Concepts in Nursing Theory Demonstrated in Mental Health Placement Practice - Coursework Example

HUMAN QUALITIES IN NURSING: CONCEPTS IN NURSING THEORY DEMONSTRATED IN MENTAL HEALTH PLACEMENT PRACTICE. Introduction Human qualities are essential in the nursing career and how they are integrated with practice determines the treatment outcomes, especially in the mental health placement practice. The qualities may be identified through the application of concepts like non-verbal communication, Assertiveness, in managing conflict, self-awareness, anger, emotional labor, resilience strategies, aggression and working with loss. The essay explores how I was able to apply these concepts during the first trimester in my practice. Three spectacular experiences with patients are explicitly discussed with each bringing out the concepts. The concepts that were focused on include; verbal and non-verbal communication, self-awareness, assertiveness, managing conflict, resilient strategies, and working with loss. In applying the concepts, knowledge from the nursing theories was used as a foundation.The theories useful in the practice were the Information theory, self-awareness theories, symbolic interactionism theory, self-efficacy theory, TKI model of conflict resolution, and substantive theory. Nursing theories Concepts Non-verbal communication in a nursing context is used when the patient(s) under care is unable to talk to the people offering care, and hence they rely on it to communicate1. The non-verbal communication behaviors fall within a wide range depending on how severe the verbal and mental limitation of a person with the verbal disability2 is. Verbal disability is closely linked to mental disability, and thus the non-verbal communication behavior is largely depended on the mental capacity of the verbally disabled person. A memorable experience with a verbally handicapped patient was during regular morning rounds in mental health placement practice. In this particular experience, I encountered a male patient with a learning disability which included limited verbal expression and physical mobility. It was my first experience with such a patient and I realized I needed to be composed and attentive in order to understand the patient’s behavior. The patient had been scheduled to be taken for swimming as part of therapy, and I needed to accompany him. I knew from the empirical knowledge that I needed to respond to his smiles and the non-verbal sounds to make him feel appreciated3. However, I also was aware that it was not enough, since communication could not be complete if I did not understand what he meant to say to me at every point of our interaction. Therefore, I engaged my intuitive and reflective skills where I needed to be informal and keen to build a relationship4. As I lifted him into his wheelchair, he kept uttering sounds I could not understand, but I could guess that he wanted to know where we were going. I kept reflecting on every facial expression, his gestures, and maintained eye contact5. As we arrived at the hydrotherapy pool, I noticed he was already comfortable with my presence. As he got into the pool, he made non-verbal sounds, then immediately after, he smiled and altered louder sounds. The first day, I learned a lot about the patient’s non-verbal movements and behaviors. As I did reflection-on-action to evaluate my interaction with the patient, I realized that the patient was comfortable with silence as long as he did not ask for any assistance6. The following day’s swimming session was more interesting than the previous day, and he did not make loud weird sounds as it was the case the previous day. It was because he was put into the pool bit by bit with legs first, then abdomen and the rest of the body. The sudden change of temperature the previous day caused the reaction by utterance of weird sounds; a sign of dissatisfaction. He repeatedly kicked his legs in the water accompanied by a loud sound of joy, which I interpreted as laughter, unlike the previous day. In my experience with the verbally limited patient, I needed to be aware of my personal influence in the patient-nurse relationship. Peplau’s theory of awareness of self, stresses that a nurse obtains the required skills by solving her problems and the conflicts that occur in her interaction with others7. I needed to improve on my non-verbal behavior in order to help the patient communicate better. Therefore, I committed myself to learn the meaning of my patient’s non-verbal sounds and behaviors every time we interacted. Drawing from the awareness of self theory, my application of nursing skills to fully help the patient was the central task8. Therefore, I needed to come to terms with the patient’s dependency situation, accept it, and adopt it in my routine as part of my duty. The first day with the patient was a bit difficult due to the newness of the situation and disengagement of the self-awareness skills. For instance, the first day in the hydrotherapy pool was unpleasant for the patient, since I did not consider the best way to treat the patient while in the pool, for the best results. According to Peplau, being aware of one’s self in the present situation enhances the awareness of the other person in the same situation9. Moreover, the Newman’s theory of expanding consciousness points that the more nurses become self-aware, the more likely they are to enter into a transformative relationship with their patients. A self-aware nurse is a transforming agent in the patient-nurse relationship, thus they contribute largely to the health of the patient. Hence, Margaret Newman, defines health as expanding consciousness10. The positive progress of my patient’s health depended on my consciousness into his situation, and that which enhanced him to respond in visible and invisible ways to the environment. The ability of the patient to communicate effectively was determined by my ability to communicate to him meaningfully first. The visible and invisible ways a patient may view the environment may also be as a result of the quality or quantity responses that the patient may display in his immediate environment. The joy and expression that he showed was a qualitative response to a smooth