The first nurse-patient encounter in a psychiatric context: an initial study in an action research process

This paper presents an initial study undertaken as the first step in action research concerning the first encounter between the nurse and the patient on psychiatric admission. The specific aim was to identify obstacles and possibilities of starting an ongoing learning process with mutual agreement upon goals and a good working relationship between the principal investigator and the participating nurses. Participant observation and questionnaires, completed by nurses and patients, were used in the data collection. The main finding was the identification of parallel processes concerning patients and nurses as to experiences of the abandonment and the lack of confirmation and autonomy. This initial study confirms the need and satisfies the requirements for continuing the action research process.     

Working under threat: fear and nurse-patient interactions in a forensic psychiatric setting

The purpose of this article is to present the results of a study conducted in a Canadian medium-security forensic psychiatric facility. The primary objective of this qualitative research was to describe and comprehend how fear influences nurse-patient interactions in a forensic psychiatric setting. Eighteen semistructured interviews with nurses were used as the primary source of data for analysis. In brief, the results from this research indicate, as other researchers have demonstrated, that within this highly regimented context, nurses are socialized to incorporate representations of the patients as being potentially dangerous, and, as a result, distance themselves from idealistic conceptions of care. Moreover, the research results emphasize the implication of fear in nurse-patient interactions and particularly how fear reinforces nurses' need to create a safe environment in order to practice. A constant negotiation between space, "at risk" bodies and security takes place where nurses are forced to scrutinize their actions in order to avoid becoming victims of violence. In parallel, participants also described how being able to self-identify with patients enabled therapeutic interventions to take place. However, exposure to the patient's criminal history fostered negative reactions on the nurses' part, which impede nursing work.     

'Something always comes up': nurse-patient interaction in an acute psychiatric setting

In this study, 10 nurses and 10 patients were interviewed to explore factors influencing nurse-patient interactions in an acute psychiatric inpatient facility. The six themes that emerged from the nursing interviews were; environment, something always comes up, nurses' attributes, patient factors, instrumental support and focus of nursing. The four themes from the patient interviews were; nurses' attributes, role perceptions, clinical care, and time. These findings have implications for clinical practice, the nurses' role and nursing education.     

Interventions in the nurse-patient relationship in forensic psychiatric nursing care: a Swedish survey

Nurses (Registered nurses, RN, and Licensed Mental Nurses, LMN) working in five Swedish forensic psychiatric units filled in a questionnaire designed for general psychiatric nursing, but modified for forensic use. In this report, data concerning the extent to which treatment interventions included verbal elements, and the focus of these nurse--patient verbal interactions, were analysed. The most commonly used interventions were 'social interaction', 'regular communication' and 'social skills training'. The most common focus in verbal nurse--patient interaction were 'explaining consequences, confronting and encouraging the patient to talk about his/her crime/behaviour', 'interpretative communications with the patient', and 'communication about functions in daily life'. The salient findings were: (1) seven of the fifteen interventions used by the nurses included verbal elements to a great extent; (2) nurses often used confronting interventions, despite the fact that the large EE (expressed emotion) literature suggest that hostility and critical remarks may provoke a worsening of symptoms among psychotic patients; (3) there was only little correspondence between actual practice and theoretical models; and (4) there were unexpectedly small differences between the two professional groups (RN and LMN), suggesting that the roles are not distinct.     

Involuntary commitment: implication for psychiatric nursing practice

The characteristics of involuntary psychiatric commitment (IPI) may cause implications on the nursing/patient relationship. The objectives of this study were to list the forms of nursing care delivered to psychiatric patients, according to the type of commitment; analyze the reaction of the nursing team towards the IPI patient, and discuss on the implications that IPI have on the practice o psychiatric nursing. A field research was performed with the nursing team of a psychiatric institution in Rio de Janeiro. After 50 hours of participant observation and 9 of focal group meetings, we found that the teams are concerned with the clinical evolution of the patients. No references of the nursing team to the IPI patient were observed. There are no records or actions of any kind that would suggest a specific look towards this type of patient. Nursing professionals are not able to clearly identify this type of patient, thus the care is provided as per the patient's needs or requests.     

