Nursing care for mentally ill patients

It is not easy for a nurse to provide nursing care for mentally ill patients as it is a complex process that has special requirements. Great understanding for human minds and behaviors is needed by a nurse who has a therapeutic relationship with a mentally ill patient. (NHS, 2014) The current assignment is a personal reflection about an experience I had in the mental illness department at a hospital as training.  It reflects a therapeutic relationship with a patient who is mentally ill receiving the care. The assignment is reflecting the skills and experiences I gained through providing a holistic care for a patient in the mental health setting in the hospital in addition to reflecting the challenges and boundaries I faced through having such a therapeutic relationship with the patient. There will also be a discussion for the used strategies in developing a therapeutic relationship with the mental illness patient.

Patients in mental health setting are not easy to deal with as other settings' patients due to what they suffer of mental and psychological problems and due to their unexpected reactions that may surprise a nurse dealing with them, shock her and perhaps make her frightened of treating such patients. Yet a therapeutic relationship between a nurse and a patient with mental illness is very important. My experience was in the setting of mental health in a hospital, I was at first hesitated and not very brave to deal with the patients there as a result of the background I had about strange actions of patients with mental illness but sooner I had some self confidence and I encouraged myself . I entered the ward with my colleagues who made some noise that seemed to annoy the patient female in the mental health ward as one of them suddenly shouted at my face as I was in the front of other colleagues, this scared me but after a moment, the patient laughed loudly and I also encouraged myself and entered. I then realized that voices of my colleagues disturbed the patients so this one shouted at us and laughed to alarm us not to make noise again. This made me understand that mental health patients must be dealt with great care, understanding and respect. I met another patient who was silent and straying but looked calm and decent. I smiled at her, she didn't smile at first then I smiled again gently and then she smiled to me. I got some information about her Ms. Jane was a 28 years old Saudi female who has schizophrenia for five years and was always alone, with aggressive attitudes. It was difficult for me to build a therapeutic nurse patient relationship with her, perhaps I did not have enough skills or experiences about how to break the ice with a mental illness patient. I tried talking with her by asking her about her name, age and family. She did not reply to me and then she said that "life is not a garden for children because it is not quiet" so I understand that she didn't want me to speak too much. I noticed that she needed to talk so I showed to her that I am listening to her carefully and she began talking freely. Hence I was sure that listening to the mentally ill patient is very important for a nurse to build a therapeutic relationship with a patient with mental illness in order to let the patient feel that the nurse is caring and interested in helping the patient and then to trust the nurse and talk which helps provide the proper nursing care for the patient. Ms. Jane is the only girl for her mother and father, she was never married before and her education level was mediate. The case began to suffer since past five years but her childhood history tells that she had epileptic seizures but she followed a mental therapy then seizures disappeared but she rarely has them now. 

According to (Fortinash, 2008)mental illness is referred to as an illness which leaves effects on the person's abilities whether cognitive, social or emotional ones and hence the patient is in risk of causing harms to oneself and to other people, symptoms associated with it are such as irrational behaviors, hallucinations, delusions, mood disturbance and strange thought form. It can be diagnosed as depression, schizophrenia or others according to the symptoms. The relationship between a nurse and a client which must be a therapeutic one can be defined as an interaction that occurs between the nurse and the patient and it aims to provide a healing atmosphere that helps the patient by learning about his or her basic needs and limit any other further illness or complications and psychiatric mental health is mainly based upon such successful relationship. (Jakopac and Patel, 2011)

