Nurse–client relationship - Wikipedia
The importance of the nurse/patient relationship is a central concept for psychiatric nursing. The present research provides a model of the nursing process. This book represents a carefully prepared, well written manual intended to stimulate the betterment of psychiatric nursing care. Not only has the author done an. to patient, protection as well as elements needed to establish an effective nurse- client relationship. Keywords: Mental health, nurse-client relationship.
He invited the patient to consider different truths and attempted to help the patient to understand a confusing experience. He had this thing that was important to him and he had a chain on it.
He takes out this old pocket watch that he had. So obviously there was that commonality that I can see how much his grandfather meant to him and right away made that little bit of extra connect, people connection. Charles illustrated how he explored his own intentions and motivations; he later articulated to me that he knew that his perspective was only one constituent of shared understanding. The notion of place seems to be particularly present in these experiences: How could nurses and patients create shared understanding when their worldviews appeared to be so different?
Perhaps the answer lies in the overarching theme of mindful approaches.
In this inquiry, the accounts of nurses and patients appeared to suggest that frontline encounters were often filled with tension and defensiveness. It makes sense then that nurses and patients, having experienced the frontline encounters, would wish to uncover and inhabit a more shared, intersubjective space. Each would be able to understand the other and, without losing the identities of patient and nurse, create an encounter that more closely resembles a person-to-person connection.
It may be that nurses and patients who inhabit common ground are beginning to cocreate a new and more shared perspective, thereby setting the stage for a new relationship. Nurse Charles recounted the following: The patient, having satisfied himself that Charles was safe and trustworthy, approached him with curiosity, and the relationship changed. Nurse Joy gave an account of a relationship in which a shift occurred despite struggles to engage and ongoing conflict: There was a young fellow; he had a hard go of it.
So with patience I slowly got through to him. Both nurses and patients seemed to notice this relational shift. I am less tearful when I spill my guts and a bit more comfortable.
I have control, so maybe I can talk to her. Before, what we talked about was always my suggestion, whereas once he started to feel a little bit better and we were able to link better to each other, I was able to ask him more.
I remember a picture on his windowsill. Do you get to visit him often? How do you feel after these visits? It looks like you have family gatherings—what is that like for you? Should they let their defenses down or should they put them back up? Patient Marie described how she experienced this kind of vulnerability as being on a pathway to recovery: At one point, I observed a nurse and a patient operating within this space of shifting vulnerability.
Managing Professional and Nurse-Patient Relationship Boundaries in Mental Health.
A sad and angry patient expressed puzzlement at a question the nurse posed, and then his eyes filled with tears. In the ensuing conversation, the patient recounted specific aspects of his story that were clearly uncomfortable and anxiety-provoking and that had not previously been a focus of their conversation.
At the end of the conversation, the nurse understood the patient in a different way; he had both articulated and argued for his vision of his future, and the nurse considered the experience to signify a change in their relationship. Within each of the subthemes of frontline, common ground, and shift, patient-participant accounts highlighted changes in openness to engagement, willingness to share uncomfortable experiences, and visions of the future. Patient experiences with unknowing and defensiveness inhabited the subtheme of frontline.
Therapeutic Relationship of Nurses in Mental Health-A Review
The importance of being viewed as a person and not an object inhabited the subtheme of common ground. The subtheme of shift highlighted the significance to the patient of a safe connection where his or her perspective could be fully articulated and given meaning. In contrast, nurse-participant accounts across all themes highlighted the importance of being alert to changes in patient experience and committed to achieving shared understanding.
The care face is the place where PMH nurses are directly engaged with patients for aims that are unique to nursing practice Barker et al. In this inquiry, the frontline was one example of the care face.
It was a place of active approach and exchange of perspectives, in which patients and nurses seemed to jostle for position, sometimes to seek advantage or exercise power and sometimes to open a window of opportunity or declare a temporary truce. For their part, patients want nurses to recognize and anticipate their needs Barker et al.
In frontline exchanges and while finding common ground, nurses worked actively to uncover feelings, helping patients to understand what was happening to them and using this understanding to frame their experiences. It may seem counterintuitive to uncover the notion of nurse as counselor in the theme of mindful approach when so many encounters were enacted in moments of acute distress.
