Mental health nursing is a complex area of nursing that requires a high level of skill and knowledge. Those nursed within the mental health setting are extremely vulnerable. People who suffer from mental illness frequently feel anxiety during their time in hospitals (Rana & Upton, 2009, p. 85). The formation of a therapeutic relationship with a patient with a mental illness is critical to positive treatment outcomes. Goals in a therapeutic relationship include; assisting the patient with problem solving approaches to help them with their activities of daily living, promoting self-care and independence, assisting the patient to develop new coping skills, and facilitating communication of distressing thoughts or feelings (reference). The establishment of a relationship with a patient who is suffering for acute depression; such as in the case of Mrs Brown requires an understanding of the nature of the disorder and specific communication strategies (reference).
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The very first process between the nurse and patient is for the patient to develop an understanding that they are entering into a relationship that is essentially safe, confidential, reliable, and consistent with appropriate and clear boundaries (LaRowe, 2004). Barry (1996. p. 18) stressed “one of the most beneficial aspects of a good therapeutic relationship is the emotional support given to the patient”. Establishing therapeutic relationship could help the patients emotionally and then enable them to cope with their problems by themselves. Ultimately the creation of a strong therapeutic relationship can give Lauren an insight into the patient’s condition and assist her in planning for the patients discharge.
Skills of communication are significantly important to establish therapeutic relationship. Day and Levett-Jones (2008, p. 483) claimed communication has two main purposes: to influence others and to obtain information. Both two purposes are really important to establish the relationship. Lauren can develop this interaction as therapeutic communication. “Therapeutic communication occurs when the nurse effectively uses communication techniques and processes with a patient in a goal-directed manner” (Day & Levett-Jones 2008, p. 492). Therapeutic communication is one of the most basic nursing interventions used in a therapeutic relationship. This form of communication encourages the expression of feeling and idea and conveys the nurses acceptance and respect (potter & perry). In Lauren’s case one communication technique that would assist her would be active listening. Active listening is one of the most important communication techniques. Active listening allows the nurse to better understand the entire message being communicated. This is a great way for Lauren to build trust with her patient. (potter and perry). By using a strategy of active listen Lauren can begin to develop a better understanding of her patient and effectively attend to Mrs Brown’s needs. If the patient felt the nurse had attend to them, they would trust the nurse and would be more likely to open up with feelings of anxiety or problems which they may be face (Rana & Upton, 2009). Once this is achieved the nurse will have a better understanding of their patient’s situation. Vital information is gathered and future plans can be made. After gaining information from the patient, nurses can make a plan how to support them. Thus, therapeutic communication reinforces the therapeutic relationship between nurse and patient.
There are a number of key components within the therapeutic relationship which can help Lauren as a graduate RN achieve her discharge planning goals. Firstly, empathy is a skill which nurses need to learn to establish a therapeutic relationship. Empathy is about observing, listening, understanding and attending”. It is being with person with physically, cognitively and emotionally (Usher et al 2005). Empathy will allow Lauren to understand Mrs Brown’s situation, and her current and past experiences objectively. It enhances the relationship between the nurse and the patient. Along with empathy a therapeutic relationship allows for the nurse to communicate with the patient without making any judgments. (reference). Being respected is a basic need for most people. By acting this way the patient can feel accepted and the relationship can be strengthened (Rana & Upton, 2009). A strong relationship built on trust can encourage patients to gain confidence and openly talk about issues with their nurse. Through implementing these strategies of a therapeutic relationship Lauren can help Mrs Brown gain the skills to achieve her goals and implement an effective discharge plan.
As previously mentioned the development of a therapeutic relationship is extremely important, especially within the mental health setting. In caring for Mrs Brown, Lauren should focus on promoting her self-care and independence. Towards the end of Mrs Brown’s hospital stay they have to focus on how she will live after leaving the hospital. Lauren will be the ideal discharge planner as the development of the therapeutic relationship will have put her in the best situation to assess and evaluate her patient. Discharge planning involves assessing the patient and providing them with the information that will help prevent health set back in the future, as well as making sure they have access to adequate support (reference). The therapeutic relationship has four phases. The preinteraction phase, introductory phase, working phase and termination phase (Day & Levett-Jones, 2008). The termination phase is the final stage of the relationship and before discharge the nurse needs to ensure the patient has enough abilities to self-care. The importance of the therapeutic relationship can again be seen here as the nurse can reinforce the patient’s abilities to cope with matters which they might be face. As well as summarising the skills which the patient has learned in order for them to return to society with confidence (reference). A close therapeutic relationship with a patient will assist Lauren to implement nursing interventions for the patients discharge and decrease the risk of Mrs Brown experiencing another episode of acute depression.
Effective interventions may help the patient to have confidence, and relieve any anxiety the patient experiences (reference). Establishing a therapeutic relationship with her patient plays an important role in enhancing the patients independence. This positive relationship would strengthen the patient’s self-esteem. It is claimed “self-awareness and self-esteem are intimately connected to self-care” (Bourgeois & Van der Reit, 2008). If Lauren has developed an effective relationship with her patient, then she should be able to meet these needs and help promote self-care on discharge. Furthermore the patient will have the confidence to handle future problems she may face.
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The development of an effective therapeutic nurse patient relationship allows the nurse and patient to work together to achieve goals of self-care and independence. This involves trust and open communication. With these present Lauren will be able to develop an appropriate discharge plan for her patient. Having gained the patients trust Laurens patient will feel comfortable enough to talk openly with her about her anxieties and worries. Lauren will also be able to create a good picture of Mrs Browns social situation so appropriate support can be put in place and changes made where needed within her environment. (ref). The creation of the therapeutic relationship and the goals set throughout the patients hospital stay allows the patient to live independently on discharge with minimal medical interventions. The relationship allows the nurse to summarise how the patient has grown through their experience in hospital and evaluate if they can live independently and confidently after leaving the hospital (Day & Levett-Jones, 2008). Open communication will allow the patient to say if they feel they can do that at the end phase of the interaction with their nurse and a discharge plan suited to them can be created.
A patient who has suffered an acute episode of mental illness needs to have a nurse who has and ongoing understanding of their situation and illness in order for discharge interventions to be successful. Establishing a therapeutic relationship allows this to happen. The development of a therapeutic relationship would give Lauren a good picture of Mrs Brown’s social situation, current stressors, goals for her treatment and highlight what the patients hopes for discharge. Such information can help develop and effective discharge plan, coordinate ongoing support and hope for the patients future.
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