Mental Health Essay
In this portfolio I was allowed the opportunity to explore an in depth discussion with nursing theorist Hildegarde Peplau. Peplau explains and justifies her approach to mental health nursing, from this discussion I will summarise the key points she gave details on. I will demonstrate an understanding of her ideas that I received through this summary. Peplau’s model applied interpersonal theory to nursing practice and had a great focus on nurse-client relationship development (Townsend, 2009).
This portfolio will explain Peplau’s belief of interpersonal relationships in mental and psychiatric health being critical, the roles that the nurse assumes to provide an interpersonal involvement with a patient and the phases the nurse-client relationship progresses through in order to implement the interpersonal relationship. Peplau’s theory of interpersonal relations has been used extensively through nursing history, it is used today as a basis for understanding, and providing care within, psychiatric nursing.
Hildegarde Peplau developed her theory for the purpose of assisting nurses to understand interpersonal relationship, to guide nursing practice and so the nurse can care for their patients in an understanding way. Peplau was the first theorist to describe interpersonal relations as the foundation of nursing practice (Townsend, 2009), her theory was described as the “mother of mental health” nursing (Arnold & Boggs, 2007). Peplau believes that interpersonal relationships are the key to mental health nursing, but more in particular developing specific interpersonal connections between a nurse and client (McQuiston & Webb, 1995).
The belief is that the nurse-client relationships should be built interpersonally through person-to-person communication (Craven & Hirnle, 2009). Peplau believed that the interpersonal relationship should be developed in a “doing with” the patient approach opposed to “doing for” the patient (Elder, Evans & Nizette, 2009). Peplau’s nursing model uses the skill of interaction with the patient, as its main theme (Simpson, 1991). Peplau believes the development of skills needed to maintain and nurture the nurse-client relationship to be the most important factor in the process of care for mental health (Simpson, 1991).
Without this, the nurse could not truly be helpful or therapeutic. In the mental health context, a therapeutic relationship allows for a meaningful journey to recovery for the patient, through a shared experience between the nurse and client. Mental health care should not have a focus on medical treatment, but rather on the interpersonal model of nursing, which uses oneself as a therapeutic agent working together with the client (Feely, 1997). Peplau believed the development of trusting relationships to be the basis of successful outcomes (Simpson, 1991).
Peplau designed her model in the belief that the nurse will work in the company of the patient with a focus on the patient’s independent decision making and problem solving, promoting autonomy (Varcarolis & Halter, 2009). Peplau views nursing as a developmental educational instrument, with which the nurse would help individuals, families and communities achieve changes in wellbeing, illness and health care status to improved function (Craven & Hirnle, 2009). The nurse has a need to develop skills in the way of therapeutic and interpersonal communication to be successful in psychiatric nursing.
Communication is a key skill that underpins mental health nursing interventions (Elder, Evans & Nizette, 2009). Therapeutic skills such as listening, observing and talking as a participant, allows the nurse to actively engage with their clients. This communication can help increase the knowledge and awareness of health issues, problems and outcomes (Craven & Hirnle, 2009). Peplau believes therapeutic skills are essential to the nurse client relationship and allow the nurse to be aware of the client’s behaviours and their own responses.
With this awareness, the nurse is able to help in providing assistance, information and encouragement to the patient as needed (Arnold & Boggs, 2007). Within the nurse-client relationship the client, their experiences, issues and problems are the main focus of communication (Craven & Hirnle, 2009). Peplau saw the interaction between nurse and client to be a pathway in developing an understanding of, and exploring, the patient’s needs, feelings, beliefs and attitudes (Simpson, 1991).
Therapeutic communication allows the client to express and work through these feelings, problems and concerns, developing coping skills related to their situation, treatment and care (Craven & Hirnle, 2009). Peplau’s model helps the client and patient to grow, become better people, and have a self-understanding. For the nurse to help the patient to help themselves achieve this growth, the nurse must first understand herself. As Peplau says: Psychiatric patients are lacking the intellectual and nterpersonal competencies so necessary for the work involved in their search for self-understanding. It is the quality of the verbal participation of nurses in their interactions with patients-listening and posing investigative questions-that slowly but surely stimulates the development of the competencies in patients. (O’Toole & Welt, 1994, p. 275) Peplau proposed her model facilitates “forward movement of personality” (Feely, 1997, p. 115), for both the nurse and the patient.
