Of the nine contracts found in Dziopa and Ahem (2009), conveying understanding is one of them. The basis of conveying understanding is being able to “walk in” or empathize with another individuals condition. According to Ross and Watling (2017) little research has been performed to efficiently assess the effectiveness and application of therapeutic relationships in the psychiatric units. Ross and Watling performed a study to assess the use of empathy within the psychiatric practice units. The premise of this research was to show the over-reliance of medical personnel in the Diagnostic and Statistical Manual of Mental Disorders and the complete or partial disregard of maintaining an environment for empathy and appropriate human interactions. The results proved that understanding and empathy were not considered appropriate in medical-psychiatric units. (Ross and Watling, 2017)
Individuals are viewed in terms of their disease instead of being viewed in wholeness, as an individual with feelings, thoughts, and emotions (Corrigan & Watson, 2002; Beauvais, 2017). The levels of stigma prevalent against individuals with mental disorders are attributed to the further degradation of the individuals and their ways of life (Subramaniam et al., 2017; Isobel & Delgado 2018). Nurses and doctors do not normally take time to understand what the patient is going through such as is the case for “I am Anne”. Nurses come and go without listening to the patient in most cases. Nurses proceed with the day to day activities that pertain to nursing such as administering medication but are never really concerned about the patient. Understanding the patient drastically aids in improving the health of the patient. The patient who is talked to and listened to feels more accepted (Berman & Chutka, 2016). Emotional healing drastically leads to an improvement in the patient’s psychological health. If Anne was just listened to, she would probably have a better prognosis other than the one that was elicited. The NMBA 2018 advocates for individualized, patient centered care. Nurses are expected to be understanding and treat others with respect. Nurses who are not respective and understanding go against the law as it is put down in Australia.
Without a particular understanding of the patient and his or her psychiatric condition, it is impossible to manage the patient effectively. This aspect is represented in the case of Anne. Anne received care from nurses who had no clear prior history of her condition and what she had gone through. The nurses also were not quite aware of her previous treatments. It is easily observed that the right of autonomy is hindered in psychiatric patients. In most cases, psychiatric patients do not get the opportunity to receive individualized care because no one wants to listen to them or get their version of the story. The solution to this downfall is being able to receive the patient’s or clients complain effectively in a time-bound manner (Suhomen, Valimiki and Leino, 2018).
An example where individuality is not considered is essentially in cases where the patient’s views are not heard or are ignored on the basis of being mentally deranged patient. Individualized nursing interventions are more effective in improving patient’s outcomes as compared to non-individualized care (Suhonen, Välimäki, & Leino, 2008). Not only does individualized care enable the identification of associated conditions but also it improves the management of the patient at the end of the day.
For instance, if Anne received standardized and individual care, she would have been able to allay her concerns effectively. However, stigma and nurse to patient ratios in psychiatric institutions throughout the world hinder the provision of care that is individualized and patient-centered care (Lilja and Hellzén, 2008; Hartin et al, 2018).
Conversely, it is against the code of conduct of the nurse in Australia to offer care that is not sensitive to the need of the patient (Bryce et al, 2017; Fisher et al., 2017). However, this is not the case for most of the patients suffering from health issues. The fact that the care that is accorded to the patients is not individualized, leaves a sphere of interference where they will not receive the needed emotional or physical care. Patients may end up feeling ignored or left behind if care is not appropriate.
Anne felt as if there was no one left to aid her. She felt as though no one cared apart from those who brought her food and one nurse who seemed to care. The fact that Anne illustrated this shows the extent unto which nurses and other medical personnel working in mental health facilities have ignored the fact that the patients admitted in this facilities are actually suffering from many conditions that are hampering their normal functioning and need support (Suhonen, et al, 2008).
Physical contact, that is a therapeutic touch, is a highly effective way of providing support to mental health patients. There is a significant relationship between a decrease in depression and physical touch. However, nurses are mostly judgmental and may not engage in the slightest association with the patients. Anne only had one nurse who was concerned about her care. Only one nurse was bold enough to talk to her about her condition and problems and offered consolation to her. It is the nurse’s duty and responsibility to offer psychological support to patients who are suffering from mental health problems (Lilja and Hellzén, 2008)
Stigma also plays a significant part in reducing the support systems in mental health facilities. Nurses are not bold enough to support patients in mental health facilities due to the stigma attributed to the patients. The nurse should be ready at all times to listen and offer emotional and physical support as this improves the patient’s prognosis and the overall state of mind and health.
