Individual Nursing Therapy: Individual Nursing Therapy
In recent years, nursing practice, particularly in psychiatric and mental health nursing, has undergone considerable transformation. Traditional approaches have evolved, and the boundaries of individual nursing therapy have expanded to include more modern techniques, such as brief psychotherapy, crisis intervention, case management, and even family interventions. The shift from inpatient to community-based mental health services has led to limited face-to-face time between nurses and clients. As a result, psychiatric nurses must focus on maximizing the impact of the time they have with patients by employing a diverse range of therapeutic interventions. This increased complexity in mental health nursing has raised important questions regarding the relevance of individual nursing therapy, especially in light of the growing emphasis on psychobiology in mental health care (Kraus, 2000; McCabe, 2002; Raingruber, 2003).
Therapeutic Relationship Building and Peplau’s Theory
The foundation of psychiatric mental health nursing remains the therapeutic relationship. Hildegard Peplau, one of the most influential figures in psychiatric nursing, described the nurse-client relationship as an interpersonal process. This relationship requires the nurse to establish trust, work towards mutually established goals, and guide the client’s personal growth. Peplau highlighted the importance of nurses as the basic tool for promoting the client’s health and well-being (Peplau, 1952).
Peplau’s theory is grounded in the understanding that nursing is a human relationship that is both dynamic and therapeutic. The relationship develops through communication and interaction between the nurse and the patient, which fosters a healing environment. Nurses need to continuously assess the client’s needs and adjust their interventions accordingly to promote positive mental health outcomes.
Phases of Nurse-Client Relationship
Peplau identified distinct phases in the nurse-client relationship, which have been studied and applied in various settings. These phases include:
- Orientation Phase: In this initial phase, the nurse and client meet, and the nurse begins to understand the patient’s needs and concerns. Trust is built, and goals for the therapeutic relationship are established.
- Identification Phase: During this phase, the nurse works closely with the patient to help them identify and express their feelings and needs. The patient starts to see the nurse as a valuable resource for their recovery.
- Exploitation Phase: The patient begins to take full advantage of the nurse’s support and guidance. The nurse facilitates the patient’s exploration of their challenges and encourages them to develop new coping mechanisms.
- Resolution Phase: The therapeutic relationship reaches its conclusion as the patient’s health improves. The patient gains independence, and the nurse helps them transition out of care while ensuring that the goals of the relationship have been met.
Researchers like Forchuk (1995) have studied these phases and the various roles nurses play in the therapeutic process. Peplau’s theory has proven to be a valuable framework for understanding how nurse-client relationships develop and how they contribute to the patient’s recovery.
Other Concepts About Client-Nurse Relationships
Peplau’s theory has inspired many other nursing theorists. For example, Ida Orlando and Joyce Travelbee also emphasized the significance of the interpersonal process in their nursing frameworks. Orlando (1961) focused on nurse-patient communication, while Travelbee (1972) emphasized the humanistic aspect of nurse-client relationships, particularly the nurse’s role in helping patients find meaning in their suffering.
Other theorists, such as Imogene King (1992), built on Peplau’s ideas by integrating communication and interpersonal relationships as central elements of their nursing models. Empathy, a critical component of therapeutic interactions, has been explored in nursing research, with studies showing that it plays a significant role in building rapport and promoting positive outcomes (Evans et al., 1998).
However, as mental health care becomes more profit-driven and inpatient stays shorten, the nature of the nurse-client relationship has changed. Nurses now often have only brief encounters with patients, particularly in hospital settings, which limits their ability to build long-term therapeutic relationships (Vaughn et al., 1995). Nevertheless, the need for individualized nursing therapy remains strong, particularly in complex cases of mental illness, where medication alone is often insufficient for effective treatment.
Psychotherapeutic Therapies
Psychiatric nurses, particularly advanced practice psychiatric nurses, are well-equipped to provide psychotherapeutic interventions. One of the most widely used approaches in mental health care today is brief therapy, which is time-limited, goal-oriented, and more cost-effective than traditional long-term therapy. Psychiatric nurses are particularly well-suited for this approach due to their clinical experience and training in both mental health and community-based care (Shires & Tappan, 1992).
Brief therapy typically lasts for six to twelve sessions, but for patients with chronic conditions, it may be extended over a more prolonged period. Sessions are generally shorter and can range from 15 to 30 minutes. Nurses in community settings often use brief therapy to engage clients actively in their treatment, and may provide therapeutic interventions alongside other services in the patient’s community (Budman & Gurman, 1988).
Psychiatric Nursing at the Community Level
Psychiatric mental health nursing at the community level has become an essential component of mental health services. Nurses working in the community provide long-term therapeutic relationships for chronically mentally ill clients and manage crisis interventions for those experiencing acute mental health crises. Communication skills are vital in this setting, as trust must be established quickly to ensure effective crisis intervention and care management (Wheeler, 1993).
Crisis intervention, particularly for clients at risk of harm to themselves or others, is a significant aspect of community-based mental health nursing. Nurses must rely on their assessment skills to gauge the severity of the situation and take immediate action to ensure the patient’s safety. They also frequently communicate with the patient’s family, who may also be in crisis, requiring the nurse to manage both client and family needs simultaneously.
One crucial aspect of psychiatric nursing in the community is case management. Many clients with chronic mental illness require coordinated care across multiple services. Unfortunately, care for the chronically mentally ill is often fragmented, leading to poor outcomes. However, psychiatric nurses in the role of case managers can help bridge the gaps in care, ensuring that clients receive the support they need to manage their condition effectively (Anthony et al., 2000).
Conclusion
Psychiatric mental health nursing has evolved to meet the changing demands of modern healthcare. Individual nursing therapy remains an essential aspect of psychiatric care, despite the challenges posed by shortened inpatient stays and the increasing emphasis on psychobiological approaches. Hildegard Peplau’s theory of the therapeutic nurse-client relationship continues to provide a valuable framework for understanding how nurses can support mental health recovery.
The integration of brief psychotherapy, crisis intervention, and case management into psychiatric nursing practice highlights the flexibility and adaptability of the profession. Nurses in community-based settings play a critical role in ensuring that mentally ill clients receive comprehensive and coordinated care. While further research is needed to explore how these therapeutic interventions can be optimized, the importance of the nurse-client relationship remains a cornerstone of psychiatric nursing practice. Peplau’s interpersonal framework remains relevant and vital, offering a foundation for nursing interventions in the treatment of mental illness across diverse settings.