Write about the Project Report for Journal of Clinical Nursing.
The approved project question is as follows:
What knowledge and skills are required for developing the therapeutic relationship/communication with mental health consumers and carers?
The rationale for selecting the aforementioned research question is that looking into it would help to establish the essential knowledge, know-how and skill set that mental health nurses need in order to establish and maintain good therapeutic relationship/communication with mental health consumers and carers. Nurse-client therapeutic relationship is very important in nursing practice. In mental health nursing for instance, the nurse-client therapeutic relationship might be the main intervention for working through difficulties and/or promoting growth and awareness (Clark, 2012). Effective nursing practice depends upon an effective relationship between the patient and the mental health nurse.
A number of scholars have attempted to explore the issue and reported their findings in peer-reviewed journal articles. In their research study, Clark, Parker and Gould (2005) examined the experience of rural generalist nursing personnel working with patients who had mental health illness. A total of 13 registered nurses took part in the study and were working full-time in an acute mental health facility. According to the researchers, the specific skills and knowledge required for building the therapeutic relationship with the mental health patients included nursing knowledge of mental illness, active listening, empathy, assertiveness, observation, patient assessment, humour, problem solving ability, and reflective practice. The strength of this article is that it reveals some of the essential skills that mental health nurses posses or ought to posses when working with their patients. The weakness is that the study used a small sample size of just 13 mental health nurses who were obtained from a single mental health facility. This may affect the generalizabilty of the findings. This source contributes to my discussion by shedding light on the essential skills and knowledge that nurses in mental health facilities require to be able to have therapeutic communication or relationship with their patients.
Other researchers Dinga and Karvinen (2008) carried out a systematic review to find out what the client-nurse therapeutic relationship entails and the way in which healthcare workers including nurses could develop these therapeutic relationships in primary care settings. Trust, interpersonal skills and communication skills were found to be very important for mental health nurses working with clients who have mental illnesses. These skills include listening, paraphrasing, empathy, non-verbal communication, and authenticity (Dinga & Karvinen, 2008). The strength of this article is that it describes what a client-nurse therapeutic relationship involves and the skills needed by mental health nurses to develop these relationships and maintain them. The weakness is that the authors included a relatively small sample size of only 9 articles. This affects the generalizability of findings of the study. This source contributes to my discussion by highlighting the skills needed by nurses to establish and sustain therapeutic client-nurse relations.
In yet a different study, Moreno-Poyato et al. (2017) sought to create changes in the way in which nursing personnel develop the therapeutic relationship within acute psychiatric units as well as to assess the efficacy of implementing evidence via this method. The researchers pointed out psychiatric nurses know that particular skills are needed for developing and maintaining therapeutic relationships with clients. Skills like empathy, teamwork, making a positive first impression, capacity to listen and creating a comfortable and safe environment are essential in fostering and helping the development of a therapeutic relationship (Moreno-Poyato et al., 2017). Reflecting skills are equally crucial. Using reflective skills effectively communicates understanding and acceptance to the patient, builds trust, and facilitates exploration, all of which help to develop therapeutic relationship/communication with the client (Scanlon, 2006). The strength of this article is that it is comprehensive, well-written, well-organized, and professionally presented. The weakness is that the study was conducted in just a single psychiatric facility and therefore the findings may not be generalizable to other settings. This source contributes to my discussion by highlighting specific skills that psychiatric nurses need to posses in order to effectively develop and maintain therapeutic relationships with their clients.
Dziopa and Ahern (2013) also investigated the subject matter. In their systematic review, they aimed to conceptualize attributes or skills that contribute to the development of a therapeutic relationship in advanced practice mental health/psychiatric nursing. They found out that empathy, understanding, provision of individualized care, providing support, being available/being there, being genuine, showing respect, demonstrating clear boundaries and promoting equality are vital in developing a therapeutic relationship between a mental health nurse and his/her patient. The strength of this article is the fact that it highlights crucial skills that advanced practice clinicians should continuously review and refine to foster and sustain a therapeutic relationship with their patient. This source contributes to my discussion by identifying a number of skills that mental health nurses need to have for them to develop a therapeutic relationship with their client.
While on placement at Bankstown Hospital, I was able to critically observe the practices within my clinical area in relation to the research question. What I observed is that in developing the therapeutic relationship with mental health consumers and their carers at the healthcare organization, the mental health nurses exhibited knowledge in mental illness. This is in line with literature findings. According to Dinga and Karvinen (2008), nurses should possess a very sound knowledge of mental illness in order to properly read what is going on. In addition, having knowledge of mental illness allows the nurses to be able to communicate well with the client and work with the client, not against him or her.
