Nursing Professional Reflections

Elham Kowsar
Antelope Valley College

Mrs. Cox
Nursing Science 201

A good nurse needs certain skills in order to operate effectively in a psychiatric setting. Although there are many attributes essential to excellent nursing care, this paper specifically focuses on empathy, self-awareness, and building of trust in the professional relationship between a nurse and her patient. In the mental health setting it is important to understand the difference between empathy and sympathy. Empathy and sympathy may appear to be interchangeable, but they are not. Both words are derived from the Greek language. Empathy means “in feeling” and is based on, and acceptance of, individual uniqueness. Sympathy means “with feeling” and is largely an affective reaction which involves sharing emotions and merging or losing oneself in another person’s experience. Empathy is intimately linked to closeness, which can prove to be difficult to attain for some nurses. The structure of empathy is described as a feeling, portrayed non-verbally, and includes thoughts and emotions related to understanding patients' situations. Nurses' own attributes and previous personal and professional experiences impact their ability to empathize, while knowledge about people and how they are feeling is important for developing empathy. Empathic feelings are difficult to generate when nurses have no context for a similar experience or when the patient is difficult to get to know or communicate with. Further barriers often include a stressful working environment and lack of time. The most important question to ask is: How does this description of the essential structure of empathy differ from sympathy? Sharing of painful feelings of another person is characteristic of both sympathy and empathy. However, the person using sympathy is feeling sorry for the person. It can send the message that the person is justified in quitting, giving up hope, and refusing to get help. Empathy says you can put yourself in the other person’s shoes, because you have been in similar situations. Empathy is not only basic to person centered counseling or therapy; it is also an essential element of most forms of therapy. “Patients are more then just a disease or illness condition, which forces them to seek health care. It also involves recognizing that emotional, psychological and spiritual elements as well as physical elements will influence patient healing and treatment (Reynolds, et al, 2000, p. 235).” I took care of a patient in the psychiatric unit who was suffering from major depression. He was in his forties, well educated, and had previously held a senior position as an engineer. He lost his job and it put tremendous strain on his relationship with his family. He confided that after losing his job, he felt less of a man, and suffered from poor self-esteem. He described that period of his life as the root cause of his depression. I could empathize with his situation, because my husband and I had experienced a similar disappointment in our life. It was a difficult time for us, but we overcame it. I was able to provide the patient with guidance and hope because I had been through it myself. Socrates’ guiding rule was “know thyself.” This is the most profound advice ever given to man or woman and is of great significance when we begin to explore this dictate, because it leads to a deep understanding and insight into all of our actions and beliefs. In the nursing profession, as in any profession that involves dealing with others, it is important to know oneself. Each of us possesses a set of biases, values and assumptions that surface in different situations. In the psychiatric setting, patients can be especially challenging. They may be drug users or child molesters or have a history of violence. As their care giver, I need to be aware of my own attitudes regarding substance abuse, promiscuity and antisocial behavior in order to avoid unfairly judging my patients who are, after all, mentally ill. I need to ask myself whether I can be without bias, and be able to empathize with those under my care, regardless of their history. Will stereotyping interfere with an honest perception of my patients? Will I place more value on one patient’s welfare compared to another based on my morals, attitudes and prejudices? Is one person more worthy of my compassion than another?
Psychiatric patients can be aggressive, hostile, and even insulting. How do I deal about being insulted? Can I go beyond an angry response that may arise naturally, put that reaction aside, and be able to reach out to my patient with kindness? On my first day, I arrived at the psychiatric unit filled with apprehension and self doubt regarding my ability to interact with mentally ill patients. I was assigned to a patient with major depression. I tried to motivate him, to encourage him to get out of bed, and to engage him in conversation. When I left, he called the charge nurse and complained that I talked too much and gave him a headache. When I learned of this, my immediate response was that of annoyance and a feeling of rejection. I felt that I would not bother with him anymore. I started using mask defense and made a joke out of it. Then I stopped myself and took some time to process these negative felling. I had to overcome these feelings to