The nurse-client relationship is client focused and goal directed but the nurse also has to assess how his or her role, communication skills, personal history and values may be affecting the interactions (Varcarolis & Halter, 2009). Communication with psychiatric patients can be a major problem, the nurse can relate to the client by self-disclosing appropriate experiences. This works to the client’s benefit in that it may help the client feel understood and respected (O’Toole & Welt, 1994). For the nurse to be able to disclose personal experiences there is a need to have an understanding of self-awareness.
Peplau believed that for nurses to provide effective care, they would need to mature and develop as an individual themselves. This would mean that the patient has a greater opportunity to learn from the nurse about their illness, allowing a larger insight into themselves and their condition (Simpson, 1991). In nursing practice today a nurse can take on different roles to help the mental health patient develop an understanding of their condition. In Peplau’s model the nurse assumes many different roles to provide care for the client (McQuiston & Webb, 1995).
Peplau believes the consideration of roles is essential in accommodating for the patient’s needs (Simpson, 1991). Using nursing roles effectively Peplau believes the nurse can encourage the patient to participate in their own care, care planning and solving problems (Alligood & Marriner-Tomey, 2010). The nursing approach that Peplau intended was as a participant observer, it was intended that the nurse actively engages with his/her clients whilst observing the client’s behaviours and this can be achieved when assuming roles (Arnold & Boggs, 2007).
When speaking of the six roles she identified Peplau states that nurses had to provide nursing services that had favourable outcomes (FITNE, 1997). Peplau’s ideas contain the following examples of roles: stranger, resource person, teacher, leader, surrogate for significant others, and counsellor (Arnold & Boggs, 2007). Mental health nursing involves therapeutic nurse-client relationships. Regardless of other roles the nurse assumed, the nurse and client always begin the relationship as strangers to each other (McQuiston & Webb, 1995).
The role of stranger can be revisited if the client makes progress and then stagnates, as the relationship will be brought right back to this first stage and the client and nurse will have to begin recognising what went wrong and start to understand each other again. The role of resource person can be undertaken by the nurse, for example, when providing information about support groups, and the role of teacher, for example, when educating the patient around symptoms of his/her illness. Peplau highlights the importance of the counsellor role in the process of psychiatric nursing (McQuiston & Webb, 1995).
The counselling role helps the client to understand the meaning of their current life circumstances, and provides guidance in the right direction to make changes (Arnold & Boggs, 2007). Having the knowledge that a relationship changes and moves through phases when nursing a mental health patient, can help the nurse understand the behaviours expected with the stage of the relationship. For example the anxiety the client may be feeling towards the situation related with that stage and having this understanding can help the nurse know how to interact with the patient.
The nurse-client relationship is believed, by Peplau, to develop through four overlapping phases which build on one another (Pubmed. gov, 1997). The phases are generally recognised as the orientation phase, the working phase which is subdivided into two aspects: identification and exploitation, and the resolution phase (Varcarolis & Halter, 2009). The nurse and patient pass through these phases during their interpersonal relationship and learn to work together to resolve difficulties focused on the patients care, the nurse assumes the different roles as discussed above throughout all phases (Arnold & Boggs, 2007).
The first meeting and development of a relationship is the orientation phase. Peplau maintained that the orientation phase sets the ground work for the rest of the relationship (Arnold & Boggs, 2007). This stage can be intimidating for the mental health patient and there will be a lot of tension and anxiety, especially heightened in psychiatric nursing. Peplau believes that the nurse’s response process, through learnt interpersonal skills, can help the patient to reduce and overcome these feelings (Barnum, 1998).
The patient uses this phase to make a comprehensive ssessment of what is happening to him and who around him he can trust and rely on (Simpson, 1991). This phase is where the nurse offers engagement and assesses ways of gathering data from the client, getting to know the situation and establishing a rapport with the client (Elders, Evans & Nizette, 2009). The orientation stage is where the nurse and client work together to define the problem, determine how the client views the problem and what strengths the patient has that can be used to resolve the problem (Arnold & Boggs, 2007).
