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Mental health nursing is commonly defined as the specialty of nursing that cares for people of all ages with mental illness or mental disorder. The American Psychiatric Association defines mental disorder as clinically significant behavior or psychological syndrome or pattern that occurs in an individual and is associated with present distress or disability. An individual is believed to have mental illness when he or she possesses these signs: he or she is not able to view him or herself clearly or has a distorted view of self; marked personality change; confused thinking; prolonged mood disturbance; excessive anxiety, fear and suspiciousness; withdrawal from society; abnormal self-centeredness; suicidal thinking; extreme anger or hostility; hallucinations and delusions; abuse of drugs and alcohol; denial of problems and resistance to help; inability to cope with the daily activities and the like.
There are many factors that contribute to the possibility of a person to acquire this illness and precise to say, this is often brought on by a crisis in life.
This crisis results to an individual’s depression, pressure and stress. When one is faced on total depression with his or her problem, he or she cannot think of himself clearly and sometimes this may lead to sudden change in behavior and the person starts to show positive signs of mental illness. This may include illnesses like schizophrenia, bipolar disorder, psychosis, depression or dementia. There are also neuroses, psychoses, psychological and personality disorders.
Dealing with people having these illnesses is never an easy task for one should not only consider one corner of their lives but also their holistic being as an individual.
Thus, Mental health nursing is considered to be one of the most tough and challenging areas of nursing. Statistically speaking, as many as one in three people are thought to suffer some form of mental health problem. The biggest challenge until today is the fact that dealing with the human mind and behavior is not an exact science.
One way to address the toughest challenge in mental health nursing is through establishing a therapeutic relationship between the nurse and the client. A therapeutic relationship between the mental health nurse and those with mental ill health is essential to successful mental health nursing. The satisfaction on helping people back to mental health is as valuable and satisfying as caring for those with a physical illness. However establishing therapeutic relationships between the nurse and mental health client is not an easy task. Certain aspects are taken into considerations in order to build a good therapeutic relationship. There are the barriers that need to be taken down before we can say that a nurse was able to have a good therapeutic relationship with the client and vice versa.
II. BARRIERS TO EFFECTIVE THERAPEUTIC RELATIONSHIP
The biggest barriers to the effective therapeutic relationship are trust, communication and environment. These aforementioned barriers are very significant pillars to mental health nursing that should never be neglected by nurses. Once these barriers are solve then creating good rapport and positive impression to the clients will not be a problem.
First and foremost is trust formation. Trust is defined as confidence in and reliance on good qualities, especially fairness, truth, honor or reliability. Trust can also be defined as responsibility for taking good care of somebody or something. Trust provides a nonthreatening interpersonal environment in which the client feels comfortable revealing his or her needs to the nurse. Trust can be considered the foundation of the therapeutic relationship. In a progressing therapeutic relationship, trust is one of the first positive connections between the nurse and the client. Once trust is established, a chance for the therapeutic relationship to develop is clear and possible. The future of the therapeutic relationship can be determined by the degree of trust given by the client to the nurse.
Trust can be gained by showing qualities such as warmth, empathy and respect towards the client. As the client experiences feelings of comfort and ease, therapeutic relationship is imminent. The formation of a therapeutic relationship can be restricted or enhanced by the developmental influences of the individual. Psychiatric nurses should place a huge emphasis on the development of trust. The first aspect of the trusting relationship is enabling the patient to feel safe and secure and this ability is conveyed to the patient.
From the clients’ perspective, finding a nurse who is caring, friendly and specially a good listener can provide safety and assurance, thus, trust is established. The characteristics mentioned are important in determining whether a client can trust the nurse and whether they can develop an interpersonal connection.
The second barrier, communication, described as the exchange of information between people by means of speaking, writing, or using a common system of signs or behavior (De Vito, 2004).The purpose of therapeutic communication is to provide a safe place for the client to explore the meaning of the illness experience, and to provide the information and emotional support that each client needs to achieve maximum health and well-being. Communication has always been seen as a major factor in nursing care, as it is used in all stages of planning, implementing and evaluating nursing care. In order to have the best communication, certain variables such as empathy, authenticity and listening should be distinguished.
The importance of empathy in the development of the therapeutic relationship is vital. The presence of empathy in a developing therapeutic relationship can help in the successful establishment of trust and rapport. On the other hand, the absence of empathy in a developing therapeutic relationship can be devastating to the rapport and can have disastrous effects on the therapeutic relationship. If nurses see a client as a person who has an illness, the clients might experience feelings of rejection that can lead to more anxiety, frustration and guilt about being ill. Clients who experienced empathy and understanding will most likely feel comfortable and at ease. In this case, client satisfaction is attainable and positive therapeutic relationship is established. Nurses should be able to let the client feel that he/she does not only care but he/she also understands the problem and situation of the client.
Communication is also affected by the authenticity or realness of the nurse towards the client. Clients do not only seek for empathy but they also desire realness. Both verbal and non-verbal way of communicating can show the realness of the nurse. If nurses display emotional support and respect to the clients as individuals then building therapeutic relationship is in progress. Clients appreciate nurses who show genuineness and honesty when dealing with them. Humor and open communication also has positive impact to the clients. Realness and openness are seen by clients to be major contributors in a positive therapeutic relationship. The way how nurses act and handle their responsibilities reflects their realness towards the client. When nurses show realness towards the client; clients in return shows full cooperation and this will be helpful in finding solutions to the client’s illness or problem.
Communication is never a one-way direction, listening is also vital in building rapport with the client. Being an active listener, the nurse gains more trust from the client hence establishing a positive this way, clients feel importance and equality. Since psychiatric nursing is not an exact science, nurses should not only be bounded by his or her ideas on understanding psychiatric patients but he or she should also be able to listen to the client as an individual and provide feedback base on the client’s situation. Mutual relationship is established when a nurse listens to the client and when the nurse had almost same explanation or understanding of the client’s problem as the clients sees the situation themselves. Positive therapeutic relationship can be seen when a nurse shows profound knowledge regarding the client beyond the expected of a professional.
The last but definitely not the least barrier to effective therapeutic relationship is the environment- not only the physical but also the emotional climate of the client. The environment in which the mentally ill person is treated is believed to be a major factor in enhancing or impeding the therapeutic effects of other treatment modalities. It is further believed by some that the environment itself has a therapeutic potential. The nurse is with the client for the longest period of time and because both are directly affected by the environment, it seems logical that the nursing staff assume major responsibility for the creation and maintenance of a therapeutic environment.
Many mentally ill clients struggle with the problem of not being able to trust other people. One of the ways a nurse can help such a person is that he or she can be trusted. If the client can begin to trust one person, it is possible that trust can eventually be extended to other people. Although there may be a dilemma in trying to help the client, we should always respect and understand their feelings. I believe that communication is effective when we accurately and clearly convey the intended messages but it can be difficult when the client and nurse do not communicate verbally, when they do not speak the same language. We should also be aware that nonverbal communication has also different meanings in various cultures. For example, touch, some cultures welcomes touch and considers it supportive in whereas other cultures find it offensive. These differences are important to note and therefore is a barrier to effective therapeutic communication.
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