The nurses at Bankstown Hospital also exhibited skills such as active listening, for example when they sat quietly with the patients and listened to them. This greatly helped to develop therapeutic relationship and effective communication between the mental health nurses and the client/patient. In addition, they exhibited empathy. The nurses knew that these patients came in an acute state and were practically left in the care of the nurses and it was sometimes rather frightening for those patients. By displaying empathy, the nurses are able imagine walking in the shoes of their patients in order to truly comprehend what they may be feeling, and this really helps to developed a relationship between the nurses and the patients (Cahill, Paley & Hardy, 2013).
Another vital skill that was observed is patient assessment when the nurses observed and assessed their patients to ensure ongoing patient of the client. Schroeder (2013) pointed out that critical, continuous assessment is of great importance in ensuring the ongoing safety of patients. Having outstanding patient assessment skills makes it easier for the mental health nurse to work with his/her patient and to predict a way forward in the patient’s care. This in turn helps to foster good therapeutic relationship with the mental health patient and his/her carer (Hem & Heggen, 2010). The other skill that was observed in the mental health nurses is assertiveness. Assertion, as Clark (2012) stated, is the ability of the mental health nurse to challenge a client in a therapeutic context and attain positive outcome. Also, the skill of problem solving, empower and educate the patients was displayed by the nurses.
Furthermore, they demonstrated the ability to communicate well with the clients. Mental health nurses must communicate effectively with their clients as this is critical in developing therapeutic relationships with the clients (Hewitt & Coffey, 2005). Lastly, they demonstrated humour which made the patients smile, and in so doing develop great therapeutic relationship with the patients. Cahill, Paley and Hardy (2013) mentioned that if possible, mental health nurses should maintain a sense of humour and give the patient a smile as this helps to establish a good therapeutic relationship. For future practice, it is recommended that mental health nurses should seek to gain relevant knowledge in mental illness. They should also strive to develop a number of crucial skills including effective communication skills, good sense of humour, active listening, understanding, respect, empathy, and assertiveness. These skills and knowledge are of great importance in developing and maintaining the therapeutic relationship/communication with mental health consumers and their carers.
Conclusion
To sum up, there is a need for improvement in effective people skills from some healthcare professionals with mental health patients. Nurses and psychiatrists in mental health facilities need to gain the essential knowledge to effectively establish therapeutic relationships. They should strive to refine their knowledge in mental illness. They should also acquire various skills such as interpersonal skills, effective communication skills, reflecting skills, problem-solving ability, humour, listening, understanding, empathy, being genuine and show respect. Having these critical skills would help the mental health nurse develop and maintain therapeutic relationship/communication with the mental health client and their carer.
References
Cahill, J., Paley, G., & Hardy, G. (2013). What do patients find helpful in psychotherapy? Implications for the therapeutic relationship in mental health nursing. J Psychiatr Ment Health Nurs, 20(9):782–791.
Clark L. (2012). The therapeutic relationship and Mental Health Nursing: it is time to articulate what we do! J Psychiatr Ment Health Nurs, 19(9):839–843.
Clark, C., Parker, E., & Gould, T. (2005). Ruralist generalist nurses’ perceptions of the effectiveness of their therapeutic inter-ventions for patients with mental illness”, Australian Journal Rural Health, 8(13): 205-213.
Dinga, B., & Karvinen, O. (2008). Building therapeutic relationships with mental health clients in primary care settings. Journal of Clinical Nursing, vol. 8, p. 643-652.
Dziopa F, & Ahern K. (2013). What Makes a Quality Therapeutic Relationship in Psychiatric/Mental Health Nursing?: A Review of the Research Literature. Internet J Adv Nurs Pract, 10(1): 12-26.
Hem, M. H., & Heggen, K. (2010). Being professional and being human: one nurse’s relationship with a psychiatric patient. J Adv Nurs, 43(1):101–108.
Hewitt, J., & Coffey, M. (2005). Therapeutic working relationships with people with schizophrenia: literature review. J Adv Nurs, 52(5):561–570.
Moreno-Poyato, A. R., Degad-Hito, P., Suarez-Perez., & Leyva-Moral, J. (2017). Implementation of evidence on the nurse-patient relationship in psychiatric wards through a mixed method design: Study protocol. BMC Nurs, 16(1): 34-39.
Schroeder, R. (2013). The seriously mentally ill older adult: perceptions of the patient-provider relationship. Perspect Psychiatr Care, 49(1):30–40.
Scanlon, A. (2006). Psychiatric nurses’ perceptions of the constituents of the therapeutic relationship: a grounded theory study. J Psychiatr Ment Health Nurs,13(3):319–329.
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