The second phase, the working phase, in the nurse-client relationship has two parts, identification and exploitation. It is the stage of the relationship where the nurse and client together implement ideas, expectations and goals. They then work through these to develop resolution of the problem and learn how to manage problems. The quality of this phase is that the client will have a feeling of trust making it easier for the client to discuss deep issues (Arnold & Boggs, 2007).
Patients identify with nurses who are open and honest in their approach and who provide them with information (Simpson, 1991). The problem solving ability of the patient grows with this therapeutic approach and will be beneficial to the planning of care. The client will assume more of a partnership with the nurse for implementation of resolution (Simpson, 1991). The first part of the working phase is identification, the nurse and the client will develop goals directed at the resolution of the clients health care needs and the way they are going to achieve them.
This sub phase can be seen in relation to the planning part of the nursing process (Arnold & Boggs, 2007). During this first aspect of the working phase the client identifies problems that need to be addressed through the relationship (McQuiston & Webb, 1995). The second part of the working phase is exploitation, this aspect of the phase acts on the plans recognised in the identification sub phase and sees the patient utilising resources that are required to achieve resolution. Nurses help their clients seek out and use health care services.
They help the client develop personal strengths in order to resolve the issues, allowing the patient to be autonomic at the same time (Arnold & Boggs, 2007). The nurse does not solve the client’s problem but provides the client with the opportunity to explore options and possibilities through assuming a teaching role or resource person role (McQuiston & Webb, 1995). The last phase of the nurse-client relationship is the phase of resolution, also viewed as the termination phase.
This part of the nurse-client relationship is where the nurse brings closure to the relationship helping the client to see the progress he or she has made. Peplau believes this final phase is where the nurse assists the client to review progress towards goals, makes referrals and brings a closure to the therapeutic relationship (Arnold & Boggs, 2007). Arnold and Boggs (2007) suggest that this phase corresponds with the evaluation phase of the nursing process. The resolution for a psychiatric client should involve a change in thoughts, feelings and behaviours (Elder, Evans & Nizette, 2009).
Simpson (1991) says that Peplau believed the resolution process to be a freeing process, where the patient begins to live a healthy life at home. In conclusion every interaction has a beginning, middle and an end. Peplau’s model shows this through four phases of the interactive nurse-client relationship. Working through these phases helps the nurse have a better understanding of the relationship when nursing with a mental health client. Having a consideration of the six role examples nurses take on in the relationship is an important process in providing for the patient’s needs.
Having had this opportunity, to discuss the underlying knowledge of Peplau’s theory, has greatly increased my understanding of the importance in creating a therapeutic interpersonal relationship in mental health nursing. Peplau’s model is a great theoretical coaching framework that will guide my practice. It is necessary for understanding the nature of the problem-solving process within mental health nursing, and gaining knowledge of the pathway that will help the patient to the resolution of their problems.
Mental Health Essay
Within this essay, I will examine the definition of mental health, as well as it’s connection in our daily lives. I will be discussing a particular mental health problem which is depression under mood disorder. By examining a scenario of a patient who I have looked after who is suffering from this mental problem, and the available treatment options. I am please to focus in this topic that made a real difference to people lives, most especially to the patients who are suffering the kind of mental illness. To understand fully what is mental health, let me first start by giving the definition of health. Health as define by the World Health Organization, “is a complete state of physical, mental and social wellbeing, not merely the absence of disease or infirmity”(WHO, 1948).
By examining the definition, one cannot conclude that anyone who is seemingly healthy to their outer appearances but in fact may be there is a possibility that person may have hidden characteristics which may consider or regard them unhealthy. For instance, a person with normal vital signs, example of this is an individual with normal blood pressure of 120/80mmhg (Uren & Rutherford,2004) ,may be suffering from any degree of anxiety or depression. By assessing the physical health of a person is relatively easy by taking health measurement of the body. Nonetheless, mental and social aspects of health are much more difficult to determine. It needs a careful and complex assessment to conclude that the individual is mentally healthy.
