Mental illness is quite difficult to cure. As a rule, these diseases, in a best-case scenario, can transform into a state of persistent remission, but the absolute cure of such a patient is a rarity in medical practice. However, the task of convalescence can be successful in the case of reasonable interaction between medical personnel and a patient. One of the main participants in this process is a nurse. The purpose of this paper is to study the need to establish a trusting relationship between a nurse and a mentally ill patient, in particular those suffering from schizophrenia. With this purpose, the practical possible actions of the nurse in relation to the patient have been considered. Consequently, a nurse is an integral part of the process of treatment of a mentally ill person, and trusting contact with her/him is one of the preconditions for successful recovery.
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Keywords: schizophrenic patients, mental illness, nursing
The Role of a Nurse in Caring for Schizophrenic Patients
It is difficult to overemphasize the role of a nurse in organizing the medical process and caring for mental patients, since her/his activities include a wide range of issues. The self-realization of the therapeutic approach to the patients and, ultimately, the state of remission or recovery can not be possible without it. It is not the mechanical fulfillment of medical prescriptions and recommendations, but the solution of everyday issues, which include the direct conduct of medical processes while taking into account and knowing the possible side effects and complications. It is necessary to analyze the process of providing care to mentally ill patients, especially those with schizophrenia, as well as its peculiarities to understand how nurses can foster the patients’ recovery.
The work of medical personnel in conditions of psycho-neurological institutions differs in various hospitals and has a number of features. These features arise from the fact that many patients do not understand their painful condition, and some do not consider themselves to be sick. In addition, a number of patients with a frustrated state of consciousness suffer a sharp motor excitation. Therefore, medical personnel in psychiatric hospitals should meet special requirements, which include constant vigilance, endurance and patience, sensitiveness and affectionate attitude, resourcefulness and strictly individual approach to the patient. Knowing all the details of care, supervision, and support for the mentally ill are crucial obligations for a nurse in a psychiatric institution.
The nursing process brings a new understanding of the role of a nurse in practical health care, demanding from her/him not only good training techniques, but also the ability to creatively treat the patients, work with them as with persons, but not as a nosological unit. Constant contact with the patient makes the psychiatric nurse the main link between a patient and the outside world. The nurse’s task is to find out his/her concerns and help in eliminating his/her ailment. Often, the outcome of the disease is dependent on the existing relationship between the nurse and the patient. The nursing process comprising five stages involves achieving certain goals in helping people with mental disabilities.
The first stage includes the collection of anamnesis, physical examination, and laboratory data. The nurse collects information about the patient examining all areas of his life and determines the need for care. Moreover, observation is an important aspect of the work of a nurse of a psychiatric profile. While communicating the nurse pays attention to the patient’s behavior (natural or affected), his/her facial expression, intonation, posture, as well as psychopathological disorders of perception, thinking, emotion, consciousness, memory, and intellect. The collection of information will determine whether the patient can function as an independent person or he/she needs an outside help.
The second stage determines the patient’s problems. It is necessary to distinguish current problems (anxiety, fear, pain) and potential problems that may arise from improper treatment or care. An important task of this stage is the formulation of a nursing diagnosis. It is aimed at revealing the body’s response to the disease and can be recorded as pain, weakness, anxiety, sleep disturbance, and others.
At the third stage, the nurse makes a plan for nursing intervention taking into account the individual characteristics of the patient. It is a detailed enumeration of the nurse’s actions necessary for the implementation of nursing care. The nurse must clearly understand the identity of the patient and the peculiarities of his/her environment (family, relatives). It is necessary for the nurse to develop goals and objectives for herself, which will help the patient to adapt to new conditions.
The fourth stage is the implementation of the action plan. Its main goal is to provide appropriate care in accordance with the prepared plan to meet the needs of the patient and his speedy recovery. This stage includes independent nursing interventions when the nurse takes actions on her/his own initiative, as well as according to the appointment of a doctor. It is crucial to establish the trusting relationship between the nurse and the patient during this period.
