Concepts used in mental health psychiatric nursing

CONCEPTS USED IN MENTAL
HEALTH PSYCHIATRIC NURSING
By
Frank Chimwala

OBJECTIVES
At the end of this session, students should be
able to:
–Define mental health, mental illness &
psychiatric nursing.
–Describe therapeutic nurse-patient
relationship.
–Explain therapeutic use of self.
–Describe assertiveness
–Describe self awareness

MENTAL HEALTH
• According to Townsend (2006:939), mental
health is successful adaptation to stressors
from the environment (internal or external),
evidenced by thoughts, feelings and behaviors
that are age appropriate and congruent with
local and cultural norms.

Cont…
• Mental health is also a positive state in which
one is responsible, displays self awareness, is
self directive, reasonably worry free, and can
cope with usual daily tensions. He / she
functions well in a society, accepted within a
group, satisfied with their lives.

MENTAL ILLNESS
• Mental illness is mal-adaptive responses to
stressors from internal or external stimuli
evidenced by thoughts, feelings & behaviors
which are not congruent with local cultural
norms and interfere with an individuals social
and physical functioning (Townsend, 2006).
• The person may fail to adapt to his
environment, has distorted view of self and
fails to maintain meaningful relationships.

PSYCHIATRIC NURSING
• Psychiatric nursing is a process of diagnosing
and managing human responses to actual and
potential health problems employing theories
of human behavior as its science and
purposeful use of self as its art.

NURSE-PATIENT RELATIONSHIP
• Nurse-patient relationship is a personal
relationship where two people come to know
each other well enough to face the problem at
hand in a cooperative way.
• It is a mutual learning experience and a
corrective emotional experience for the
patient.

AIMS
• Nurse patient relationship aims at the nurse
using personal qualities and clinical
techniques in working with the patient to
bring about insight and behavioural change.
• It is based on the humanity of nurse and
patient with mutual respect and acceptance of
cultural differences.
• In this type of relationship, every interaction
has a potential to promote and maintain
health of the patient.

Cont …
• The patient is able to deal with some difficulty
effectively.

ASPECT OF NURSE PATIENT RELATIONSHIP
1. Goal Directed
• This applies a purpose for the relation
existence
• The overall goal for any therapeutic
relationship is to help the patient move
towards health by becoming more self
responsible.
2. Client Centered
• This implies that the relationship is focused
on the client and it is the clients goals,
reactions, coping strategies and growth that
are at the centre of the relationship.

Cont …
• It requires the nurse turns their attention to
the clients for a while and suspend their pre-
occupations with events in their own lives in
order to experience a clients sense of being.
3. Objectivity
• Implies an analytical approach to the
subjective experience.
• Nurses should deal with their own reactions
in away that allows them to be useful
therapeutically.

FUNCTIONS OF NUERSE-PATIENT RELATIONSHIP
• Helps the patient to identifying emotionally
felt difficulties
• Helps nurses to understand and use
themselves therapeutically.
• Nurses are able to apply personal qualities
when helping patients to solve their
problems.

QUALITIES OF A THERAPEUTIC NURSE
• There is a growing recognition that the
qualities of a therapeutic nurse are very
important in promoting growth.
• The nurse should express a positive view of
people’s ability to solve their own problems
and mange their own lives.
• The nurse should view people as dependable,
friendly and worthy.

Cont …
• Nurses should identify with people rather
than things, have a capacity to cope and
willing to reveal their thoughts.
• Nurses should show the sense of strength and
maturity in experiencing and solving life’s
problems.

STAGES NURSE-PATIENT RELATIONSHIP
1. Pre-interaction
• Begins before the nurse’s first contact with
the patient.
• The nurse explores herself and analyze
his/her feelings and fears.
• The nurse may have misconceptions and
prejudices, e.g stereotyping psychiatric
patients with violence.
• Involves the nurse reviewing patient file,
collecting data from significant others.

2. Introductory or orientation phase
• The nurse and the patient first meet .
• A nurse finds out why the patient sought help.
• The nurse establish a climate of trust,
understanding, acceptance and open
communication.
• A contract is formulate with the patient.
• Setting of specific goals together with the
patient.

3. Working phase
• Most of the therapeutic work is carried out
during the working phase.
• The nurse and patient explore relevant
stressors and promote the development of
insight in the patient by linking his
perceptions, thoughts, feelings and actions.
• The nurse helps the patient to gain
independence, self responsibility and
develop constructive coping mechanisms.
• The focus of this phase is behavior change.

