"I just wanted to tell you 'thank you', I can tell you really care." Anonymous, 2015
So often I have heard this statement from my clients. Not to toot my own horn, but I began to wonder personally how much my empathy for the mentally ill population promoted my competency in providing optimal care. So I began to analyze the fundamental components of my work as a psychiatric registered nurse that are conducive to promoting my psychiatric clients' stability.
The fundamental foundation in initiating competent skills as a psychiatric nurse is similar to any specialty in nursing. We must implement the necessary processes of providing the standard of care by using the method known as the nursing process. The nursing process includes the following steps:
Assessment, Diagnosis, Planning, Intervention, and Evaluation.
In saying such I would like to rephrase these steps into the perspective of a mental health nurse. In similar order of the nursing process assessment is viewed as "I need to know what you are experiencing so I can help you", diagnosis as "I listened and acknowledged your needs", planning as "This is what we can implement to meet your needs", interventions as "let's apply these individualized strategies and alleviate your acute circumstances", and evaluation as "How did this work for you? ".
Each stage conveys the primary idea of client - focus care; centering around the client's individuality. However, with clients experiencing severe depression, paranoia, and/or psychosis establishing rapport is essential in obtaining accurate data to promote stability (Decety & Fotopoulou, 2015). This requires implementation of the vital principle of Jean Watson's Theory of Human Caring which is to promote the client to achieve HIS/HER optimal being of holistic health (Suliman, Welmann, Omer, & Thomas, 2009). For the psychiatric nurse this requires empathy that encompasses finding understanding of the client's current stressors, perceptual, and actual needs through genuine interest that encompasses calculated verbal and non-verbal communication (Derksen, Bensing, & Largo-Janssen, 2012).
Finally, the "light bulb" illuminated for me on the reason why my clients felt potentially more considered than their peers. It was a simple math equation of caring by distinguishing individuality, building rapport through sincere, calculated, verbal/nonverbal communication that resulted in an accurate empathic understanding of my clients. Thus, a healthy nurse-client relationship is established providing a platform for a conducive and productive recovery from acute mental illness. The following were communicative actions implemented:
"I need to know, so I can help you":
Establish rapport/ building trust, by active listening, respecting individuality, giving time, maintaining individuality actions throughout each stage
Nonverbal communication i.e. body movement, facial expression
Removing overwhelming stimuli
Discussing more than the reason for admission but general topics of conversation; "implementation of "soft concepts of empathy with hard science" (Derksen, Bensing, & Largo-Janssen, 2012, p. 2).
"I listened and acknowledged your needs": (Decety & Fotopoulou, 2015)
You have noted the external symptoms of this patient
The patient has shared, their internal symptoms experienced
You have noted the congruency or non-congruent behaviors/symptoms in their diagnosis
"This is what we can implement to meet your needs":
Active participation in planning with a client to meet his/ her needs; promoting compliance
Confirmation of short and long term goals; the steps in which the client desires to reach these goals
Suggestions offered and multidisciplinary, familial, and outpatient supports established
"Let's apply these strategies according to your circumstances":
Implementation begins, support measures positioned to encourage
Consensus of specific supportive mechanisms implemented by the multidisciplinary team, and family
The flexibility provided to the client's circumstances
"How did this work for you?":
The noted growth, stagnant, or regression of results reviewed
Challenges acknowledged, barriers noted
Suggestions on interventions that may promote his/her desired outcomes
To successfully implement these steps it is necessary to seek an understanding of the clients' individuality which takes effort, establishment of rapport, and time. Empathy is an essential factor to obtain accurate data, individualize interventions, and best outcomes addressing the clients' uniqueness. As a psychiatric nurse one noted that empathy plays a significant role in providing competent care and optimizing positive outcomes for my acute mentally ill clients. (Decety & Fotopoulou, 2015). Empathy allowed me to care for the client's individuality by grasping an understanding of their personal strengths, struggles, and journey to mental stability. Likewise, empathy is the foundation for competent psychiatric care.
Decety, J., & Fotopoulou, A. (2015, January 14). NCBI Resources. Retrieved March 5, 2015, from PMS US National Library of Medicine; National Institutes of Health: Why empathy has a beneficial impact on others in medicine: unifying theories
Derksen, F., Bensing, J., & Largo-Janssen, A. (2012, December 19). NCBI Resources. Retrieved March 5, 2015, from PMS US National Library of Medicine; National Institutes of Health: Effectiveness of empathy in general practice: a systematic review
Suliman, W., Welmann, E., Omer, T., & Thomas, L. (2009). Applying Watson's Nursing Theory to Assess Patient Perceptions of Being Cared for in a Multicultural Environment. Journal of Nursing Research, 293-299.