Psychiatric Nursing Theory

Psychiatric nursing is one of the five core mental health disciplines. It functions alongside psychiatry, psychology, social work and marriage and family therapy to address the mental health needs of the community. It takes place in varied settings. In addition to traditional psychiatric hospitals, psychiatric nurses can also work in group homes, drop-in centers, drug and alcohol treatment facilities and outpatient centers. Psychiatric nurses assess and evaluate patients, provide case management services and advanced practice nurses also provide individual, family and group therapy.

Philosophy

• Every discipline has a theoretical basis upon which practice is based. Psychiatric nursing theory maintains that the nurse-patient relationship itself can be healing. Psychiatric nursing is grounded in relationship and interpersonal process. It strives to promote and maintain the patient's highest possible level of wellness and functioning. According to the American Nurses Association, psychiatric nursing is "a specialized area of nursing practice, employing the wide range of explanatory theories of human behavior as its science and purposeful use of self as its art." In other words, the nurse's greatest therapeutic instrument is the nurse herself and her relationship with her patient.

Foundation of Psychiatric Nursing

• Psychiatric nursing theory is built upon the belief that every individual has inherent value and that every person has the potential to change and the ability to become healthier and more self-sufficient. First, people need to have their basic physical needs met. Once this happens, all human beings need to feel safe and loved and that they belong. All people seek self-esteem and self-actualization. Psychiatric nurses help people heal by therapeutically meeting these basic needs that were not met earlier in life. All human behavior has meaning and can be understood only from the person's internal frame of reference. People vary in their ability to cope and psychiatric nursing seeks to increase the healthy coping abilities of the patient by engaging them therapeutically.

Therapeutic Nurse-Patient Relationship

• The therapeutic nurse-patient relationship provides a corrective emotional experience for the patient. The nurse uses both clinical techniques and himself as therapeutic instruments to increase patient insight and healthy functioning. According to Gail Wisarz Stuart, author in the field of psychiatric nursing, "The key therapeutic tool of the psychiatric nurse is the use of oneself." In order to do this successfully, the psychiatric nurse needs to possess certain qualities, including authenticity, empathy, a clear sense of self and a desire to help others. The willingness to share behaviors, thoughts and feelings is a central characteristic of the therapeutic relationship and the nurse needs to be empathetic and emotionally available for the patient to feel safe enough to do this.

Therapeutic Communication

• While there are various theoretical perspectives in psychiatric theory, effective therapeutic communication is necessary to fulfilling the goals of psychiatric nursing in all of them. Even the medical model, which maintains that even the most complex psychological operations arise from the function of the brain and that deviant behavior arises from a brain disorder, requires the ability to be able to therapeutically communicate with the patient even if only to explain procedures and medications and help alleviate fears.

  Therapeutic communication seeks to employ techniques that maximize patient sharing of feelings, thoughts and ideas. It therefore employs communication techniques such as restating, clarification and reflection that encourage communication and seeks to avoid communication styles such as advice giving that discourage openness and sharing. A full discussion of each of the techniques is outside the scope of this article, but a link to a thorough discussion is provided in the Resources section below.

  It is important to keep in mind that all behavior is communication and all communication affects behavior. Nonverbal behavior is as important as verbal. It gives the therapist a great deal of information.

Stages of the Therapeutic Relationship

• There are four basic stages of the therapeutic relationship. The first is called the pre-interaction phase because it happens before the nurse meets the patient. It is one of self-exploration for the nurse. In order for the nurse to be therapeutically effective, it is vital for him to be aware of his own preconceptions, prejudices and fears before he interacts with the patient.

  The second phase of the therapeutic relationship is the introductory or orientation phase. The goals of this stage are to establish a trusting relationship with open communication and formulate a contract between patient and nurse if a contract is appropriate to the particular setting. The contract defines roles, the purpose of the relationship as well as the duration and such details as frequency of meeting. The main task of this phase remains establishment of trust, and a contract exists only to serve that goal.

  The third phase is the working phase, in which most of the therapeutic work is done. The nurse and patient work to help the patient gain insight into his thoughts, feelings and behaviors that can be translated into mutually determined goals.

  The final phase is termination. This is when nurse and patient evaluate progress and share feelings and memories.