4. Termination phase
• Termination is one of the most difficult but
most important phases of the therapeutic
nurse patient relationship.
• During the termination phase learning is
maximized for both the patient’s progress and
goal attainment.
• Levels of trust and intimacy are heightened,
reflecting the quality of the relationship and
the sense of loss of experienced by both nurse
and patient.

Criteria for termination
• The patient experiences relief from the
presenting problem.
• The patient’s functioning has improved.
• The patient uses more adaptive coping
responses.
• The patient has increased self –esteem and a
stronger sense of identify.
• The patient has achieved the planned
treatment outcomes.

DEFINITION
• Therapeutic use of self is the ability to use
one’s personality consciously and in full
awareness in an attempt to establish
relatedness and to structure nursing
interventions.
• It requires that the nurse should have a great
deal of self awareness and self understanding.
• The ability and extent to which one effectively
help others in time of need is strongly
influenced by this internal value system, thus
continuation of intellect and emotions.

ESSENTIAL CONCEPTS
1. Rapport
Implies special feelings on the part of both the
client and the nurse based on acceptance,
warmth, friendliness, common interest, a sense
of trust and non-judgmental attitude.
2. Trust
One must feel confident in that person’s presence.
Nurses should be reliable and have integrity, veracity
and sincere desire to provide assistance when
requested.
• Trust worthiness is demonstrated through
nursing interventions that convey a sense of
warmth and caring to the client.

5. Respect (unconditional positive regard)
• To show respect is to believe in the dignity and
worth of an individual regardless of his/her
unacceptable behavior.
• Nurses can convey an attitude of respect by:
–Using name, title (if referred by the clients)
when calling them.
–Spending time with the client.
–Allowing sufficient time to answer
questions and concerns.

Cont …
• Promoting atmosphere of privacy.
• Always being open and honest with the client.
• Taking the client ideas, preferences, opinions
into consideration when planning care.
• Striving to understand the motivation behind
the client’s behavior, regardless of how
unacceptable it may be.

4. Genuineness
• This is the ability of the nurse to be open,
honest and real (to be aware of what one is
experiencing internally and allow the quality
of this inner experience to be apparent in the
therapeutic relationship).

5. Empathy
• Is the process in which an individual is able to
see beyond outward behavior and sense
accurately another’s inner experience at a
given point in time.
• With empathy, one can accurately perceive and
understand the meaning and relevance of the
client’s thoughts and feelings.
• Empathy is always confused with sympathy
which is that the nurse actually shares what
the client is feeling and experiences a need to
alleviate distress.

Cont …
• In empathy, the nurse perceives and
understands what the client is feeling and
encourages the client to explore these feelings
that may have been suppresses or denied.
• Positive emotions are generated as the client
realizes that he or she is truly understood by
another (nurse, counselor).
• As the feelings surface and are explored, the
client learns about personal aspects of which
he or she may have been unaware.

Cont …
• This contributes to the process of personal
identification and the promotion of positive
self concept.
• With empathy, while understanding the
client’s thoughts and feelings, the nurse is
able to maintain sufficient objectivity to allow
the client to achieve problem resolution with
minimal assistance.

Cont …
• With sympathy, the nurses feel what the client
is feeling, objectivity is lost and the nurse may
become focused on relief of personal distress
rather than on helping the client resolve the
problem at hand.

DESCRIPTION
• Assertiveness refers to the behaviour that is
directed towards claiming one’s rights without
denying the rights of others.
• It is the way people communicate feelings,
thoughts and beliefs in an open, honest
manner without violating the rights of others.
• An individual’s behaviour is directed towards
claiming one’s rights without denying the
rights of others.

Cont …
• Assertiveness behaviours convey a sense of
self assurance and communicates respect for
the other person (Stuart & Laraia, 2005)
• The assertive person speaks clearly and
distinctly, feels free to refuse an unreasonable
requests and share rationale.
• An assertive person gives compliments to the
ones who deserve it and at the same time
he/she accept positive inputs from others.

PASSIVE BEHAVIOUR
• The passive person consistently subordinates
his own rights to the perception of others.
• When a passive person becomes angry,
he/she tries to camouflage it, thereby creating
increased tension in himself.

AGGRESSIVE BEHAVIOUR
• An aggressive person ignores the right of
others.
• He operates under the assumption that every
individual must fight for his own interests and
expects the same behaviour from others.
• To him, life is a battle.