The fifth stage is the evaluation of the results of care. It is grounded on the analysis of the effectiveness of work performed by the nurse her-/himself, the patient, and his/her relatives. It is important to assess the results of care, the mental, somatic, and social status of the patient. If necessary, especially in case of patient’s recall of the care received, the management can review the nursing plan.
Care of patients with mental disabilities has a number of specific features. First of all, it is necessary to stress that the nurse deals with a person who due to a disease cannot control his/her emotions and actions. Therefore, a nurse caring for a mentally ill patient should be constantly on guard to prevent the occurrence of possible attacks of aggression or seizure. A nurse should also have such qualities as patience, vigilance, and resourcefulness, since in the treatment of mental illness it is very important to provide the necessary assistance in time and to be able to react properly in the current situation.
Care for the sick should consist not only of physical, but also of moral support. A nurse caring for a mentally ill person is obliged to be polite, affable, affectionate, and sympathetic. When caring for patients with mental illnesses, it should be borne in mind that many of them can not self-service themselves. The patient needs to receive constant help in solving seemingly simple questions such as washing, dressing, eating, and even getting out of bed (Fontaine 417). Care of patients with schizophrenia is especially complicated since the patient’s normal condition can sharply change to aggressive actions and psychomotor agitation.
Quality care is possible only in the case of a partnership between the patient and caring staff, which grounds on trust. Pinho et al. state that “active listening and empathy are especially important and should focus on the patient’s experiences” (2). Therefore, the nurse must have communication skills, knowledge of medical psychology, and certain personal qualities such as respect for an individual, empathy, endurance, and others.
In communication with mental patients, one cannot raise one’s voice, order anything, neglect their requests, and ignore their appeals or complaints. Any sharp, disrespectful treatment of patients can provoke excitement, aggressive actions, attempts to escape, or even suicide. It is necessary to refrain from discussing with patients the condition and behavior of other patients, express their views on the correctness of treatment, the regime. It is important to regulate the behavior of patients very carefully. Conversations with patients should only concern the issues of treatment and be aimed at reducing their anxiety.
First, it should be borne in mind that patients suffering from schizophrenia are often immersed in their experiences and fenced off from the outside world. Consequently, attempts to gather information and penetrate into their inner world can cause the resistance and even aggression. It is especially characteristic in patients with a paranoid form of schizophrenia. Therefore, it is critical to limit the duration of conversations with patients, even in a state of incomplete remission, not to mention the periods of acute manifestations of the disease. With schizophrenia, it is important to emphasize that nurses are required to know the content of any hallucination or delusion (Melrose 4). It is necessary to maintain a confidential conversation with the patient during further treatment, and active listening often helps to understand what motivates the patient at certain points.
Confidential relations between the nurse and the patient are the key to his/her successful drug treatment. According to Mahone et al. “nurses can play a vital role in improving medication follow-through by collaborating with clients”. It is often difficult to convince a patient of the need to take medicine and go to a particular procedure when, under the influence of delusional motivations of hallucinatory experiences or emotional disorders, he/she opposes medical measures. Often only a nurse who knows her/his patient as a person and is thoroughly familiar with his/her medical history, can find the right words to reach his/her mind and persuade to take medication. In this case, the task of the nurse is not only to persuade to take the pill, but also to monitor their adoption, since dispensing of drugs without control over their reception is not allowed.
The ability to understand the emotional world, feelings, and experiences of mentally ill people such as fear, resentment, pain, hatred, jealousy, longing, need for kindness and care, anxiety and despair are extremely important in the work of a nurse. Nurse support, sympathy, and understanding on her part are of great help to the patient since empathy and solidarity are always more important than just advice that can be hasty, lacking understanding of the basics of the situation. The trusting relationship between the mentally ill and medical staff is the key to the patient’s effective stay in the medical institution. At the same time, the nurse simultaneously performs the role of medical worker and moral support for the patient.
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