Therapeutic Use of Self in Mental Health Nursing - Essay Example

The Concept of the Therapeutic Use of Self in Mental Health Nursing The fundamental core of nursing is to care so that health and well-being may be achieved by those whom nurses serve, in any circumstances or across domains. In the field of mental health care, the self is one of the most powerful and creative tools that nurses possess for the delivery of positive interventions and outcomes. In understanding the concept and the factors that contribute to its effectiveness, nurses can develop the knowledge, skills and abilities that enable them to practice the therapeutic use of self. Continual learning and personal development will enable them to further enhance that practice, so that all client nurse interactions are directed toward positive changes, with a view to meeting all challenges in the process. Contents Introduction and Background Developing Skills, Knowledge and Abilities Enhancing and Challenging Therapeutic Use of Self Reflection: Use of Self in Clinical Practice Conclusion Reference List Introduction and Background: Speaking on the concept of nursing, Virginia Henderson (1978) stated: "This intimate and essential service is, in my opinion, the universal element in the concept of nursing. It is a service, which at its best is emotionally and intellectually rewarding to those who give it, and highly prized by those who receive it." The mental health domain demands great depth of intimacy and use of the nurse's presence, or self, to give that service. The ANCI Nursing Code (n.d) describes the role as a "specialised field.embodying a concept of caring, which is designed to be therapeutic by: Supporting consumers to optimise their health statue within the reality of their life situation. Encouraging consumers to take an active role in decisions about their health care Involving family/significant others and communities in the care and support of consumers. To put this concept of caring into practice, to form a therapeutic relationship, the mental health nurse must understand what essential principles are included therein, and how to skilfully apply them. Many theories of counselling and psychotherapy are brought together to assist the process, but the Humanist concept of person-centred interaction and intervention could be said to originate with the work of Carl Rogers. His approach identified that personality changes in therapeutic settings could be achieved as a result of the qualities of the therapist - in this instance, the nurse. These qualities he defined as: Unconditional Positive Regard Empathetic Understanding Congruence (Rogers, 1956) Interpreting these and applying them to the nursing role simply means that the person in need would always be accepted for what they were, without prejudice, rejection or condemnation; that empathy should enable the nurse to put his/herself in the person's place, see things from their perspective; that being congruent, they would respond with genuine, open authenticity, with no barriers to communication. This approach is a foundation for all theories, models, research suggestions and standards put forward regarding the therapeutic use of self. For example, Boykin (1993, p.45) stated: "Trust and courage are needed for such presence to occur. This mutual process is set in motion when the nurse risks entering the other's world and the other invites the nurse into his/her sacred space." Through the phases of orientation, working together, reaching resolution, all the nurse's interpersonal skills, scientific knowledge and practical abilities come together to establish and manage therapeutic interventions in which the self is a powerful and creative tool for positive outcomes. Developing Skills, Knowledge and Abilities: Standards and codes lay down the rules and provide guidance for the role. The Practice Standard of the College of Nurses of Ontario, while relating to all domains, is particularly apt when applied to the concept of therapeutic use of self, as all the necessary components are present. "Trust, Respect, Professional Intimacy, Empathy and Power" (CNO, 2006) When these are brought to nurse client interactions, and combined with medical, pharmacological, technological, socio-psychological and physiological areas of knowledge, the basis for treating the whole person is established; science and humanity are joined. The underlying principle to be remembered is acceptance that the individual, whatever their life experiences, background or current condition, is the focus of the caring interaction. By being there, fully attuned to the person's needs, the nurse can learn from the person and from their own experiences, in ways that help to develop skills and abilities. Obvious ways of increasing knowledge include the use of evidence based practice, research, formal lectures, observation, feedback and sharing experiences with other professionals. One important aspect of all learning must include self-knowledge and awareness of personal beliefs, behaviours, strengths and weaknesses, bearing in mind that the aim is to achieve skilled use of self in the interventions of the therapeutic relationship. Horrocks, (2005, p. 6) maintains: "the chief tool of the psychotherapist is his or her own person...Perhaps