Mental health reflects a person approach or ability to adapt and respond to life by communicating emotions, giving and receiving ideas, working alone as well as with others, accepting authority, displaying a sense of humour and coping successfully with emotional conflicts (Shives & Issaacs p.6). Another definition of mental health is a state of wellbeing in which individual realises his or her own abilities, can cope with the normal stresses of life productively and fruitfully, and to be able to make contribution to his or her community (World Health Organization, 2001). It is easy to disregard the intrinsic value of mental health until some unusual circumstances or behaviour is noticed. We live in the world full of challenges such as pressure from work, studies, family issues, financial difficulties, relationship problems and poor physical health.
These are only few examples that affects individual to perceive and act accordingly to their surroundings. Mentally healthy people who achieve self-actualization are able to have positive self concepts and relate well to people and their environment, form close relationships with others, make decisions pertaining to reality rather than fantasy, be optimistic and appreciate and enjoy life (Abraham Maslow, 1970). Problem solving occurs because people are able to make decision pertaining to reality rather than fantasy; they are able to appreciate and enjoy life; optimism prevails as they respond to people, places, and things in daily encounters; they are independent or autonomous in thoughts and action and rely on personal standard of behaviour and values such people are able to face with relative serenity and happiness circumstances that would drive other to self- destructive behaviour, they are creative, using a variety of approaches as they perform tasks or solve problem (cited in Shives, 2002).
Mental illness cannot be viewed in isolation from physical functioning; the two are inseparable. Memory and cognition are mental functions, but because they are initiated in the brain, they are also physical function. A change in brain chemistry- a physical occurence, cause, perhaps by something as seemingly benign as stress- can cause changes in mental functions that manifest as anxiety, panic attacks, or depression. Physical and mental are two inseparable components of the complete human experience. In attempting to understand the complexities of mental illness, it is important to understand that physical and mental, that is, body and mind, cannot exist in isolation from one another ( Marie Thompson,2007 p.5) .
Although scientist do not know exactly what causes mental illness, like cancer, mental illness can strike anyone and variety of causes. Scientist are certain that genetic vulnerability plays a role in many mental illness, since the risks of becoming ill is greater if you have a close relative who suffers from depression, bipolar illness, schizophrenia, anxiety or alcoholism among others. However, no specific gene has yet been isolated that causes any of this illness (James Hicks, 2005 p.2). Mental illness or mental disorders defined as an illness or syndrome with psychological or behavioural manifestation and /or impairment in functioning as a result of a social, psychological, genetic, physical/chemical, or biological disturbance ( The American Psychiatric Association).
Depression is an important global public health problem due to both it’s relatively high lifetime prevalence and the significant disability that it cause. In 2002, depression accounted for 4.5% of the worldwide total burden of disease (in terms of disability- adjusted life year ). It is also responsible for the greatest proportion of burden attributable to non-fatal health outcome, accounting for almost 12% of the total years lived with disability worldwide. Without treatment, depression has the tendency to assume a chronic course, to recur, and to be associated with increasing disability overtime (World Health Statistics ,2007, p. 16). Depression is considered a disorder of mood (sometimes called an affective disorder, 2 signifying the disturbance of “affect”) in all widely used classification and diagnostic schemes. In general, a mood disorder represents a departure from what we might consider to be a typical mood state experienced by most persons most days of their lives.
Depressive disorders are characterized by sad, guilty, remorseful, tired , withdrawn moods and the influence of these moods on a person’s day to day behaviour ( Sam Victor et al., p. 6 ). The term depression is used in variety of ways. In everyday language, it is commonly used to describe feelings of sadness or despondency. These feelings are part of normal emotion and may be the consequence of disappointments or failures. As a medical term, depression can refer to a symptom, syndrome or illness. In its usual clinical context, depression denotes a disorder of mood that is distinct from normality.
Disorders involving abnormalities of mood used to be called manic-depressive but are now more often termed affective disorders. This is more accurate because only a minority of sufferers experience episode of both mania and depression (bipolar affective disorder) and most have recurrent episodes of depression only (unipolar depression) (Malhi, p.1). It is imperative to recognise the severity of depression as it can lead to life threatening such as suicide. Therefore ,it is important for health professionals to assess the potential risks for this. As presence of depression can sometimes not obvious to clinicians, some symptoms, when observed in combination with the others can clearly indicate that a person is in depression.
