Therapeutic Interpersonal Relationship and Nurse-Client Relationship - Essay Example

Therapeutic interpersonal relationship Author’s name Institutional affiliation Therapeutic interpersonal relationship Introduction Mental health nursing is considered therapeutic because it is classified as a healing art that is helping an individual in need of psychological healing. Additionally, mental health nursing can be seen as an interpersonal relationship since it encompasses the interaction between individuals who share a common goal and objective (Fitzpatrick & Kazer, 2006). As far as mental health nursing is concerned, this therapeutic relationship or rather the common goal offers the incentive for the nurse-client relationship in which the patient and the nurse deal with each other with utmost respect as individuals and in the process, both parties learn and grow due to the interaction process (Lind et al., 2011). In other words, an individual learns the appropriate time to embrace stimuli in their environment of operation and then afterwards, reacts to the stimuli accordingly (Basavanthappa, 2007). Therefore this paper will critically discuss the theory of interpersonal relationship and drawing on relevant theories, it will also discuss the nurse’s use of unconscious and conscious processes that can take place between a therapeutic relationship using relevant practical examples. The concept of interpersonal theory The theory of interpersonal relations was postulated by Peplau in the year 1952 and established itself in the year 1968 as the crux of psychiatric nursing. Additionally, it is classified as a middle-range theory which is descriptive in nature. Moreover this theory is believed to be made up of four distinctive components (Lind et al., 2011). The first component is the Person, which is fundamentally a developing organism that in one way or the other tries to curb the anxiety caused by the wants and needs. In this case, the mental health patient client is a person with a felt need such that they are struggling with mood disorders, anxiety, depressions or stress. The second component is the environment which is made up of other existing forces surrounding an individual and is described in the culture context (Basavanthappa, 2007). The third component is health which symbolizes forward movement of individual personality as well as other human processes that work towards constructive, creative, personal, productive as well as community living (Fitzpatrick & Kazer, 2006). However, although the theory of interpersonal relations does not address the society or the environment directly, it does encourage and motivate the mental health nurse to put in mind the culture of the mental health patient as well as the values when the client adjusts to the routine of the environment. Hildegard Peplau refers to nursing as an important therapeutic interpersonal process (Basavanthappa, 2007). Additionally, in her theory, she explains and describes the nursing as a human relationship between a person who is in need of health attention or sick and a nurse who is specifically gone through an education system to respond and recognize the patient’s need for help. However, therapists, counselors, nurse practitioners, psychologists, physicians and life coaches can assist accomplish behavioral health anxieties with treatments such medication, therapy and counseling (Basavanthappa, 2007). In all this treatment processes, they focus entirely on health promotion which is not the case with Peplau’s theory. The therapeutic nurse-client relationship By definition, therapeutic nurse-client relationship is a planned and professional relationship that exists between the nurse and the patient that concentrates on the patient’s needs, problems, feelings as well as ideas. In other words, mental health nursing involves the interaction between individuals who share a common goal (Fitzpatrick & Kazer, 2006).For instance, the goal of the mental health nurse is to help the patient struggling with a mental or behavioral health to get better health and the patient also aims for better health. Additionally, the realization of this common goal is attained through a number of steps that go through a sequential pattern. The first stage is the orientation stage which basically defines the problem. By so saying, it means that, it commences when the patient and the nurse meet and the two parties are strangers. After the definition of the problem, the orientation phase clearly identifies the service type that the mental health patient needs (Fitzpatrick & Kazer, 2006). For instance, the patient seeks clarifications, asks questions, shares expectations and preconceptions based on the past history (Weinstein, 2014). Therefore, the orientation phase can be otherwise being stated as the mental health nurse’s general assessment of the condition of the patient. The next stage is the identification stage which involves the selection of the proper assistance from a mental health professional. During this stage, the client starts developing a sense of belonging which in the process reduces the feeling of hopelessness and helplessness (Weinstein, 2014). Generally, this stage is fundamentally the development of the healthcare plan based on the client’s goals and situation. The exploitation phase employs professional help for problem-solving solutions. Additionally, the merits of the professional health services employed depend entirely on the interests and the needs of the patient. However, the patient during this stage may feel part of the health environment team and may as well make some requests and attention-getting approaches as part of the helping environment (Lind et al., 2011). One of the fundamental techniques used when communicating with the patient in this phase is the interview method since it helps the mental health nurse to understand, explore and adequately deal with the situation at hand. Moreover, the nurse should be in a position to help the client to adequately explore all avenues of assistance as they progress slowly towards the final phase (Weinstein, 2014). By way of explanation, the exploitation phase is considered the implementation of the healthcare plan and an action step towards the goals stipulated in the identification phase. The final phase is fundamentally the resolution stage. Additionally, it is the completion of the professional relationship since the client needs have been catered for through the patient and the nurse collaboration. Moreover, they must find a way of severing their relationship and end any ties that have developed between them. However, this is difficult on both sides if psychological ties had emerged (Lind et al., 2011). By so saying, it means that, the patient may incur difficulties to drift away from the mental healthcare professional and in the process break the bond that had developed between them. Otherwise, a healthier emotional balance between the patient and the nurse exists and each party becomes mature persons. In other words, this phase acts as the evaluation of the nursing entire process (Fitzpatrick & Kazer, 2006). Owing to these facts, both the mental health nurse and the client evaluate their health situation at hand based on their relationship’s goals set and whether they were realized or not. Brief discussion of the therapeutic nurse-client interpersonal relationship in mental health The major goals of psychodynamic nursing revolves around assisting to comprehend ones conduct, assist others to discover felt needs and put into practice human relations practice to the issues that come up at all professional experience levels (Fitzpatrick & Kazer , 2006). However, some of the assumptions that are made in all this stages are that; the mental health patient and the nurse can be able to interact, both the nurse and the patient are able to improve maturely due to the therapeutic inter-relationship, interviewing and communication remain basic nursing tools (Lind et al., 2011). Above all, the healthcare professionals must be able to comprehend themselves to promote their patients growth so as to avoid reducing the patients choices to those valued by the nurse. The phases of the therapeutic nurse-client relationship describe the natural progression of the therapeutic relationship between the nurse and the patient in a more simplified manner. Additionally, this simplification of the therapeutic nurse-client relationship leads to adaptability in any interaction that occurs between the mental health patient and the nurse thus in the process, provides generalizability (Lind et al., 2011). However, the nurse-client relationship as described by Peplau portrays some weaknesses in that it emphasized less on health promotion and maintenance. Moreover, the therapeutic nurse –client relationship theory cannot be employed to clients who does not possess a felt need such as withdrawn patients (Fitzpatrick & Kazer, 2006). Analysis of the therapeutic interpersonal relationship and the role played by the nurse. The therapeutic nurse-client relationship postulated by Peplau clearly explains the roles and functions that should be performed by the nurse. By way of elaboration, the primary roles that each and every nurse should play include the following; first, the mental health nurse should act as a stranger in that, they should give the same courtesy and acceptance that they would offer to any stranger. Second, a nurse is a resource individual such that they should be able to give responses and solutions to questions within a complex context (Weinstein, 2014). Third, a nurse is a teacher in the way they help the patient either informally or formally. In summary, the nurse should be a leader, a surrogate, a counselor and takes up some other roles that may encompass safety agent, consultant, tutor, observer among others (Lind et al., 2011). By so saying, it means that, Peplau conceptualized a number of nurse’s roles that can be employed by each and every healthcare professional within their context. By way of explanation, this implies that, a mental healthcare professional’s obligation most especially the nurse does not only revolve around care but the nursing profession comprises of many other health activities that may have an impact on the patients care (Weinstein, 