the most important quality is humility - a sense that the client is the real expert" One of the best methods for learning about the self has to be reflective practice (Gibbs, 1988) where the cycle aids identification of learning achieved and the areas for improvement. So too, are the processes of receiving feedback and keeping a journal. Perraud et al (2006) presented an interesting method, taken from an online programme for Advanced Practice Psychiatric Mental Health Nursing. Designed to develop therapeutic use of self, students were given written sample cases, then used a process called 'Moment Maps, "where students used snippets of dialogue to display the processes and content of a patient encounter, their attunement with the patient's narrative, non verbal aspect of the encounter, as well as their clinical reasoning and sense of the evolving relationship." By responding, analysing, reflecting and describing what occurred, the students could absorb the concept and identify all aspects of the interactions. Every aspect of communication was examined, as this was seen as a vital factor. Every form of communication must be developed fully, and used. Listening, reflecting back, paraphrasing, confirming, appropriate use of questioning techniques (open/closed), are part of the array of verbal strategies in any domain of nursing. Within the mental health field, this is a challenging prospect, given the condition of some clients or patients. So non verbal skills take on greater significance. The correct use of eye contact, reading body language and gestures, non threatening movement and therapeutic touch must all be developed, utilised and incorporated into the learning processes mentioned earlier. Feedback from colleagues, tutors and mentors will help, but perhaps the most important response that will inform whether the skills and abilities meet the needs, is that given by the person the nurse aims to assist. If the nurse is working skilfully, then the relationship is developing into one of therapeutic benefit. Verbal cues and non verbal signals must be interpreted, watched for and listened to at all times. Long (1999, p. 296) suggests "The way in which we can try to understand the full relational messages is to attend to a pattern of cues, both verbal and non verbal, and not focus on just one." That process is of particular importance with the mental health client and so the nurse must use every method to confirm they possess the skills to use it in practice. Enhancing and Challenging Therapeutic Use of Self: The processes described earlier for the development of skills, abilities and knowledge are applicable to ways of enhancing and challenging, but there is a need to explore further and more widely. It is by challenging that changes and learning occur, and this should take the form of continuous personal development. Assessments, courses, research projects, these are ways to take it forward, as is the need to remain open to new experiences and ideas. Self-examination is a vital element in the process; it would be simple if positive experiences could be taken as evidence of competency, like "That worked, so I must have got it right, I can do that every time." The contention here is that there is a need to challenge one's assumptions and experiences continually, so that such analysis will help to maintain authenticity and aid further learning and good practice. For example, when looking at ethnicity, education, religion, culture, class and so forth, from a personal viewpoint, these must be recognised as part of what makes a person what they are and how they relate to the world. The danger is that such views may colour the way the client nurse interaction develops, and could be potentially negative. To avoid this and enhance the therapeutic process, the mental health nurse must challenge his/her own assumptions, and seek further knowledge; this is integral to the role. A study on indigenous mental health clients in Australia examined how cultural differences needed to be considered, and were not fully understood. The suggestion was that service providers and professionals needed to be more aware of feelings, spiritually, attitudes to mental health, culture, gender and pride issues. These were not being taken into account when delivering help to that part of the population. The writer, Westerman (2004) concluded that change was needed, the focus of which "should be to embed elements of cultural and clinical competence within practice they must ultimately aim to have minimal standards of cultural competence that must be attained by all staff who work directly with Indigenous People Services." The thinking behind this is applicable to all areas of the mental health field, and it is by recognising the importance of such issues and applying the knowledge gained, that the nurse is meeting a challenge and enhancing skills in use of self, seeing the world through another's eyes and centering wholly on that person. Similarly, assumptions with regard to the treatment of dementia and the use of drug therapy were challenged by Camp et al (2002). They concluded that, although there was a need for additional research, findings showed that: "uncovering and addressing unmet needs of persons with dementia should be the central