NEW YORK NURSE: March 2008
by Elizabeth Gallagher, RN, BSN, Director of Nursing, Hutchings Psychiatric Center, Syracuse, NY, for the Foundation Center for Nursing Research Planning Committee
The therapeutic nurse-patient relationship is the foundation of nursing practice. This relationship is even more important for nurses working with patients who suffer from mental illness. Besides facing social stigma and misconceptions about mental illness, these patients can be guarded, paranoid, and fearful. Their perceptions and feelings about themselves and others make it very challenging for healthcare professionals to develop a safe and trusting relationship.
Psychiatric nurses are pulled in many directions to provide quality patient care. The current nursing shortage, regulatory constraints on staffing, and the increased demands of nursing tasks all compete for the time nurses can spend with their patients. Nurses must possess not only psychiatric knowledge, but also expertise in caring for and understanding their patients.
Several nursing theorists, including Peplau, Watson, and Orlando, have researched the nurse-patient relationship and validated that this crucial bond promotes patient recovery (Kolcaba, 1994). We know that both verbal and nonverbal communication influences these relationships, which must be formed in just a few minutes. But how can we tell if a patient feels understood and safe in this relationship? And what can we do to convince a fearful or guarded patient that we do indeed understand and want to help them in their recovery?
Shattel, McAllister, Hogan, & Thomas (2006) tried to explore these questions by first describing what it means to the patient to be understood. They used an existential phenomenological approach, interviewing participants and asking them to describe and identify feelings. The responses were then carefully analyzed for meaning.
The participants in this research study revealed that they knew what it is like to be misunderstood rather than being understood by healthcare professionals. However, the participants were able to identify three themes that did help them feel that they were being understood. These included “I was important,” “It really made us connect,” and “They got to my level.”
For patients, “I was important” meant that healthcare professionals asked how they were doing, remembered something they had said in the past and asked about that, or stated that they thought about them between their sessions. “It really made us connect” revealed that being physically touched by the professional was significant. For instance, being touched on their arm or shoulder made patients feel that they were being heard and were receiving feedback in a positive, nonverbal way. The phrase “They got to my level” identified that participants felt more comfortable talking to professionals who disclosed personal experiences. The prevalent theme among all participants was that patients with mental illness need to be treated with respect as individuals.
The use of touch and disclosure has long been debated among healthcare professionals. The provider behaviors that promote the sense of “being understood” among patients need further exploration. Such research could influence our understanding of the role of touch and personal disclosure in the nurse-patient relationship.
Existing research describes simple nursing interventions that helped patients feel that we understand and value their perspectives of our relationship. Taking the time to listen, making good eye contact, asking patients how they are doing, and checking on patients personally are all easy interventions that patients stated enhanced their sense of being understood. The provider should consider how these approaches will help or hinder the patients’ recovery.
Despite time constraints placed on us, we cannot minimize the importance of feeling cared for, understood, and valued. Our focus cannot afford to be task-oriented, but must continue to focus on patient care to promote recovery.
Kolcaba, K. (1991). An analysis of the concept of comfort. Journal of Advanced Nursing, 16, 1301-1310.
Shattell, M, McAllister, S., Hogan, B., & Thomas, S. (2006). She took the time to make sure she understood: Mental health experiences of being understood. Archives of Psychiatric Nursing, 20, 234-241.