Psychiatric Nursing

1. In your own words operationally define psychiatric nursing.

It is a specialty of nursing that cares for people dealing with challenging behaviors associated with mental distress or illness. It is a specialized area of nursing practice committed to promoting mental health through the assessment, diagnosis, and treatment of human responses to mental health problems and psychiatric disorders. Psychiatric mental health nursing is unique that employs a purposeful use of self as its art and power. It is more on interaction, communication, attitude or behavioral approach and therapy and not merely focus on physical and pharmacological treatment.

2. looking back to your experiences in your one-to-one relationship as a background:
2.1. Define nurse-patient relationship in your own words.

It is a basic building block in dealing with mentally ill patients which need to be understood and extend our hand to raise them in their own world and put back in reality. I believe in my experience in the field of psychiatric nursing, healing involves more than medicines and treatment protocols but through effective communication and establishing productive interaction. There are certain guiding principles – purpose, mutuality, authenticity, empathy, active listening, confidentiality and respect for the dignity of the patient- strengthen the entire process and flow through identifiable phases of a nurse-patient interaction.

2.2. Identify the four phases of NPR and describe each by citing specific excerpts from your process recording to illustrate each phase accurately.

There are four phases in NPR, as follows:
1. Pre-orientation – According to Coombs, self-concept is the way to understand the uniqueness of the nurse and the patient, as the basic units of NPR. It represents a self knowledge of one’s coherence and authenticity. How open and honest a person is able to be in a relationship with another person correlated with the self-concept.

2. Orientation – NPR is formally begun at this stage. Identifying self and knowing my patient in his name and other data-related to my patient is essential. Showing my sincerity in caring and interest which may stimulates an atmosphere of trust and hope. Convey honesty.

Ex: “ Magandang umaga sa iyo. Ako si Ms. Rubeth San Diego, nurse. Anong pangalan mo?” ……. “Anong gusto mong itawag ko sa iyo bilang palayaw mo?”

I have set limit at the very beginning of the interaction. It must be clear to the patient my status to prevent from wrong expectations specially I and patient is opposite gender. I used my clinical eye and be observant of the patient’s behavior.

Ex. “ Ako ang magiging nurse mo at ikaw ang aking pasyente.”

Follow it and keep appointments. I informed the patient regarding the date, time, meetings, duration of each meeting, purpose, roles of both nurse and patient, use of information that will obtained.

Ex. “ Narito ako upang malaman ko ang mga concerns mo upang magtulungan tayong maiayos mo ang mga pangangailangan mo.”

3. Working – The patient begins to identify with the nurse and identify problems, which can be worked on. The meaning behind feelings and behavior of the nurse and patient are explored. Peplau (1952, p31) states that when a nurse permits patients to express what they feel, and still get all of the nursing that is needed, then patients can undergo illness as an experience that reorients feelings and strengthens positive forces in the personality. The tasks of this phase are to develop clarity about the patient's preconceptions and expectations of nurses and

nursing, develop acceptance of each other, explore feelings, identify problems and respond to people who can offer help. In particular the nurse assists in the expression of needs and feelings, assists during stress, shows acceptance and provides information. The nurse and patient may make plans for the future.

Nurse: “Mabuti, nakikita ko ang magandang pagbabago sa iyo. Nakikita ko rin ang determinasyon mo upang makauwi. Mayroon tayong gagawin ngayon upang mapagpatuloy natin ang nasimulan nating paraan at lalong maging epektibo.”

Patient: “Sige po, anu poi yon? Simulan na natin.”

Nurse: “Gagawa tayo ng listahan sa malaking papel at ididikit natin sa station. Ito ay magiging gabay mo sa araw-araw upang wala kang makaligtaan sa mga nailista nating mga dapat mo gawin.”

Patient: “Tama, para palagi ko iyon titingnan pagkagising ko pa lang. parang mapa, meron akong guide. Hehehe.”

We are both working to make a checklist of the things that my patient should do to be able to live prodective everyday and so to prove to himself that he can live and interact productively in the community.

4. Termination - The termination phase involves the gradual freeing from identification with helping persons, and the generation and strengthening of ability to stand alone, eventually leading to the mutual ending of the relationship (Peplau, 1952, p39).

My patient abandons old needs and aspires to new goals. He continues to apply new problem solving skills and maintains changes in style of communication and interaction. Termination includes planning for alternative sources of support, problem prevention, and the patient’s integration of the illness experience.

Nurse: “Inaasahan ko na marami kang natutunan sa lahat ng ginawa natin.”

Patient: “Opo, Ma’am. Marami ako natutunan at gagawin ko lahat ng iyon kahit wala na kayo. Kakayanin ko at gagawin ko lahat ng natutunan ko para makauwi na ako at maging maayos ang buhay ko dito.”

2.3. Describe and explain at least 3 various nursing roles which you have actually utilized in working with your client.
Nurses may assume many other roles but in the context of the interpersonal relationship all aim to assist the patient to meet the goals of therapy, need satisfaction and growth (Stuart & Sunden, 1987, p45).

I have done different roles within our relationship. I function as a resource person, providing specific answers to questions made by my patient to clear and give information to what my patient wants to know and ought to know. As teacher, I assist the patient as a learner to grow and learn from experience. I share knowledge to lead my patient to have positive coping mechanisms. As leader, I assist my patient as follower in implementing nursing process and encourage participation in all nursing interventions and therapy. I cast into surrogate roles by my patient based on their significant past relationships. Considerable importance is also assigned to the role being a counselor which is viewed as helping my patient integrates the facts and feelings associated with an episode of illness into his total life experience.