Symptoms often associated with depressed states include early morning wakening, a feeling of grinding tiredness, loss of energy, loss of sexual interest in relationship, loss of appetite, feeling “down” and feeling of bad temper (Alexander et al, 1994). To maintain confidentiality the patient’s name has been changed to a pseudonym, in order to conform to the Nursing and Midwifery Council Code of Conduct (NMC, 2008). I will call my patient Mrs. M is a 35-year-old woman who complained of feeling very low for the last 4 months but always attributes this from being tired from work.
She was diagnosed with Sero-posivite Rheumatoid Arthritis five years ago but refused to be treated because she believes her joint pains and inflammation can be cured with only paracetamol . Not until her inflammation was uncontrollable and left some of her joints in hands and feet some deformities. Mrs. M. has a husband and two children who are still very young. She describes that the family relationship is good. She was brought up mostly of her childhood by her grandparents. Mrs. M. worked full-time as a Registered Nurse where she was admitted as a patient. Mrs. M has been in the hospital for some time due to the flare up of her disease and over a week I have looked after her. I can still remember when I first met her, the doctor ordered to give her intravenous steroids infusion. It has to be administered through her peripheral line in her right radial vein by Aseptic Non-Touch Technique (ANTT) (Anonymous, NHS Trust, 2007).
This is the protocol to decrease risks of acquiring infection through intravenous lines. To observe how is this being done, I went with my mentor. At first, we greeted her and introduced ourselves. My mentor explained what we were about to do. I observed that Mrs.M. was calm and only answer when we speak to her. It was discussed by her doctor that after having been given steroids , inflammation of her joints will get better and so improve her mobility but she would have some side effects. Mrs. M. knew these will happen which made her felt hopeful but somehow low and upset. As a nurse herself, she was aware the medication would lower her immune system, could experience mood swings, difficulty sleeping at night, increase her appetite in eating and will contribute in gaining weight. I found it interesting as a student nurse to learn how to respond to a particular situation and observe a patient’s treatment can improve his/her disease or condition.
Every shift I am working , I made sure I go and see Mrs. M. For me always visible and ready to listen to verbalise her concerns in consistent way will develop a rapport which I learned was very important in a nurse-patient relationship. I can remember there was a day Mrs. M. was feeling so happy and laughing telling me stories about her family in her own family, her favourite hobby making handicrafts and her experience being a nurse. She also told me how her strength differs prior to the diagnosis of her disease. There were times I saw Mrs. M. not interested in doing anything for the day. She was only lying down in bed crying frustrated in trying to get out of bed independently. She was irritated expressing she did not wish anybody to be near her if not her own doctor or assigned staff nurse. It has been reported she never sleeps soundly at night and always seen sitting at the bedside seemed in deep thoughts. The curtain around her bed was remained closed all the time.
As her student nurse, I made sure I frequently checked and asked if she was needing any help. Whenever she was ready to speak , I was there for her. During one of my conversation with her , I have learnt that she used to be being independent with her activities of daily living and looking after her family. She rarely asked for other people’s help. Since she suffered from the disease, she had some deformities in different joints of her hands and feet which added to her mobility problems. She had mentioned to me how she felt frustrated when she cannot complete her household chores. Mrs.M. remembered the day told by doctor to commence on anti-depressant tablet because she was diagnosed with mild depression, she was very scared her family and friends to know. She had decided not to take any medication for her depression.
After few days of looking after her she is somewhat different from our first meeting. She became more relaxed,expressing her interests in eating her food, more energy when meeting people, good eye contact and happy while talking. To actively listen to Mrs. M was showing her that I can be always ready to listen and trusted like her family or close friend. Although some patients can be quite adamant to take medications for their depression , there are some that are referred for counselling. GP’s frequently find themselves in the position of providing emotional support, advice and counselling to depressed patients in an effort to give reassurance, warmth and encouragement . Indeed, this is probably the most common and effective treatment for the majority of patients with mild depression. In this situation, active listening is more important than advice-giving; paying attention to non-verbal and hidden messages as well as what the patient is expressing verbally, and feeling empathy for their predicament. It should be noted that much of this support is provided by ministers of religion, voluntary agency and self-help support groups (Wilkinson, G.etal).
