbal behavior. Similarly, Scanlon found that genuineness was expressed by fulfilling intended tasks. Self disclosure proves to be the key to being open and honest. Self-disclosure involves the psychiatric/mental health nurse sharing life experiences. Self-disclosure is also essential to therapeutic relationship development because as the relationship grows patients are reluctant to give any more information if they feel the relationship is too one sided. Multiple authors found genuine emotion, such as tearfulness, blunt feedback, and straight talk facilitated the therapeutic relationship in the pursuit of being open and honest The friendship of a therapeutic relationship is different to a sociable friendship because the therapeutic relationship friendship is asymmetrical in nature. The basic concept of genuineness is centered on being true to one’s word. Patients would not trust nurses who fail in complying with what they say or promise.
Promoting Equality
For a successful therapeutic relationship to form, a beneficial co-dependency between the nurse and patient must be established. A derogatory view of the patient’s role in the clinical setting dilapidates a therapeutic alliance. While patients need psychiatric/mental health nurses to support their recovery, psychiatric/mental health nurses need patients to develop skills and experience. Psychiatric nurses convey themselves as team members or facilitators of the relationship, rather than the leaders. By empowering the patient with a sense of control and involvement, psychiatric nurses encourage the patient's independence. Sole control of certain situations should not be embedded in the nurse. Equal interactions are established when psychiatric nurses talk to patients one-on-one. Participating in activities that do not make one person more dominant over the other, such as talking about a mutual interest or getting lunch together strengthen the levels of equality shared between professionals and patients. This can also create the "illusion of choice"; giving the patient options, even if limited or confined within structure.
Demonstrating Respect
To develop a quality therapeutic relationship psychiatric/mental health nurses need to make patients feel respected and important. Accepting patient faults and problems is vital to convey respect; helping the patient see themselves as worthy and worthwhile.
Demonstrating Clear Boundaries
Boundaries are essential for protecting both the patient and the psychiatric/mental health nurse and maintaining a functional therapeutic relationship. Limit setting helps to shield the patient from embarrassing behavior and instills the patient with feelings of safety and containment. Limit setting also protects the psychiatric/mental health nurse from "burnout” preserving personal stability; thus promoting a quality relationship.
Demonstrating Self-Awareness
Psychiatric nurses recognize personal vulnerability in order to develop professionally. Required knowledge on humanistic, basic human values and self knowledge improves the depth of understanding the self. Different personalities affect the way psychiatric nurses respond to their patients. The more self aware, the more knowledge on how to approach interactions with patients. Interpersonal are skills needed to form relationships with patients were acquired through learning about oneself. Clinical supervision was found to provide the opportunity for nurses to reflect on patient relationships, to improve clinical skills and to help repair difficult relationships The reflections articulated by psychiatric nurses through clinical supervision help foster self awareness.