entry into the hydrotherapy pool. The positive quality response contributes to the patient’s positive progress in health. The finding emphasizes the nurse’s role in the patient’s health through maturity in self-awareness11. Self-awareness of the nurse is pivotal in creating rapport with the patient12. As a result, the nurse influences the patient to start relying on others and accept to be dependent on others. In addition, the patient was able to develop participatory skills such as doing physical exercises alone, unlike before when he waited for a physiotherapist to facilitate him. The skills in both non-verbal skills and self-awareness came in handy in that situation. However, after evaluation I noted that I needed to improve on the reflection-in-action skills so as to be able perceive the effects of the situation and act right away to save the situation. The two concepts cannot operate independently without being supplemented by other key concepts such as assertiveness and the skill of managing conflicts. Assertiveness is an essential quality in nursing and more so in nurses for them to effectively carry out their duties. According to Freeman and Adams, “assertiveness is an interpersonal behavior that promotes equality in human relationships by assisting individuals to express their rights, thoughts, and feelings, while also recognizing and respecting the others’ rights.”13 An assertive person takes responsibility for their action and communicates consistent messages about what they expect from others in a relationship. One sunny afternoon, during my usual ward rounds, I was administering medicine to the patients. When I got to the last ward, where a new patient had just been admitted, an elderly lady, writhing in pain, was lying on the bed. The doctor had instructed that she needed to take an intravenous injection at the upper part of the arm, as well as oral medication. I needed to take time with her to build trust and rapport before I could administer the medicine. As a result, I realized she was not ready to take either of the medicines, since she believed it would harm her. I knew that I had to be forceful in order to help her get well. It was only through administering the medicine that she would be relieved of her pain and to deal with the cause of the pain. I believed that I could handle her resistance and that there was no other way. As I checked her medical report, I learned that the lady had hurt herself as she jumped from the window of her house from a two storied building, since she suffered from schizophrenia. I started massaging her body; especially the back where she complained of pain, and initiated a conversation that was not directional. In the process, I persuaded her and convinced her that the injection was not as painful as her injured back. As a result, she trusted that I was concerned about her pain, and reluctantly allowed me to inject her with the medicine. After a sharp shriek, she sighed with relief, and with minimal complaints she relaxed. The oral medicine was yet to be taken, and I had one more round of persuasion. Finally, I succeeded in giving the oral tablets to her after crushing them into smaller pieces. Substantive theory explains that both the external and the internal task generators play a role in causing an individual to undertake a certain task with assertiveness14. My external task generators were my job description as a nurse, and the institution’s regulation that when on duty, I ought to faithfully administer medicine. Internally, I felt it was ethically right to ensure that the sickly lady gets her medicine, and in the right dosage. In addition, I felt the need to help her to overcome her ill health and condition. My religious faith also played a role in the persistence to accomplish the task and the confidence that I was doing what was acceptable before God. The responsibility from within that I was persistent for the old lady’s good gave me the confidence to be more assertive in administering the medicine15. In many occasions, where an individual or a group of individuals becomes too assertive, the opponent who the individual may be raising up to experiences a conflict. This is true, especially where there is sharp disagreement on the issue at hand. The experience I encountered with the schizophrenic elderly lady was a potential conflict situation. In order to manage the situation, I took the time to familiarize myself with the lady and build some level of trust. The initial reaction towards medicine may have been due to the association of the medicine with a stranger. I showed her empathy that convinced her I was supportive and was a friend, not an enemy. I practiced constant special observation (CSO) on her together with friendly communication to avoid feeling like I was intruding into her privacy, hence resentment towards my presence. Many patients have a negative perception towards constant special observation, and they view it as a way of intruding into their personal space; hence restricting them to do as they please16. However, CSO is one way of protecting mental health patients who may be suicidal or capable of inflicting self-harm17. Therefore, I needed to use the economic theory of nursing to balance the time I spent between persuading her to take her medicine and the time I spent with other patients. Nevertheless, the two activities had to be done satisfactorily to the best interest of the patients. The patient-nurse relationship in a mental health facility may become poor if the nurse does not manage the rising conflicts that often occur18. It may be achieved by the nurse when they calm agitated patients, help patients to control their behavior and any out of ordinary incidents by the patient19. The nurse’s conflict style in conflict management is very useful in determining the outcome of the conflict or a potential conflict situation. The Thomas-Kilmann Conflict Mode (TKI) Instrument elaborates the five behavioral approaches that are exhibited when resolving conflict. They are based on assertiveness and cooperativeness for the outcome to be either positive or negative in each dimension20. The behavior of an individual towards a conflict determines the style they adopt to resolve the