According to my research for patient to be emotionally responsive, I found out some interventions that nurse can use independently without doctor’s order. Use a warm, accepting, empathic approach. Be aware of and in control of one’s own feelings and reactions (anger,frustration,sympathy). With depressed patient: Establish rapport through shared time and supportive companionship. Give the patient time to respond. Personalise care as a way of indicating the patients value as a human being. With the manic patient: Give simple, truthful responses. Be alert to possible manipulation. Set constructive limit on negative behaviour. Use a consistent approach by all health-team members. Maintain open communication in sharing of perceptions among team members. Reinforce patient’s self-control and positive aspects of patient’s behaviour (Stuart,G.,1998).
Within this assignment, I am going to use (Gibbs, 1988) reflective cycle. I choose to use this cycle because it encourages a clear definition of this project. The analysis of the feelings, the evaluation and the way to make sense of the experience, and pla what needs to be done in the future. It has helped me demonstrate my ability to reflect on my personal experiences in doing this essay and gave the opportunities to explore my personal learning needs. Before I continue my reflective writing ,let me first discuss the importance of reflection. Reflection as defined by ( john, 2000 ) as a window through which a practitioner can view and focus self within the context of their own lives experience in a way that enable them to confront, understand and work towards resolving the contradictions within their practice.
Knowing how to reflect is a process for making sense out of all experience (Taylor, 2000 ). For my first assignment, I have to write a reflective project based on what I have learned. We were asked a project focusing on the subject ,” What is mental health?”. At first, I was struggling to figure out what topic to write about the given subject. I started to collect data from vast resources of books but the more I read, it becomes more difficult to put my ideas into writing. I am getting more frustrated because I was making little progress. My idea was to sit down and write one long essay and then be finished early.
Finally, I decided to write about depression. This essay was about a patient I have encountered and looked after who was diagnosed with sero- positive rheumatoid arthritis. When I wrote this assignment, I have to look back and remembered an interesting nursing experience. Writing this kind of essay was difficult and challenging in a way it was emotional and stressful due to time pressure in meeting deadline and juggling placements and family time. I felt more confident now in dealing with my personal issues as well as dealing with my patient’s physical and emotional needs. I think my writing has improve during this time because of all the different resources and help I have use. With regards to my future assignment, it has broaden my knowledge in constructing my essay. Instead of collecting vast materials to read, I will be more selective of materials to read and will more focus on the specific subject given. I will do more planning and thinking around the topic as much as possible.
The benefit of this approach is that from the start, I can get the sense of the shape my essay will take. To the greater extent, I really enjoyed writing this essay because it is about the professional nursing field which I am pursuing through schooling. I believe that thru studies and placements, I wil develop my capabilities to be a good and proper nurse to help and support every person to be physically, emotionally, socially and mentally healthy. Because of the many things that I have learned and witness from nurses and nursing aids, I feel this reflective essay will help me in my future career.
In conclusion, this reflective assignment demonstrates my ability to show and express my feelings concerning different kind of situations and difficulties while I am writing this project. By basing my own reflection using Gibbs reflective cycle, it gives me the chance to explore, to improve my skills and knowledge to have a better foundation for the nursing career I am aiming for. Through critical reflecting, I can learn from my mistakes and highlight my knowledge and expertise. Nurture yourself with good nutrition: Depression can affect appetite. Appetite is typically decrease and you may loose weight. Sometimes, although appetite is still decrease, you tendto eat for comfort and may gain weight. So you will need to be extra mindful of getting the right nourishment. Proper nutrition can influence a person’s mood and energy.
Identify troubles, but don’t dwell on them: Try to identify any circumstances that have contributed to your depression. If you know what is the cause and you feel down, why not talk about it with a caring friend. Talking is a way to release the feelings and to receive some understanding. Focus yourself and look on the bright side: Depression affects a person’s thoughts, making everything seem dismal, negative, and hopeless. If depression has cause you negative outlook in life, make an effort to notice the good things life has to offer. Consider your strengths and blessings. Most of all, do not forget to be patient with yourself. Depression takes time to heal.