The Mental Health Nurse

Introduction:

Angelina presents to the ward with indication of suicidal thoughts without intent or plan, with the following symptoms manifesting “depressed mood most of the day & everyday., feelings of hopelessness, helplessness and worthlessness., decreased interest in her nursing subjects and missing classes, weight loss of ~8kgs., insomnia, psychomotor retardation, fatigue, reduced concentration & attention with all the above symptoms leading to thoughts of suicide without suicidal intent or plan”.

The mental health nurse (MHN) must now instigate therapeutic engagement with Angelina, involving the use of the following select of therapeutic skills suggested by (Browne, Cashin, & Graham, 2012): unconditional positive regard, empathy, and authenticity. These skills will assist in creating trust, and a build therapeutic relationship to start assisting Angelina. After creating a therapeutic relationship, The MHN can introduce potential treatment modalities in order to reduce or even eliminate the reason of admission. These modalities that will be explored include Interpersonal Psychotherapy, Cognitive behavioral therapy, and Motivational interviewing, with a brief mention of pharmacological interventions. Mental Health Nursing goals should focus on building therapeutic relationship, facilitating mood control, returning Angelina to her studies, and the removal of thoughts of suicide.

To fully engage with the Mental health nurse, Angelina must feel safe, accepted, in order to build trust and discuss her concerns. Referring to Cochran (2015), Unconditional positive regard (UPR), is the acceptance and prizing of a client to fully understand them. Cochran (2015) refers to prizing as holding clients with importance, and when uncovering new truths about them, for the Mental health nurse is to celebrate a client’s self-discovery. In Angelina’s case, opening up to the Mental health nurse may be difficult, hence encouragement, acceptance of the client’s circumstances, and celebrating milestones will allow for the client to trust the mental health nurse, hence UPR regard explored in Cochran (2015) would suggest positive therapeutic relationship establishment. In (Lees, Procter, Fassett, 2014), UPR is also stated to be vital to therapeutic engagement, uses anecdotal quotes from anonymous Mental health nurses and clients to portray the effectiveness of UPR, it explores similarly to Cochran (2015) how a rapport can be built.  (Lees, et. al, 2014) also refers to clients’ experiences as positive upon feeling accepted with UPR, with one client stating “I felt that he really cared… Him caring… it showed me that I’m worth something… that I’m worth being alive”. (Lees, et. al, 2014) was more specific towards suicidal clients, which is more relevant than Cochran (2015), a textbook regarding therapeutic relationships and how they are built, but the general consensus leaned towards positive outcomes with the use of UPR. Next, closely linked to UPR is the therapeutic skill empathy.  

Hand in hand with UPR would be the therapeutic skill empathy. Dziopia & Ahem (2008) suggests that just listening and lending the client an outlet to vent is not enough, but a further understanding and appreciation of the problems the client faces is essential to empathize with the patient. Dissecting behaviors and assign meaning to them will allow clients to feel more understood, as construed by Dziopia & Ahem (2008). This source also focuses on respecting individuality as part of therapeutic engagement, that the same approach can be taken for all clients, in Angelina’s case empathy may include exploration of her circumstances and identifying with her in her difficult times.  (Alhadidi, Abdalrahim, & Al-Hussam, 2016) on the other hand is a national survey of Jordanian psychiatric hospitals. This study quantified empathy in a series of questions using the Toronto empathy questionnaire, which focused on patient-nurse interactions and feedback from clients regarding their mental health nurses. (Alhadidi, Abdalrahim, & Al-Hussam, 2016) suggests that “exploring a clients lifestyle”, “assessing psychosocial aspects of the client”, and “keeping the families informed about client progress” were high-ranking items on the empathy questionnaire, which all were aimed to cater towards the client’s needs and build a healthy relationship using empathy. (Alhadidi, Abdalrahim, & Al-Hussam, 2016) refers to empathy in Jordanian nurses, and (Dziopia & Ahem (2008), which discussed nurses in Queensland. Based on geographical location mental health services may not have the same level of therapeutic skills training, however, both articles agree that empathy is a beneficial therapeutic skill to engage clients. Next, the therapeutic skill Authenticity will be explored.

Authenticity, hand in hand with genuineness, assists in building therapeutic relationship as (Shattell, Starr & Thomas 2007) suggests, by looking at a patient as a whole and not focusing on technique. Authenticity involves being engaged not just verbally but emotionally to cater to the client’s needs. For Angelina to trust and be willing to use the MHN as a therapeutic tool, Authenticity must be conveyed. To understand the client’s situation and not judge the client by their condition or stereotype. (Shattell, Starr & Thomas 2007) illustrates the client side of therapeutic relationships, based on feedback from clients, the client appreciates Mental health nurses taking their time to build a mutual understanding. Karen (2014), however, focuses more on the mental health nurse and how the mental health nurse attempts to communicate with the client. Karen (2014) suggests authenticity as “being one’s self”, and this heightens the client’s trust in the mental health nurse. Whilst both articles have different approaches to different perspectives of the therapeutic relationship, both stress the importance of authenticity to build trust.

After building a therapeutic relationship, the mental health nurse can delve into the possible treatment modalities for Angelina. Markowitz (2013) and Crowe et al. (2012)

suggests Intrapersonal Psychotherapy, (IPT) as an effective modality to treat symptoms of depression. IPT uses the connection between real life events and the link to depressive symptoms to assist in client’s struggle against their condition. The assumption for this therapy, as retrieved from Crowe et al. (2012) involves identifying, challenging and confronting real life events that maintain or exacerbate depressive symptoms, and by addressing the real life events, depressive symptoms will subside.  Markowitz (2013) introduces depression as a clinical manifestation, a treatable condition that relieves the client of self-blame. By allowing the client to face the symptoms with the knowledge that these are commonly predicted symptoms, this prevents the client from personalizing the symptoms and creating self-blame.  Markowitz (2013) also suggests that solving individual interpersonal problems directly correlates to positive recovery and alleviation of depressive symptoms. This is referred to as therapeutic optimism, and assists in bolstering the patient’s morale. Markowitz (2013) implies mindfulness techniques that keep the client in the now, and solving problems now lead to a positive mindset. Adopted from Markowitz (2013), the Mental health nurse could explore and analyze the client’s wishes by asking an opening question regarding Angelina’s current moods, focusing on hopelessness and helplessness, exploring communication problems that Angelina may face at the moment, helping Angelina see valid decisions, and role-playing potential challenging interpersonal scenarios. Crowe et al. (2012) compared client feedback from initial contact of IPT to when progress was made and the responses of clients that improved their condition and those that didn’t. Crowe et al. (2012) discusses the changes in client responses, from self-blame and focusing on character traits to identifying interpersonal issues that contributed to the depressive symptoms, and addressed these using suggested strategies by the Mental health nurse. For Angelina to obtain positive outcomes from IPT, Crowe et al. (2012) suggest that Angelina must identify relationship difficulties that link directly to, and reformulate her description of the problems she faces. Angelina may not respond well to IPT if as Crowe et al. (2012) explores, she refers to her problems as something out of their control or she does not want to improve interpersonal relationships. IPT may help Angelina combat her suicidal ideation and assist her assimilation into her university life. To summarize, both Crowe et al. (2012) and Markowitz (2013) explore IPT as a positive therapeutic modality, with Crow et al. (2012) evaluating the effectiveness of IPT on non-receptive patients, and Markowitz (2013) focusing on IPT’s theory instead of application in a study.