Support can also be included in mental health facilities by being involved in occupational therapy activities within the mental health facilities. The isolated patient can be involved in writing, discussing, dancing, singing or any other activity that ensure they are not secluded from the world. Being in a mental health facility means that the patient is isolated in one place for a long time and that the patient may not get access to the world. However, involving patients in team building activities not only increases their strength and belief in their abilities but strongly aids in reducing the much built up anxiety of being secluded. A sense of belonging develops among the mental health patients due to the creation of a strong support system. The code of conduct for nurses in Australia 2018 advocates for evidence, respect and compassion for patient’s needs. In the case where the nurse does not show compassion and support to the patient, the nurse is found to have breached the code of conduct that is necessary for nurses to follow (Lilja and Hellzén, 2008). Support both emotionally and physically is necessary for the improvement of the patient’s condition and it should be observed by nurses. Nurses are the primary care providers in most psychiatric healthcare units.
The aspect of being there for a patient in mental health facilities is highly crucial. The presence of a nurse to share ideas and talk with the patient during their time of need significantly improves the patient’s prognosis. Nurses, making up the part of the healthcare team with the highest number of hours with the patient, need to be around both physically, emotionally and even spiritually as needs may arise. This aspect can be seen in the case of Anne who had been suffering from intense anguish. However, Anne remembered the nurse who was there during her trying times. She was able to remember the nurse who talked to her and consoled her despite having a child with cancer. The presence of a nurse may be seen lightly but it plays a very crucial role in the improvement of a patient prognosis (Lilja and Hellzén, 2008).
The label that is associated with being a psychiatric patient makes some nurses to alienate patients. Anne, for instance, was thrown into isolation when she tried to raise a complaint regarding her care. She was depending on the nurses as her advocate to defend and take care of her but the nurse did not do so. The nurses were also not ready to share information regarding her care. The fact that there was professional negligence in the care of Anne and other psychiatric patients prove the necessity of the nurse to be around for the patient. The nurse should listen to the patient at all times and collect appropriate data for care. Changes to care can also be identified through team shared decision making after the nurses have spent enough physical time with the patient and collected relevant data for patient care. Therapeutic communication is also enhanced by being available to take care of the patient.
The nurse should be genuine in order to foster a therapeutic relationship. By being genuine, the nurse should ensure that truthfulness is maintained at all times. The patient should not be lied to. The autonomy of the patient should be maintained at all times and private information shared by the patient should always remain private. In cases where the patient may present with signs of or states that he or she will cause harm to himself or others the action should be taken (Lilja and Hellzén, 2008).
The nurse should not lie to patients but rather maintain the principle of fidelity at all times. It is clear through the case of Anne that the nurses lied. The nurses did not explain to Anne the meaning of the documents that she was signing. The nurses, in this case, made Anne even more confused. Being honest and genuine to the patient allows the patient to feel accepted. By being open to the patient, the patient’s health is likely to improve further as compared to where lies are used to mask truths (Lilja and Hellzén, 2008).
Equal access to healthcare is one of the keys in the code of conduct for nurses. It is necessary for nurses in mental health care facilities to ensure that they offer equal care to patients. For Anne’s case, for instance, she should have been protected because of her age and her history. She should behave receive appropriate care (Lilja and Hellzén, 2008). According to the NMBA standards, nursing care should be provide equally to all patients regardless of their age, gender or medical condition. There should be no stigma when care is being administered to patients (Lilja and Hellzén, 2008).
The nurse should display respect for psychiatric patients. They need to be treated with respect as this strengthens patient and nurse relationships. Anne, for instance, should have been informed before she received injections and medications. She was injected and undressed before she gave her consent. Nurses should ensure care is patient-centered and follows the code of ethics and conduct for the nurse. Respect is within the code of conduct and should be observed (Lilja and Hellzén, 2008). Without respect for the patient rights, a breach of the NMBA code of conduct occurs. Nurses in this case went against the laid down standards of care (Lilja and Hellzén, 2008).