conflict21. According to the TKI model, to succeed in conflict resolution, an individual needs to adopt a collaborating and compromising stand where they display a cooperative and assertive style of resolving a conflict*. In my situation with the Schizophrenic patient, I applied a collaborating stand by massaging her back and flowing along with her directionless conversation. Hence, what would have aroused the conflict resulted to accomplishment of the intended activity. The concepts under discussion overlap in different situations, and in some cases more than two concepts may apply in one situation22. Hence, it is difficult to separate them entirely. Also, very useful in mental health practice is the concept of resilience strategies and working with loss. The two are closely linked since resilience strategies are used to support individuals in situations of loss. In order to overcome a difficult situation or a stage in life and remain emotionally strong, an individual requires some extra energy from within, commonly referred to as resilience. A nurse preparing for practice needs to learn and train on the strategies necessary for their patients to overcome the effects of difficult events and adjust to a normal and healthful life. In my mental health placement practice, I came across an elderly man who had just moved into the facility for he was struggling with the idea of living in a nursing home away from his family. The man only had a son, who was married with two children, but the young couple was working full time, and the grandchildren were in school. They had tried hiring a family caregiver to take care of the old man in the family home in vain. The only solution was to take him to a home for the elderly where they were sure he would get enough care and attention. However, the old man did not adjust immediately, and hence he experienced symptoms of depression in his early days of confinement in a nursing home. As a result, he required specialized attention in order to overcome the situation and to adjust to his new life. Although he was optimistic that he would adjust, and that he had what it took to ‘survive’ in a nursing home, which were good indicators of resilience, the effects of separation were too much for him to handle. My supervisor delegated the duty of counseling him for two hours on a daily basis. It was my first experience dealing with such a case alone in my nursing career. However, considering the self-efficacy theory, I knew he had a good chance of bouncing back to his normal life, because he had displayed his belief and trust to overcome his situation. Research studies on the adjustment of the elderly in nursing homes indicate that they negotiate through four stages of adjustment before they can finally settle down in a new home. Disorganization occurs during the first weeks of admission in a nursing home, while the re-organization stage starts during the third month after admission. Relationship building starts after the third month where they now start forming new relationships and rebuild the old relationships. After they accomplish building relationships successfully, they stabilize, settle down, and they have a sense of being at home23. My patient was in the disorganization stage of adjustment, hence required a lot of psychological support in order to move on and re-organize his life. I engaged him in psychological, emotional, and behavioral coping strategies that would help in restoring his normalcy of life24. The strategies included; being content with the situation, praying regularly, making time for solitude, obeying the rules of the nursing home after returning, and actively participating in social activities with other patients25. I explored further during the counseling session to find out whether the culture accepted taking of the elderly to a nursing home or not, in order to be sure of the actual cause of his depression. The coping strategies assisted the old man, and within a month he was taken back to the nursing home, since he applied the coping strategies without supervision. Furthermore, considering the above experience with the elderly man, his main concern was on experiencing the loss of his only son, and family. Depression is a symptom of a person who is grieving over the loss of something or somebody they valued. In the case of the elderly man, he had lost a family and home. He may have analyzed the meaning of living in a nursing care for the elderly and interpreted it as having lost a very important part of his life26. It may also have been tied to losing his social interaction with the people who were very significant in his life. Probably playing with his grandchildren, waiting for his son and daughter-in-law to come from work every day, the quality of services he received from his family members, the love he received from them, and many other things that were of value to him constituted the loss. According to the symbolic Interactionist theory, reflection on the meaning and interpretation of events that happen to an individual lead to the way they react to the events27. Therefore, the elderly man’s meaning of the change of residence meant a big loss of livelihood thus the withdrawal to adjust to the loss. Conclusion The mental health placement practice was quite an adventure in terms of learning and skill application, as earlier introduced in theory. The experience of handling a person with verbal limitations, and hence use of non-verbal communication was quite experiential. I learned to use my intuitive skills in communication. Moreover, dealing with a schizophrenic woman was a big challenge that involved mobilization of my emotional resources. Although it was difficult, I managed to achieve the goals intended for accomplishing the task. I learned to be assertive without using literal force, but through being empathic, persuasive, and using verbal communication. In addition, I managed a potential conflict that would have resulted to an uncontrollable situation, hence involvement of more staff or use of force to administer the medicine to the patient. Lastly, the therapy sessions I administered to the depressed elderly man were a climax for me. 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