continue to care effectively for the patient. The first step towards a good nurse/patient relationship is to build trust. This can be especially challenging with psychiatric patients, who have issues of trust, and do not open up easily. The most important nursing action in building a trusting relationship with the patient is to be consistent with the delivery of care. Even the simplest act, such as keeping your promise to return with ice water for the patient can earn respect and trust. Our work can be very demanding and we are often tired, but patients can easily sense if we are irritated or impatient. Therefore, we should make every effort to maintain a caring approach even when our workload is high. The patient should feel secure that whenever they need the assistance of the nurse, she is available. In the psychiatric setting, nursing care ranges from helping the patient with the activities of daily living, to taking the time to listen if the patient needs to talk. A comforting squeeze of the hand, a reassuring pat on the shoulder and a warm smile can go a long way in developing a good relationship. The patients in a psychiatric unit are often conscious of the fact that they have been admitted to a mental facility. Sometimes they are ashamed, defensive, and acutely sensitive about their situation. They may feel that everybody thinks that they are “crazy”. We must treat them with respect and understanding, and effectively communicate to them that psychiatric illness is nothing to be ashamed of. We can convey that understanding to the patients by never putting them down or making fun of them. In the psychiatric unit, patients may have a history of violence. The nurse may feel fearful or uneasy with such a patient. If the patient senses fear in the nurse, he will never be able to develop trust in her. In fact, he may in turn feel hostile and angry. As nurses, we need to develop mechanisms to overcome our fears. A nurse must not take the anger of a patient personally. There will come a time when the nurse is annoyed or angered by a patient. This is simply human nature. I try to never take personally anything a patient says. How can it be personal when they don’t even know me? In her article titled “When Emotions Escalate: How to Handle Angry Patients,” Orlovsky (2005) states, “It really isn’t personal, so don’t take it that way. Anger directed at a nurse usually isn’t even about the nurse. It’s coming out of the patient’s distress – their situation of powerlessness and misery. A nurse is often an easy target.” She goes on to further state that, “When you take patients’ anger personally, you’re setting yourself up for your own angry reaction. Instead, it’s best to realize that the person is just trying to express a need; he’s just going about it the wrong way. We can nurture a good relationship by being caring, attentive, compassionate and kind. This can be compared to building a friendship but we must be aware that a nurse/patient relationship cannot be a friendship. In a friendship, both parties equally benefit each other. However, in a professional relationship, the patient is in a relatively vulnerable position. As healthcare providers, we need to set boundaries in our professional relationships. It is not acceptable to become emotionally involved. Feeling hurt, dejected or angry can be a justifiable response with a friend, spouse or other family member in certain situations but these emotions cannot be allowed to enter into a professional bond. Social relationships are often based on mutual dependence, but this should not be the core of a professional relationship. A good nurse can make a difference in the lives of her patients. With good communication skills, a nurse can build trust. A skilled nurse knows herself and therefore can maintain a steady control over her emotions. She should be able to empathize with her patients. Caring for others is at the very core of nursing. Even though a nurse must focus on meeting the patients’ emotional and physical needs, she can also derive great personal satisfaction from seeing the positive impact she makes in another person’s life. This defiantly ties in with the Regis University mission. A nurse makes a drastic impact on society. Without nursing there would not be anyone to tend to patients. Nursing also forces us to go above and beyond the average skill because our choice could be the difference between life and death for a patient. Being a nurse in it self is contributing to the new society.

References
Frisch, N., and Frisch, L. (2002). Psychiatric Mental Health Nursing (2nd ed). Australia:
Delmar Thomsom Learning.
Brown, J. O. (2002). “Know thyself: the impact of portfolio development on adult learning.” Adult Education Quarterly, 52(3), 228-246.
Orlovsky, C. (2005). When Emotions Escalate: How to Handle Angry Patients. NurseZone.com. Retrieved March 26, 2006 from http://www.nursezone.com/stories/SpotlightOnNurses.asp?articleID=13554
Reynolds, W., Scott, P. A., & Austin, W. (2000). “Nursing, empathy and perception of the moral.” Journal of Advanced Nursing, 32(1), 235-242.
Yamashita, M. & Foehuck, C., & Mound, B. (April 2005). Nurse Case Management: Negotiating Care Together Within a Developing Relationship. Perspectives in Psychiatric Care, Volume 41, (Issue 2). Retrieved March 26, 2006, from EBSCOhost Research Database.