Sociology and nursing: Role performance in a psychiatric setting

The role of sociology in nursing continues to cast new light on many aspects of health and illness. Over the last 20 years, nursing practice has seen sociological theory become a valuable clinical tool, both in the diagnosis and prognosis of a wide range of illnesses and long‐term conditions. Nevertheless, of these, the sociological examination of mental health problems and its impact upon nursing practitioners has received little coverage, simply because, as a discipline, mental health nursing has historically been wedded to a biomedical model, one which continues to embrace psychiatry/psychology as the driving force in the diagnosis and treatment of psychopathology. Adopting a sociological approach, this paper brings to light previously unexplored insights into the way nurses interact with patients experiencing mental health problems. Drawing on social interactionist methodology, this paper considers depression and other mental health problems in relation to current psychiatric nursing practice. Specifically, the paper focuses on aspects of role performance and interpersonal care in a psychiatric setting, and the impact the individual role may have on the wider aspects of institutional and official practices. The paper concludes by making a number of recommendations/observations for nursing practice.     

Experiences of student nurses in a multicultural nurse-patient encounter

South African nurses have accepted the challenge that was brought about by the Health Reform Policy of 1990 which decreed that health service centres be opened to people of all cultural and racial groups. However, studies on transcultural; nursing have revealed that, problems have occurred during a multicultural nurse patient encounter. Most of these studies have approached the problems from the patients point of view, this study was therefore an attempt to look into the problem from the nurses point of view. The researcher was interested in exploring the sources of such problems, their effects on the nurse patient relationship as well as to find out from the respondents, the possible solutions to such problems. Through focus group interviews (FGI), respondents who had experienced problems with culturally different patients were given an opportunity to reflect on those experiences, report on these and recommend possible solutions. The results revealed that differing perceptions about the encounter between the nurse and the patient, previous experience which led to the formation of stereotypes, was the major source of problems. The results further revealed that stereotype relevant information, if used during the nurse patient encounter, led to inadequate care delivery. The solution to the problem according to the results, would be a positive approach to the problem of cultural differences.     

Origins of difficulty in the nurse-patient encounter

The purpose of this study was to look beyond the patient as the source of difficulty and to examine the context of care encounters for factors that contributed to the construction of difficulty in the nurse-patient encounter. The study explains the origins of difficulty in the nurse-patient encounter. This explanation broadens the thinking limits previously imposed by locating difficulty within the individual. Key elements of this explanation are: knowing the patient minimizes the likelihood of difficulty in the encounter; and families, availability of supplies and equipment, who is working, and care space changes are contextual factors that contribute to the construction of difficulty in the nurse-patient encounter. Awareness of these findings has implications for the strategies nurses employ in difficult encounters.     

Respect in forensic psychiatric nurse-patient relationships: a practical compromise

The context of forensic psychiatric nursing is distinct from other psychiatric settings as, it involves placement of patients in secure environments with restrictions determined by the courts. Previous literature has identified that nurses morally struggle with respecting patients who have committed heinous offences, which can lead to the patient being depersonalized and dehumanized. Although respect is fundamental to ethical nursing practice, it has not been adequately explored conceptually or empirically. As a result, little knowledge exists that identifies how nurses develop, maintain, and express respect for patients. The purpose of this study is to analyze the concept of respect systematically, from a forensic psychiatric nurse's perspective using the qualitative methodology of focused ethnography. Forensic psychiatric nurses were recruited from two medium secure forensic rehabilitation units. In the first interview, 13 registered nurses (RNs) and two registered practical nurses (RPNs) participated, and although all informants were invited to the second interview, six RNs were lost to follow-up. Despite this loss, saturation was achieved and the data were interpreted through a feminist philosophical lens. Respect was influenced by factors categorized into four themes: (1) emotive-cognitive reactions, (2) nonjudgmental approach, (3) social identity and power, and (4) context. The data from the themes indicate that forensic psychiatric nurses strike a practical compromise, in their understanding and enactment of respect in therapeutic relationships with forensic psychiatric patients.     

Managing diabetes in the hospital setting: a nurse-patient partnership

People with diabetes who are admitted to hospital often experience deterioration in their blood glucose levels because of their presenting condition. This paper discusses the principles of diabetes control, how hospital admission may affect the condition and how nurses can contribute to providing state-of-the-art diabetes care.     

Negotiating commitment and involvement in the nurse-patient relationship

The relationship that is established between the nurse and the patient is the result of interplay or covert negotiations until a mutually satisfying relationship is reached. Depending on the duration of the contact between the nurse and the patient, the needs of the patient, the commitment of the nurse and the patient's willingness to trust the nurse, one of four types of mutual relationship will emerge: a clinical relationship, a therapeutic relationship, a connected relationship or an over-involved relationship. If the nurse is unwilling or unable to be committed to the patient, a unilateral relationship will develop, with the patient continuing to use manipulative or coercive behaviours, attempting to increase the nursing involvement in the relationship. If the patient is unwilling to trust the nurse and accept his or her illness situation, she or he will manifest 'difficult' behaviours, be withdrawn or elope. The changing nature of the relationship, and the conditions and consequences of each type of relationship are discussed.     