I tried to make an interaction with my patient through learning about her needs and encouraging her to express herself. There are stages involved and required for a nurse client therapeutic relationship such as the orientation stage when assessment is very important to be done by the nurse as it involves introducing the nurse to the patient and explaining goal of care. (Ostendorf et al, 2013)I told Ms. Jane about my name and told her that I am the nurse to care for her, I also intended to use nonverbal communication methods with her as smiling and simple hand signs. I tried to assess her behaviors and reactions to recognize her needs as I collected as much information as possible about her. According to (Ballard et al, 2012), working stage follows that of orientation stage in the nurse patient relationship. The nurse has to spend enough time to convince the patient to talk and nonverbal communication is very important to do this, a nurse has to show respect and interest to the patient to raise levels of trust and relieve stress. (Rogers et al, 2012)  I gave X, my patient, a flower and then she smiled and I began some simple discussions with her as she expressed some fear of light and when I closed it, she relaxed and talked a little about herself. I assessed her readiness to communicate with me, her language and her desire and ability to talk. I noticed that the patient stopped talking when I tried to interrupt her or when I talked too much so I realized I shouldn't have done this. According to (Basavanthappa, 2011), the resolution stage comes next to the working stage in a nurse client therapeutic relationship. The last stage which is the termination stage or the resolution stage involves the nurse's review for patient's progress and relief of symptoms, evaluation for goals achievement, setting possible problems the patient may encounter after discharge and thanking the patient with promises of more interventions. (Videbeck, 2011). I thanked Ms. Jane and promised her to come again then I assessed my goals achieving, reviewed the progress of patient as she was very communicative when she trusted me and told many important points about her feelings and needs and I suggested that she might face problems of anxiety, loneliness and depression after discharge if her life circumstances did not change. (Craig and Davies, 2009) 

The interpersonal relationship between a nurse and a patient with mental illness can be faced with challenges that may work as obstacles against the nurse's role in providing care within a client centered therapy. (Nizette et al, 2012)During my work with X, I faced many challenges such as encouraging her to speak as at first, she resisted to talk with me but I exerted great efforts to encourage her. Her language was not very clear when she talked as some words were not understood by me.  I also found some difficulties with dealing with the patient's family, they refused to confess she is mentally ill and her mother said she does not have to talk about her daughter's life. It seemed to me that culture and traditions of the family prevent them from confessing that they have a patient who is mentally ill. Among the challenges I faced was working in a noisy and busy environment as the room was not having enough quietness in addition to the existence of many persons around me. I also faced another challenge which was shortage of time as I didn't stay with my patient enough time due to many reasons as she had to take her medications. Another challenge was my lack of enough listening skills as sometimes I interrupted the patient which made her angry and stopped talking. Another challenge was that the patient's profile lacked some important information about the patient and her physician was very busy to provide me with the information I needed.

I learnt many things through this experience such as learning that a nurse has a very important role in mental care as a caregiver but not to do her tasks only without deep assessment. (Boyd, 2008) I learned how to care for a patient with mental illness, how to communicate with the patient, nursing skills and many techniques of therapeutic communication such as how to build a successful client nurse relationship. According to (Lain et al, 2013), therapeutic communication is a very vital step for a nurse dealing with a mental illness patient as there are signs and body language that should be used with the patients and a good nurse should avoid any thing that can make the patient angry or nervous. I learned many skills and strategies of assessing the patient from many sides regarding her illness history, current physical state, violent attitudes, communication, needs and medication following. I also learnt to make self assessment for my work. According to (Varcarolis, 2010)assessment is a main step a nurse should process with patients with mental illness in order to learn about patients' suicide attitudes, depression, physical health and feelings of the patient in order to focus on the patient's problem leading her to have the illness. I learned to face any challenges that hindered my work and frustrated me as according to (Bonham et al, 2013) nurses can change work challenges to opportunities such as making good use of the limited time by specifying everything to be done with the patient before beginning the work. I didn't have good plan before beginning my work. I also learnt many things about how to deal with the patient's family and not to address them as having a mental patient if they cannot cope with this but to be careful when dealing with them to encourage them to help in the care process. According to(Shives, 2008), the family helps a lot in improving the state of patients who have psychiatric disorders because the family members can support the patient to overcome the illness and respond to treatment.

Conclusion

Nursing care provided for patients with mental illness require many strategies and procedures that nurses have to be acquainted with in order to provide a care that helps improving the patients' quality of life. A nurse's role is a major one that needs many skills to be learnt and it also needs to be assessed and evaluated by the nurse herself. There are many challenges that a nurse may face during providing the care in the mental illness setting but a good nurse needs to learn strategies to overcome such challenges so as not to work against care processes the nurse provides as being a major caregiver.      

  

References

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