An Interpretation of Nurse–Patient Relationships in Inpatient Psychiatry
of mental health nursing is more clearly defined and differs from other relationships. A therapeutic nurse-client relationship has specific goals and func- tions. The nurse–client relationship is an interaction aimed to enhance the well-being of a "client," . The nurse empowers patient and families to get involved in their health. should be on the feelings, priorities, challenges, and ideas of the patient, with progressive aim of enhancing optimum physical, spiritual, and mental health. International Journal of Mental Health Nursing The importance of the therapeutic relationship in improving the patient's experience in the.
The ongoing challenge is to understand the variations in practices and paradigms that exist in inpatient PMH nursing. The purpose of this hermeneutic phenomenological inquiry was to explore the relational experiences of patients who were hospitalized for treatment of acute mental illness and their nurses.
In this inquiry, I defined relational experience as any planned or unplanned, brief, incidental, or long-term interaction or series of interactions between nurses and patients. The Research Process The setting was a large tertiary care hospital with the only acute inpatient psychiatric service in the region.
Participants were recruited from three of four available acute care units; no participants were recruited from the fourth unit. The research ethics boards of the clinical facility and educational institution granted ethical approval. Participants I invited nurses and patients to engage in a series of audiotaped conversations about their relational experiences on the inpatient unit.
Using purposive sampling, I recruited nurses who had worked on the study units for at least 6 months by posting study information and giving verbal presentations at staff meetings. I sought patient-participants who met the following criteria: The latter criterion was established on recommendation from a PMH nurse expert who suggested that patients who were closer to discharge were more likely to be well engaged with unit nurses and that researcher contact was less likely to substantively interfere with existing nurse—patient relationships.
To avoid enrolling patients for whom participation might have posed a significant risk to health, the charge nurse screened eligible patients in terms of symptom severity and ability to engage in conversation. Nine PMH nurses and six patients were enrolled in the study, and their participation was not discussed with their peers or treatment teams. All participants gave informed consent, and all were free to withdraw from the study at any time. I reconfirmed consent at each meeting and ensured that participants knew that I was not formally connected with their clinical decision-making teams or their nursing supervisors.
Unit managers were not informed about the participation of any particular nurse. During nonparticipant observation, those who were present on the unit were informed that the researcher would be present and observing study participants and that no observation data relating to study nonparticipants would be recorded or used unless their specific consent was given.
Data Collection Conversations took place over a month period. Approximately 40 hours of nonparticipant observation also took place. Patients were interviewed while in the hospital, and nurses were interviewed during or immediately after their work shifts. I conducted semistructured interviews in a formal, quiet interview room in or near the inpatient unit. I followed the interview guide, and at the same time, I attempted to establish rapport with each participant to encourage a free flow of ideas.
I used a form of iterative questioning whereby I relied on earlier information to suggest and create new lines of questioning. With patient-participants, I ended the interview if I sensed that the patient was seeking a therapeutic encounter rather than engaging in a research interview.
In our first meetings, I asked patients the following: Data consisted of texts transcribed from participant accounts as well as data from nonparticipant observations and journal notes. To be credible, my analysis needed to be a fitting representation of a my conversations with participants and b the meanings that emerged from my experiences and those of the study participants Shenton, To enhance credibility, I actively reviewed the accounts of the patients and nurses before I conducted the secondary interviews, so that I could focus my attention on emerging themes and questions for discussion that arose from their previous accounts.
I engaged in reflective writing, which helped me to clarify my own perspective on my research experiences. As is always the case in hermeneutic phenomenology, my interpretation must be understood by readers to be speculative, imperfect, and incomplete.
Other than exceeding the number of interviews necessary for saturation suggested by Morse and Guest et al. The focus of this article is the theme of mindful approach Oxford University Press, In this case, a mindful approach represented the experiences of PMH nurses who recognized that patients were experiencing intense psychological distress and potential behavioral volatility and who adopted a consciously strategic approach to achieving a therapeutic connection.
It is often, what does that mean for you? I identified three subthemes in the theme of a mindful approach: The theme of a mindful approach is illuminated in the following accounts of nurses and patients, who are identified by pseudonyms. Frontline PMH nurses and patients frequently engaged each other in moments of patient distress, and this distress sometimes led to conflict. I understood conflict between the nurse and the patient as expressions of differences that needed to be reconciled before patient and nurse could work relationally.
I employed the metaphor of the frontline to signify these experiences. A frontline is a place where parties first engage. It can be a place of courage and confrontation, but above all, a frontline is a place of possibilities, where each party meets the other and conflicts eventually dissipate. In the following anecdote, a nurse recounts a frontline experience: I went in to relate to him.
I sat where we were eye to eye. I can get to know you better and you can get to know me too, so we can work. Patients sometimes expressed anger overtly, in both words and actions. The nurse in the following situation described an encounter in which the patient seemed likely to act out. In the face of an escalated risk of physical harm, Nurse Joy attempted to engage the patient by openly communicating care and concern. Her response was framed by her understanding that the patient needed to vent his feelings safely, her language was patient-centered, and she did not attempt to situate herself in a position of power.