focus of non pharmacological treatment. Reducing physical restraints and providing engaging activities and environmental supports can reduce inappropriate behaviours, because these interventions either reduce unmet needs or prevent them from worsening. That simply suggests, that nursing care that involves being there for the person, developing a therapeutic relationship, may prove more effective and beneficial for the person than keeping them physically or pharmacologically restrained. The idea offers a challenge to the nursing process involved with such clients or patients, while enhancing the self as a therapeutic tool. The biggest challenge is to learn, to change, to grow and develop an inner self that allows the nurse to help the person to develop, grow and change, moving them towards well-being and possibly mental health, within the limitations of their condition. Reflection: Use of Self in Clinical Practice: ********* Conclusion: From orientation to resolution, the nurse's skills, scientific knowledge and practical abilities combine to establish and manage therapeutic interventions where the self becomes a powerful and creative tool for positive outcomes for their patient/client. There is a need to understand and apply the concept, to possess a depth of self-knowledge and to use all methods and resources available to support this process. Along with codes of practice and official standards, the mental health nurse must hold to the values that provide the foundations for care in all domains, and in particular, develop and enhance the interpersonal skills, knowledge and attitudes that contribute to the formation and maintenance of therapeutic relationships. All sources of learning and development must be used, with a view to further development, especially those that offer opportunities for challenge and positive change. This must be an on-going process, with the basic, underlying premise borne in mind - that the focus is on the person, the nurse is there for them. In this way, the use of self becomes a fundamental quality of the nurse and the care he/she seeks to deliver to those unique individuals whose needs they strive to meet. Reference List ANCI. n.d. Australian and New Zealand College of Mental Health Nurses. "Standards of Practice for Mental Health Nursing in Australia" [online] Available at: http://www.users.bigpond.com/telemed/NursingCode.htm [cited 14 April 2007] Boykin, A. 1993. Caring Through the Reflective Lens. In Johns, C. and Freshwater, D., eds. Transforming Nursing Through Reflective Practice. Oxford. Blackwell Science Ltd. 1998 p.45 Camp, J. C., Cohen-Mansfield, J., and Capezuti, E. A. 2002. Mental Health Services in Nursing Homes: Use of Nonpharmacological Interventions Among Nursing Home Residents with Dementia. [online] Psychiatric Services 53: 1397-1401, November 2002. American Psychiatric Association. Available at: http://psychservices.psychiatryonline.org/cgi/content/ Full/53/11/1397 [cited 14 April 2007] College of Nurses of Ontario. 2006. Practice Standard: Therapeutic Nurse Client Relationships, Revised 2006. Available at: http://www.cno.org/docs/prac/41033_Therapeutic.pdf [cited 14 April 2007] Gibbs, G. 1988. Learning by Doing: A Guide to Teaching and Learning Methods. 1998 Oxford Oxford University Press. Henderson, V. 1977. The Concept of Nursing. 3rd Battersea Memorial Lecture, London, November 4, 1977 In 30th Anniversary Issue of Journal of Advanced Nursing. Blackwell Publishing 2006 [online] Available from: http://journalofadvancednursing.com/docs/jan_1978_pdf [cited 14 April 2007] Horrocks, R. 2005. Foundations of Psychotherapy: An Introduction to Individual Therapy. Basingstoke, Hampshire and Worldwide. Palgrave Macmillan. Long, A. 1999 Clarifying Communication for Advanced Interaction. In Long, A. Interaction For Practice In Community Nursing. Hampshire and Worldwide. Macmillan Ltd. 1999 Chapter 11, pp. 286-306. Mulhauser, Dr. G. 2006. An Introduction to Person-Centred Counselling. [online] Counselling Resources. Available at http://counsellingresource.com/types/personcentred/index.html [cited 14 April 2007] Perraud, S., Delaney, K. R., Carlson-Sabelli, L., Johnson, M. E., et al. 2006. Advanced Practice Psychiatric Mental Health Nursing, Finding Our Core: The Therapeutic Relationship in the 21st Century. Perspectives in Psychiatric Care. November 2006 [online] Available from: http://findarticles.com/p/articles/mi_qa3804/is_200611/ai_n17194652. [cited 14 April 2007] Rogers, C. 1956. The Necessary and Sufficient Conditions for Therapeutic Personality Change. Journal of Consulting and Clinical Psychology [online] December 1992. Vol. 60 No. 6 pp. 827-832. Available from: http://www.drlinden.net/ccp606827.pdf [cited 14 April 2007] Slevin, E. 1999. Use of Presence in Community Health Care Nursing. In Long, A. Ed.. Interaction For Practice in Community Nursing. Basingstoke, Hampshire and Worldwide. Macmillan Ltd. 1999. Chapter 2, pp. 24-45. Westerman, T. 2004. Guest Editorial: Engagement of Indigenous clients in mental health services: What role to cultural differences play [online] Australian Journal for the Advancement of Mental Health (AeJAMH). Vol. 3, Issue 3. 2004. Available at www.auseinet.com/journal/ Vol3iss3/westermaneditorial.pdf. [cited 14 April 2007] Read More