2014). However, the concept of a nurse-client relationship is hindered by those people who are unable to converse most especially those who are unconscious. In other words, the nurse-client relationship concept is highly used with those patients under psychiatric care bearing in mind Peplau’s background (Fitzpatrick & Kazer, 2006). However, the interpersonal relationship is not limited to psychiatric patients care individuals but it is also applicable to any individual who is possesses the capability and has the will to interact or communicate. The phases described in the therapeutic nurse-client relationship can be easily compared to the process of mental health nursing making the phases more applicable in real life situation (Peplau, 2004). Additionally the assessment process coincides with the stage of orientation while planning and nursing diagnosis in mental health goes hand in hand with the identification stage, implementation of the nursing plan goes alongside the exploitation phase and finally, the evaluation in real mental health nursing situation coincides very well with the resolution stage (Fitzpatrick & Kazer, 2006). The nurse’s use of self, conscious and unconscious processes that may occur during the nurse-client relationship The self-concept in nursing The self-concept is an important pre-requisite in mental health nursing profession as it is in any therapeutic alliance (Peplau, 2004). By so saying, it means that, whenever the patient feels any discomfort in terms of stress, mental disorders or anxiety, the most consistent and striking feature that is reported to have undergone changes is the self-concept. Additionally, the purpose of any therapeutic nurse-client relationship is to give room for facilitation of the authentication of the self-concept (Peplau, 2004). By explanation, the authentication of self goes beyond the self-images, sub-personalities and self-concepts. In this case, individuals are expected to take full charge and responsibilities for being human and most especially for being themselves (In Braithwaite & In Schrodt, 2014). Therefore, the role of the mental health professional such as the nurse in caring can be classified as to transcend the persona or the self-concept so as to offer voice to the authentic self, organismic self of the mental health patient. Moreover, this process offers a vas extent of self-consciousness and self-awareness (Peplau, 2004). However, postmodern theories doubt the whole idea of being organismic or the idea of self-concept in real life meaning that there is no such thing like self-actualization and self-autonomous (Lind et al., 2011). Consequently, to challenge the idea of the postmodern theories, the practice of self-reflection is one of the most effective skills that may enable an individual to develop self-awareness. By so saying, the concept of repeating one thing or a certain task over and over again something that has dominated the nursing profession makes individuals to lose the self (Ramsey, 2012). For instance, the continuous day to day repetition of the therapy and counseling process may make an individual to start behaving like their patients in order to identify with them. In other words, self-reflection is meant to assist the nurse practioners to modify their identity through engaging in a relationship with the patient, themselves and others instead of developing an identity that is sharpened by the work environment (Peplau, 2004). In this case, without self-reflection, the nurse practitioner may not be in a position to comprehend the loss of self which in most cases manifests itself in psychological and somatic symptoms such as disconnectedness, sense of meaninglessness and burn-out (Fitzpatrick & Kazer, 2006). Research shows that, contextual attributal factors conspire to lessen the efficacy and subsequently the self-esteem most especially the therapeutic potential of the mental health nurse practioners resulting in submissive, self-doubting and most often, disillusioned mental health practioners (Lind et al., 2011). Above all, this mental change is termed as therapeutic if it reduces or alleviates the individual suffering from behavioral or mental disorder. However, some mental health practitioners may choose to conceal themselves behind their professional masks talking in crescendo pitches that imitate the soft representation of the real practioners (In Braithwaite & In Schrodt, 2014). By so doing, they are able to protect them from the day to day battle-front of professional clinical work where in most cases, emotional knocks and the results are bruises which may be the norm. The concept of critical consciousness in nursing Comprehending critical consciousness and self-awareness works hand in hand and are imperative to improving the mental health care professional services, opportunities and outcomes for mental health nurse practioners. Additionally, they involve analyzing, evaluating and carefully monitoring thoroughly the instructional behaviors and personal beliefs about the individual with a behavioral or mental disorder value of cultural diversity (Fitzpatrick & Kazer, 2006). In this