Background: Mental health nurses encounter great extrinsic difficulties when it comes to providing psychotherapeutic interventions due to the fact that they are not allowed to perform such practice in some countries. Secondary analysis is the use of existing data, collected for a previous study, in order to explore a research question distinct from the original inquiry. Relying on pragmatic problem-solving is problematic in terms of decision-making transparency and service user involvement. Mental health nursing practice has always been strongly influenced by psychiatric discourse because of its dominance in the clinical setting. Journal of Psychiatric and Mental Health Nursing 7, 343—354. The therapeutic relationship is a concept held by many to be fundamental to the identity of mental health nurses. They might, for example, acknowledge that a particular diagnosis simply means that a person has a particular cluster of symptoms and acknowledge that this does not imply that the cause, treatment, or prognosis can be derived from the diagnosis.
Comparative inter-country research which identifies similarities and differences in the work of mental health nurses in different social and political contexts is an important means of determining how changes in health care systems could lead to better outcomes for patients. One can, by virtue of this, proceed in a very efficient and economical, as opposed to piecemeal, fashion. Expert knowledge is partial and provisional with as yet no definitive proof to support one perspective over another Morant 2006. Consonant with community care policies, analysis suggests that professionals conceptualize mental ill-health and its treatment in social rather than medical terms. These formulations provide an explanation of the problem along with a road map of what needs to change to ameliorate the problem.
These findings raise healthcare providers' awareness about developing and deteriorating nurse-client relationships, and support the value of the therapeutic relationship as an instrument to restore and promote clients' health. Using the language of interpersonal neuroscience three key engagement processes are detailed, i. The lack of focus on problems puts solution focused work at odds with most other mainstream therapies, and a lack of problem formulation is but one of the differences thrown up by working in a solution focused way. If mental health nursing practice is a patient-centred partnership, as many of our nursing standards suggest, then nursing's focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. Although views on explicitly sharing a formulation in full with a client can differ on the basis of the therapeutic model being used e. Nurses were invited to reflect on aspects of their role including identifying the most and least satisfying elements of their work and suggesting ways in which it could be improved. Being able to discern the presence of a central organizing linchpin in a given clinical case represents a highly advantageous state of affairs.
The clinical examples also demonstrate the patient's movement in group therapy through the steps of the learning process: observation, description, analysis, formulation, validation, testing, integration and utilization. Attention will be given to the necessity of using pluralistic methodology in order to do so. This paper will present a content analysis of what mental health nursing research is currently being published in nursing journals and discuss the implications of the research assessment exercises on its future. Although views on explicitly sharing a formulation in full with a client can differ on the basis of the therapeutic model being used e. When groups of five clinicians were considered, clinicians showed moderate agreement in listing overt problems, and, except for one type of belief dysfunctional attitudes for one client, high agreement on ratings of underlying cognitive mechanisms. However, New Zealand literature from the 20th century shows that the therapeutic relationship, as part of a general development of a therapeutic discourse, came to assume a central place in conceptualizations of mental health nursing.
The aim of this study was to identify the conceptual models that underpin mental health nursing care in clinical settings. Eells and Lombart, 2011 , formulation within teams can be used to broaden the understanding team members have for an individual's difficulties, improve consistency and can result in team members feeling supported and valued Christofides et al. Case formulation has been recognized to be a useful conceptual and clinical tool in psychotherapy as diagnosis itself does not focus on the underlying causes of a patient's problems. The role of power and the function of social representations in reconciling sources of tension and ambiguity associated with this unique social position are discussed. The authors conclude that the arguments presented in this paper are likely to challenge people's loyalties to a particular perspective of the human condition.
This study tested the hypothesis that clinicians can agree on two aspects of a cognitive-behavioral case formulation: the client's overt problems and underlying cognitive mechanisms. Peplau's theory can be used to help patients resolve symptoms by guiding them through the steps of observation, description, analysis, formulation, validation, testing, integration, utilization. In this article, we contribute to understanding the interactional aspects of making clinical diagnosis in mental health care. This eclectic approach to theory development enhances the broad humanistic theory base on which effective, professional nursing practice is based. Despite acknowledgment of the importance of the relationship, there has been little attention paid to the knowledge embedded in psychodynamic theory that can provide a basis for understanding the nurse-patient relationship. This paper examines what goes on between clients and nurses during interpersonal relationships, from the perspective of the clients.
To test this hypothesis, 46 clinicians listened to part or all of an initial interview for two anxious, depressed clients and then listed each client's overt difficulties and rated each client's underlying cognitive mechanisms. . This study explored how inpatient psychiatric nurses make sense of and respond to behaviours in dementia. A key advantage of formulation over diagnosis is that it can be used to predict how an individual might respond in certain situations and to various psychotherapies. The authors argue that case formulation remains an important and indispensable integrative tool for therapists and residents in training who are involved in psychotherapeutic interventions.
Much has been written about the limitations of diagnoses in psychiatry, but perhaps the greatest of problems arise when their use presumes unfounded aetiological and prognostic certainty; when they don't illuminate the problem or provide for an effective solution. This study describes how one group of nurses manage these tensions and suggests a more patient-centred model of care. It is also an evolving and dynamic statement of understanding. Six of the articles were literature reviews, and char- acteristics and concepts surrounding diagnostic practice in mental health nursing were identified in two of the articles Crowe et al. However, this strength is dependent upon recognition and respect for differences. A cognitive therapy approach supplemented by life review techniques is an excellent example of an effective, eclectic treatment approach of affective disorders in older adults.
It is further argued that the integration of these perspectives has not been well considered or articulated in practice. Guidelines for using this integration process in psychiatric mental health nursing clinical practice are presented and illustrated through the case study approach. Participants were recruited from community and acute hospital facilities across Ireland and responded to two tasks: identifying the nature of the person's problems and recommending what to do next. Various schools of psychotherapy, and more recently nursing Crowe et al. It demonstrated that nurses need to be supported to move flexibly through a range of emotional connections, which were found to underlie the negotiations made at work and influence sense making and responding.