Counseling is conventionally understood to take place over a longer time period and within the context of a formally contracted therapeutic relationship with specific goals.
Furthermore, Peplau stated, Counseling in nursing has to do with helping the patient to remember and to understand fully what is happening to him in the present situation, so that the experience can be integrated with, rather than dissociated from, other experiences in life. In accounts of mindful approach, nurses sought this kind of exploration.
As I discussed this work with colleagues, a few suggested that the frontline subtheme too strongly evoked an image of battleground and war, but as I reviewed the accounts, I continued to see strong evidence of confrontation. I have yet to uncover a more peaceful metaphor for the mindful approach, which after all is only one dimension of the PMH nurse—patient relationship: Strengths and Limitations The inquiry had both strengths and limitations.
The research design and data collection process support my claim that the study meets the criterion of dependability. I ensured that participants knew that I was not connected in any formal way with their clinical team or nursing supervisors.
I conducted interviews in a formal interview room and adhered to the interview guide, bringing the interview to a close if researcher boundaries were threatened. I reviewed initial accounts before secondary interviews, and I engaged in reflective writing. After data collection was completed, I sought feedback from my peers by presenting some accounts to a national conference of PMH nurses and a seminar of graduate students.
There were a number of challenges in conducting this inquiry. Prior to study initiation, two of the units were changed from acute care to rehabilitation, thus reducing the pool of acute psychiatric inpatient nurses and patients. On any given day, there were more patients on the study units who were certified as incapable of consenting than were certified as capable.
Sample size is typically small in studies of this nature, but in this inquiry, the sample size was both small and unevenly distributed: Although rich and meaningful texts emerged from conversations with both groups, many may consider that the nurse perspective at times overwhelmed the patient perspective. Although I do not hold that the results of this study are transferable or generalizable in the postpositivist sense, and some may assess this as a study limitation, I attempted to make firsthand accounts the centerpiece of this work so that readers can understand both the context of the inquiry and how participants interpreted the phenomena.
Implications for Nursing Practice and Research In this inquiry, nurses and patients revealed that in a psychiatric inpatient setting, it is possible to create knowing and transformative relationships. Nurses approached patients with the intention of creating meaningful encounters even when they were uncertain of the potential for intimacy and long-term engagement.
Patients responded to nurses by meeting them at the frontline, seeking recognition, and working with nurses to find meaning in their experiences. Despite the fact that acute inpatient PMH nurses experience serious constraints on their ability to work relationally with patients, they continue to find ways to engage patients in therapeutic work.
This is the kind of evidence that acute inpatient PMH nurse leaders will need in order to make a strong case for program funding that supports nurse—patient engagement in acute inpatient settings and leads to more effective utilization of inpatient services.
Acknowledgments The author gratefully acknowledges the guidance of Dr. Franco Carnevale, who supervised this research. Footnotes Declaration of Conflicting Interests: Relationships between patients and nurses in psychiatric wards. International Journal of Nursing Studies, 8, — Archives of Psychiatric Nursing, 24, — Developing a person-centered approach to psychiatric and mental health nursing. Perspectives in Psychiatric Care, 37 379— Myth of mental health nursing and the challenge of recovery.
International Journal of Mental Health Nursing, 20, — What are psychiatric nurses needed for? Developing a theory of essential nursing practice. Journal of Psychiatric and Mental Health Nursing, 6, — Embodiment, caring and ethics in health and illness. The primacy of caring: Stress and coping in health and illness. The bulldozer and the ballet dancer: Journal of Psychiatric and Mental Health Nursing, 17, — Reasons for admission and their implications for the nature of acute inpatient psychiatric nursing.
Journal of Psychiatric and Mental Health Nursing, 12, — The original sin of mental health nursing? Patients longing for authentic personal care: A phenomenological study of violent encounters in psychiatric settings.
Issues in Mental Health Nursing, 27, — Models of care delivery in mental health nursing practice: A mixed method study.
Journal of Psychiatric and Mental Health Nursing, 19, — Nurse-patient interaction in acute adult inpatient mental health units: A review and synthesis of qualitative studies. Issues in Mental Health Nursing, 33, 66— The experience and views of mental health nurses regarding nursing care delivery in an integrated, inpatient setting. International Journal of Mental Health Nursing, 14, 72— Nursing Research, 52, — Model of therapeutic and non-therapeutic responses to patient aggression.