case, corresponding norms and behaviors have to be modified to encompass more perceptions and more positive knowledge about cultural diversity. Moreover, in order to engage in the efforts and continuous critiques as far as critical consciousness, unconsciousness and self-awareness is concerned so as to make them more relevant in healthcare professional, mental health nurse practioners need to have a thorough comprehension of their very own culture first, different ethnic group’s cultures and how all this cultures may influence healthcare professional (Ramsey, 2012). Balancing critical consciousness and self-reflection in nurse-client relationship is one of the most challenging attributes to mental health nurse practioners but is something that can be accomplished. Additionally, a natural step to begin with is some of the challenges, barriers and obstacles that may interfere with the healthcare process when it comes to critical consciousness and unconsciousness (Bailey et al., 2010). Some of the barriers revolve around the mental health nurse practioners self-reflection challenges in terms of racial, ethnic and cultural diversity (Lind et al., 2011). According to the critical thinking theory, it is believed that, it is only via critical discussions and criticisms that individuals can realize the truth (Bailey et al., 2010). In other words, a clear reflective thinking is triggered by a perplexed condition that invites guesses about how to implement and resolve the issue at hand. In this case, the rational problem solution pauses to strategize the problem so as to develop a hypothesis (Abedi et al., 2005). Unconscious processes during the nurse client relationship In most cases the unconscious process occurs when the mental health patient is not in a position to communicate clearly or rather is withdrawn. During this stage, the only communication that occurs is between the family members and the mental health healthcare professional (In Zandvliet, 2014). Additionally, high quality interaction with the patient’s family members is the backbone of the science of mental health nursing at this stage (In Zandvliet, 2014). By so saying, it means that, it affects the individual with the mental or behavioral disorder’s well-being significantly as well as the outcome quality of the mental health nursing care (Rose et al., 2008). Above all, good interaction with the patients family during the unconscious process is in one way or the other related to the family satisfaction overall with the mental healthcare services. In simple terms, the maintenance of this interrelationship depends entirely on the patient’s family and the mental health nurse in charge (Bailey et al., 2010). However, one notable cry is the general conduct of mental health nurses in the absence of the doctors since most doctors attend to their wards occasionally and in most cases they are only available to attend to seriously mentally sick patients (Anoosheh, 2009). Therefore, identifying and comprehending factors that facilitate good interactions between the patient’s family and the mental health nurse as well as the challenges will be of great help to the patents under mental healthcare (Lind et al., 2011). In other words, during the unconscious process, it is important for the mental health nurse to establish ways of understanding the problems and the issues affecting the patients through proper communication and fostering good relationship with the patient’s family or any other individual associated with the patient (Bailey et al., 2010). By so saying, it means that the dignity of the patient is one thing that the family values most so they will cooperate for the well-being of the mental health patient. Conclusion It is universally known that the therapeutic nurse-client relationship is one of the most important healthcare professional attributes (Fitzpatrick & Kazer, 2006). Additionally, it is important that the mental health nurse practioners places themselves in the patient’s position so as to understand, practice, and provide good quality healthcare to their patients as well as their families (Aein et al, 2008). However, a code of ethics needs to be formulated so as to ensure that the mental health nurses remain professional throughout their healthcare activities and that their attitude do not affect and influence their interrelationship with planning and implementing patient’s healthcare services (Bailey et al., 2010). Therefore, the major goals of mental health nursing revolves around assisting to comprehend ones conduct, assist others to discover felt needs and put into practice human relations practice to the issues that come up at all professional experience levels (Ghods et al., 2010). References Abedi H, Alavi M, Aseman rafat N, Yazdani M, (2005). Nurse-elderly patient’s relationship experiences in hospital wards- a qualitative study. Iranian Journal of Nursing and Midwifery Research. (29):5–16. (Persian) Aein F, Alhani F, Mohammadi E, Kazemnejad A, (2008). Marginating the interpersonal relationship: Nurses and parent's experiences of communication in pediatric wards. 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