The first experiences of clinical practice of psychiatric nursing students in Taiwan: a phenomenological study

Aims and objectives. The purpose of this study is to understand the experiences of psychiatric nursing students during their first encounters with psychiatric patients in a clinical setting. The objective is to assist educational professionals in mental health to improve teaching strategies. Background. In clinical settings, student psychiatric nurses have to face complex problems and situations that can result in distress. Sometimes the student nurse will be uncertain of their own ability and this is reflected in a sense of fear on the part of some nurses. However, little research has been conducted into the first clinical experiences of such nursing students in Taiwan. Design. A qualitative phenomenological study was devised to explore what psychiatric nursing students perceived during their first experiences of clinical practice and narratives were analysed using Colaizzi’s seven‐step method. Method. A phenomenological approach and purposive sampling were used in the study. Face‐to‐face interviews were conducted to collect the data and during the process of data analysis we established epochs (bracketing) and focused on the reality of the student nurses’ experience to keep the data objective. Results. Four themes were identified: breaking the stigma of mental illness, developing a trusting relationship with the patient, gaining professional knowledge and skills and the process of student growth. Conclusion. The findings from this study demonstrate that it is important to understand the perceptions of students during their first experiences of psychiatric nursing in a clinical setting and highlight the importance of educational programs. Relevance to clinical practice. By understanding the emotional process that psychiatric nursing students may go through during their clinical practice, educators can be better able to design suitable training courses in the future.     

The first year: employment patterns and job perceptions of nursing assistants in a rural setting

Meyer D., Raffle H. & Ware L.J. (2014) Journal of Nursing Management 22 , 769–778 The first year: employment patterns and job perceptions of nursing assistants in a rural setting Aim The aim of this study was to follow rural certified nursing assistants (CNAs) (n = 123) in the United States for 1 year post-training to identify retention and turnover issues in the long-term care (LTC) setting by exploring the CNAs’ perceptions of the LTC work experience. Background Turnover among CNAs impacts the quality of care, imposes a financial burden on facilities and taxpayers, and creates increased stress and workloads on those who remain. Method A longitudinal survey design was used to track individuals completing CNA training for 1 year. Results At 1 year post-training, 53.7% of respondents currently worked in LTC, 30.9% worked in LTC and left, and the remaining 15.4% never worked in LTC. Conclusion While the training site does not appear to impact retention, the first 6 months of employment appear critical. The CNAs cited pay as a reason for leaving LTC, but better pay did not characterize the jobs taken by the CNAs who left. Implications for nursing management This study highlights the importance of the first 6 months of employment to retention and provides practical information for nurse managers evaluating the resource-effectiveness of hosting training programmes. Additionally, the key issues influencing retention were identified and practical suggestions for nurse managers to improve retention are provided.     

The faceless encounter: ethical dilemmas in telephone nursing

Aim. This paper aims to present the findings of a study designed to describe ethical dilemmas, in the form of conflicting values, norms and interests, which telenurses experience in their work. Background. Telephone nursing is an expanding part of health care. Telephone nurses in Sweden assess care needs, provide advice, support and information, and recommend and coordinate healthcare resources. Lately, ethical demands on healthcare professionals in general have increased. The reasons include new biomedical competence, an ageing population and constrained resources which have made priority setting a primary concern for doctors and nurses. When ethical problems arise, colleagues need open dialogue. Despite this, nurses lack such a dialogue. Method. A purposeful sample of 12 female telenurses in Sweden was interviewed twice during 2004 and 2005. The transcribed interviews were analysed thematically. Results. Five themes were found: talking through a third party; discussing personal and sensitive problems over the phone; insufficient resources and the organization of health care; balancing callers’ information needs with professional responsibility; and differences in judging the caller's credibility. Conclusion. The present study has identified five different themes in which Swedish telenurses experience ethical dilemmas in their work. This shows how ethical dilemmas in various forms are present in telenursing. Questions of autonomy, integrity and prioritizing are particularly highlighted by the participating nurses. Telenurses in Sweden also experience new ethical demands due to a multicultural society. Although several of the identified dilemmas also occur in other areas of nursing we argue that these situations are particularly challenging in telenursing. Relevance to clinical practice. The work organization should provide opportunities for ethical competence‐building, where ethical dilemmas in telenursing are highlighted and discussed. Such a strategy might lead to decreased moral uncertainty and distress among telenurses, with positive consequences for callers.