Issues in Mental Health Nursing, 30, — Comparisons from Canada and Scotland. Journal of Psychiatric and Mental Health Nursing, 8, 45— The role of the registered nurse in an acute mental health inpatient setting in New Zealand: International Journal of Mental Health Nursing, 14, — Characteristics of staff interactions with forensic mental health inpatients.
International Journal of Mental Health Nursing, 21, — How many interviews are enough? An experiment with data saturation and variability.
Field Methods, 18, 59— Patients opinion on what constitutes good psychiatric care. Scandinavian Journal of Caring Sciences, 17, — The health-care environment on a locked psychiatric ward: International Journal of Mental Health Nursing, 15, — The relational core of nursing practice as partnership. Journal of Advanced Nursing, 47, — Having a feeling of control and of self-determination is highly important, and this sense of meaning and control is provided by interpersonal relationships [ 12 ].
So much so, that what patients want most are empathetic nurses, ie, those able to identify what the patient expects or needs from the nurse at any given moment [ 4 ]. Patients value nurses who are patient and imaginative and have a sense of humour [ 9 ], who listen and are empathetic [ 4 ]. The greater the chronicity, the more patients lose interest in their physical needs and the more they value relational aspects of care [ 13 ].
Despite evidence of the greater effectiveness of the TR and psychodynamic training in clinical practice [ 14 ], mental health nursing has been strongly influenced by the biomedical model and has become increasingly depersonalized [ 15 ]. There is no recognition of the need for the care of emotions, or of the importance of the emotional work required to develop and maintain a quality TR [ 13 ]. In this regard, routine tasks and administrative duties, as well as the time they consume, hamper the provision of individual attention and consequently the effectiveness of the TR [ 11 ].
Nevertheless, some evidence suggests that staff spend increasingly less time with patients, despite an increase in the staff-to-patient ratio in some units [ 16 ]. For some patients, inaccessibility and lack of communication-and therefore a lack of information provided by some staff-are factors that limit the TR [ 17 ].
Likewise, lack of availability, inequality, and differences in values and experience are factors that distance nurses from patients and hamper the development and maintenance of the therapeutic alliance. Often, patients feel they are given little opportunity to collaborate in their care [ 17 ], perceive that they spend most of their time alone and that they have little relationship with the care team [ 16 ].
Some patients feel like prisoners and report that staff who are themselves insecure adopt intimidating and condescending attitudes [ 18 ].
In this regard, and although nurses are aware of the importance of the TR and how to foster such an alliance, the scientific evidence shows that theoretical knowledge of communicative and interpersonal skills alone is insufficient to develop these skills effectively, and hence to establish an effective therapeutic relationship and provide high-quality nursing care [ 3915 — 1720 — 23 ].
Nurse-Patient Relationships in Psychiatry
Therefore, if knowledge of these skills does not necessarily lead to their use in daily clinical practice, it seems necessary to devise strategies to promote these competencies. Effecting change for action and through action is characterised by participation and reflection, which encourages both learning through action and about the action taking place. Theoretical framework Participatory Action Research PAR is a method that encourages participatory and reflective change at the same time as it increases an understanding and transformation of practices [ 24 ].
Thus, PAR aims to achieve reliable, effective and efficient results to improve group or collective situations. PAR is a research method because it aims to increase knowledge and understanding of phenomena through exploratory scientific techniques. Moreover, PAR is also an action because it aims to intervene in the phenomenon being explored by effecting change in that phenomenon. Finally, PAR is participatory since it encourages collaboration and cooperation among all the persons involved throughout the process.
Therefore, PAR is a dynamic method consisting of an open, holistic and egalitarian process among researchers and participants [ 25 ]; the action needs to be filtered through experience and reflection before it can improve or change practices. In PAR, knowledge generation is viewed as a collaborative process, in which the skills and experiences of each participant are essential to the outcome of the project.
The goal of PAR is to resolve or modify specific problems in communities, in this case, in acute care nursing teams. The process is effected through a series of steps included in a spiral of self-reflective circles Fig.
Planning a change, 2. Acting and observing the process of change, 3.