ASSERTIVENESS TRAINING
• Includes teaching patients communication
skills like, eye contact, gestures and distance.
• Teach patients assertiveness skills that will
help them in making decisions or choices.
• Educate patients of their rights,
responsibilities and how to respect others.
• Teach patients negotiating skills, e.g. choose
right time and place and discuss differences.

BENEFITS OF ASSERTIVENESS
• Helps the individual to improve self esteem.
• Lowers anxiety levels and destructiveness of
anger.
• Assist an individual to build confidence.
• Enhances communication.
• Assist an individual to develop greater respect
for self and others.
• Lessens misunderstandings.
• Reduces conflict.

DESCRIPTION
• Self awareness is the most valuable resource
of nurse in the ability to use oneself to help
others.
• To ensure the most effective use of self, nurses
should be aware of personal stress that can
interfere with the ability to care for the
patients.
• The nurse should be able to answer the
question, “Who am I” in order to provide
effective biopsychosocial needs.

Cont …
• Nurses should learn to deal with anxiety,
anger, sadness, joy in helping patients.
• Self awareness is the key part of psychiatric
nursing experience.
• Its goal is to achieve authentic, open and
personal communication.
• A good understanding and acceptance of self
allow the nurse to acknowledge a patient’s
difference and uniqueness (Stuat & Laraia
2005).

HOLISTIC NURSING MODEL
1. PSYCHOLOGICAL COMPONENT
• Knowledge of emotions, motivations, self
concept and personality.
• Being psychologically self aware means being
sensitive to feelings and outside events that
affect those feelings.

2. PHYSICAL COMPONENT
• Knowledge of personal and general physiology
and bodily sensations, body image and
physical potentials.
3. ENVIRONMENTAL COMPONENT
• This includes social-cultural environment,
relationship between humans and nature.
Tuesday, 28 September 2021 41

4.THE PHILOSOPHICAL COMPONENT
• Sense of life having a meaning (why do you
live?).
• A personal philosophy of life and death may
include spiritual being and also take
responsibility to the world and ethics of
behavior.
• This model can be used to promote the self
awareness of nurses and patients who are
being cared.

HOW TO INCREASE SELF AWARENESS
The Johari window: (Figure A)
• No-one ever completely knows the inner self
Quard 1. Quard 2.
Behaviours, feelings, Blind: things that others
thoughts known to an know but individual doesn’t.
individual and others.
Quard 3 Quard 4
Hidden things Things unknown to
individual & others.
about self.
1. 2.
3. 4.

Cont …
• A change in one quadrant affects all other
quadrants.
• The smaller quadrant 1, the poorer the
communication.
• Interpersonal learning causes a change so
that quadrant number 1 becomes larger,
while one or more quadrants become smaller.
• The goal of increasing self awareness is to
enlarge the area of quadrant 1 and reduce the
other quadrants.

QUADRANT 1: (figure B)
1 2
3 4
• For one to increase knowledge, it
is necessary to listen to the self
hence the individual allows
genuine emotions to be
experienced; identifies and
accepts personal needs and
moves the body free, joyful and
spontaneous ways.
• This include: exploration of
memories, thoughts, feelings and
impulses.

QUADRANT 2: (Figure C)
1
2
3
• Quadrant 2 can be reduced by
listening or learning from others.
• Knowledge of self is not possible
alone.
• Relationship with others broaden
our perceptions of self but also
requires active listening and
openness to the feedback others
provide.
4

QUADRANT: 3
• Quadrant 3: Can be reduced by self disclosing
or revealing to other important aspects of
self.
• Self disclosure is a means of achieving health
personality (for those already sick).
• Figure (A) above represents a person with
little self awareness whose behaviours and
feelings are limited hence quadrant 4
enlarged.

Cont ...
• Figure (B) shows an individual with great
openness to the world.
• Much of this individual's potential is being
developed and realized.
• The individual has increased capacity for
experiences of all kinds e.g. Joy, hate, work,
love etc
• This individual has few defence and can
interact more spontaneously and honestly with
others.

REFERENCES
• Town Send M.C. (2006). Psychiatric Mental
Health Nursing. Concepts of Care in Evidence
Based Practice. 5th Edition. Philadelphia: F.A
Davis Company Publishers.
• Stuart, G.W. & Laraia, M.T. (2005). Principles
and Practice of Psychiatric Nursing. (8th
Edition St. Louis: Mosby-Year book Inc

Concepts used in mental health psychiatric nursing

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