Where I get a chance to have a little more rapport. I have to find a window, that quiet moment or pause: The nurse in the following exchange looked for an opening, but that moment was difficult to find: There was no break in the conversation for me to get in. It was unleashed anger continually. How you know that a conversation is going to go anywhere or get anywhere positive is if there is an opportunity to speak and if they have stopped and listened for a moment.
But you know you are getting in there. Nurse Diane The following experience highlights different qualities of frontline encounters. Nurse Samantha recounted an experience in which a patient surprised her with his threatening actions: I had my chair in the doorway and he came over the chair to get out of the room because he thought somebody was coming to kill him.
I knew that he had this fear of people coming to kill him.
Therapeutic Relationship of Nurses in Mental Health-A Review
He came to the point where he recognized me. I was able to redirect him and do some reality orientation. This patient experienced hallucinations and delusions and acted out a scenario that the nurse only partially understood. Patients gave accounts of conflict with nurses. At the time of our conversations, Marie still did not comprehend the experience, and she had made little progress in working with her nurse in a more engaged manner.
Nurses reported that they continued to situate their searches for a place and time of engagement even when they themselves were experiencing anxiety and fear: Nurse Diane Furthermore, Nurse Samantha seemed to understand that she needed to think through her responses in a frontline encounter: There is always something going on in the back of my head. Even though Samantha valued the emergence of any possibility of common ground, she continually reviewed her approach: A value such as personal safety came into the foreground and Samantha would question the route she was taking.
Nurse Hilary gave an account of a different reaction. She had been confronted by an angry patient and she responded in a manner that she later regretted: This patient has a propensity for. I forget what I said to her. I thought afterwards I could have handled it differently. This exchange revealed the challenge of enacting a mindful approach. I thought, just let her say it. She worked hard to uncover the possibility of a more engaged relationship in the future.
I could kill you. During hard times, clients are looking for a therapeutic relationship that will make their treatment as less challenging as possible. Many patients are aware that a solution to their problems may not be available but expect to have support through them and that this is what defines a positive or negative experience.
Past experiences can help the clinician can better understand issues in order to provide better intervention and treatment. The goal of the nurse is to develop a body of knowledge that allows them to provide cultural specific care. This begins with an open mind and accepting attitude. Cultural competence is a viewpoint that increases respect and awareness for patients from cultures different from the nurse's own.
Cultural sensitivity is putting aside our own perspective to understand another person's perceptive. Caring and culture are described as being intricately linked. It is important to assess language needs and request for a translation service if needed and provide written material in the patient's language.
As well as, trying to mimic the patient's style of communication e. Another obstacle is stereotyping, a patient's background is often multifaceted encompassing many ethic and cultural traditions.
In order to individualize communication and provide culturally sensitive care it is important to understand the complexity of social, ethnic, cultural and economic.
This involves overcoming certain attitudes and offering consistent, non-judgemental care to all patients. Accepting the person for who they are regardless of diverse backgrounds and circumstances or differences in morals or beliefs. By exhibiting these attributes trust can grow between patient and nurse. It includes nurses working with the client to create goals directed at improving their health status. A partnership is formed between nurse and client. The nurse empowers patient and families to get involved in their health.
To make this process successful the nurse must value, respect and listen to clients as individuals. Focus should be on the feelings, priorities, challenges, and ideas of the patient, with progressive aim of enhancing optimum physical, spiritual, and mental health. It is stated that it is the nurse's job to report abuse of their client to ensure that their client is safe from harm. Nurses must intervene and report any abusive situations observed that might be seen as violent, threatening, or intended to inflict harm.
Nurses must also report any health care provider's behaviors or remarks towards clients that are perceived as romantic, or sexually abusive. Interviews were done with participants from Southern Ontario, ten had been hospitalized for a psychiatric illness and four had experiences with nurses from community-based organizations, but were never hospitalized.
The participants were asked about experiences at different stages of the relationship. The research described two relationships that formed the "bright side" and the "dark side". The "bright" relationship involved nurses who validated clients and their feelings. For example, one client tested his trust of the nurse by becoming angry with her and revealing his negative thoughts related to the hospitalization.
The client stated, "she's trying to be quite nice to me For example, one client stated, "The nurses' general feeling was when someone asks for help, they're being manipulative and attention seeking ". One patient reported, "the nurses all stayed in their central station. They didn't mix with the patients The only interaction you have with them is medication time". One participant stated, "no one cares. It's just, they don't want to hear it.
They don't want to know it; they don't want to listen". These findings bring awareness about the importance of the nurse—client relationship. Building trust[ edit ] Building trust is beneficial to how the relationship progresses.
Wiesman used interviews with 15 participants who spent at least three days in intensive care to investigate the factors that helped develop trust in the nurse—client relationship.
Patients said nurses promoted trust through attentiveness, competence, comfort measures, personality traits, and provision of information. Every participant stated the attentiveness of the nurse was important to develop trust. One said the nurses "are with you all the time. Whenever anything comes up, they're in there caring for you". They took time to do little things and made sure they were done right and proper," stated one participant. Exploring pedometer use in adults with schizophrenia.
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