Nurses should ensure that clear boundaries in relationships with patients are set. Sexual relationships or intimate relationships are not appropriate for nurses and patients. Clear boundaries should also be set regarding what can and cannot be discussed (Lilja and Hellzén, 2008). It is highly crucial that the fiver rights of patients are also identified (Lilja and Hellzén, 2008).
During all that nurses do, they should ensure that they are aware of what they are doing. Self-awareness entails being able to identify and know what they are doing. The nurse should recognize their own feeling and attributes and how they affect the patient (Lilja and Hellzén, 2008; Birnbaum 2017). Nurses in the case of I am Anne, were not aware that the patient was emotionally hurt by their actions of negligence and physical harm. Nurses did not control their own emotions so as to avoid confrontation with the patient and to avoid harm to the patient’s psyche. According to the NMDA standards of care, nursing care should be patient centered. However, in the case of I am Anne it was not centered on improving the patient’s way of life (Lilja and Hellzén, 2008; Birnbaum 2017).
Conclusion
It is necessary that the nurse ensure that the patient’s right are met. The only way that these goal can be achieved is by having a good and therapeutic relationship with the patient. A therapeutic relationship is the only way that quality care in psychiatric untis can be achieved. Nurses should be at the forefront in ensuring the constructs identified by Dziopa and Ahem (2009) are followed, for better patient prognosis.
References
Berman, A. C., & Chutka, D. S. (2016). Assessing effective physician-patient communication skills: “Are you listening to me, doc?”. Korean journal of medical education, 28(2), 243.
Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World psychiatry, 1(1), 16.
Dziopa, F., & Ahern, K. J. (2009). What makes a quality therapeutic relationship in psychiatric/mental health nursing: A review of the research literature. Internet Journal of Advanced Nursing Practice, 10(1), 7-7.
Lilja, L., & Hellzén, O. (2008). Former patients’ experience of psychiatric care: a qualitative investigation. International Journal of Mental Health Nursing, 17(4), 279-286.
Ross, J., & Watling, C. (2017). Use of empathy in psychiatric practice: constructivist grounded theory study. BJPsych open, 3(1), 26-33.
Subramaniam, M., Abdin, E., Picco, L., Pang, S., Shafie, S., Vaingankar, J. A. & Chong, S. A. (2017). Stigma towards people with mental disorders and its components–a perspective from multi-ethnic Singapore. Epidemiology and psychiatric sciences, 26(4), 371-382.
Suhonen, R., Välimäki, M., & Leino?Kilpi, H. (2008). A review of outcomes of individualised nursing interventions on adult patients. Journal of Clinical Nursing, 17(7), 843-860.
Birnbaum, S. (2017). Therapeutic communication in mental health nursing: Aesthetic and metaphoric processes in the engagement with challenging patients. Routledge.
Isobel, S., & Delgado, C. (2018). Safe and collaborative communication skills: a step towards mental health nurses implementing trauma informed care. Archives of psychiatric nursing, 32(2), 291-296.
Beauvais, A., Andreychik, M., & Henkel, L. A. (2017). The role of emotional intelligence and empathy in compassionate nursing care. Mindfulness & Compassion, 2(2), 92-100.
Ferrara, K. L., Davis-Ajami, M. L., Warren, J. I., & Murphy, L. S. (2017). De-Escalation Training to Medical–Surgical Nurses in the Acute Care Setting. Issues in mental health nursing, 38(9), 742-749.
Fisher, M. (2017). Professional standards for nursing practice: How do they shape contemporary rehabilitation nursing practice?. Journal of the Australasian Rehabilitation Nurses Association, 20(1), 4.
Bryce, J., Foley, E., & Reeves, J. (2017). Conduct most becoming. Australian Nursing and Midwifery Journal, 25(6), 25.
Hartin, P., Birks, M., & Lindsay, D. (2018). Bullying and the nursing profession in Australia: An integrative review of the literature. Collegian.
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