medical professionals, nurses as a group come closest to the ideal of treating the whole patient, addressing physical, emotional, psychological and even social concerns. This is especially true of psychiatric nurses who work to help patients address both the physical and cognitive symptoms of their conditions as well as to come to terms with the stigma attached to having a mental illness - a stigma that often is applied as much by the patients to themselves as by others.
This paper examines the paradigm of psychiatric nursing through the lens of Betty Neuman's Systems Model. Neuman believes that the demands and opportunities of nursing as unique because the nurse is the only medical professional who truly does care for the whole person, helping to alleviate all of the stresses that affect each individual. Because nurses see their patients as "whole" people, by extension Neuman sees the profession of nursing as a set of actions that collectively assists individuals as well as their families to achieve and maintain a state of wellness. Nursing, especially for the psychiatric nurse, requires that attention be given to all of those stressors that affect the patient as well as all of those stressors that affect the caregiver, i.e. The nurse.
Because of the stresses that the nurse feels, it is imperative that she or he have a system through which to reduce the level of stress in his or her own working life. There are a number of techniques to reduce stress and nurses, like others in high-stress occupations, should consider the particular mixture of stress-reduction strategies that is best - including such basic considerations as a good diet, exercise and not smoking, all areas in which health-care professionals are not as diligent as they should be. But of paramount importance for psychiatric nurses is an attention to the importance of spirituality in their lives. The importance of spirituality in the lives of psychiatric nurses is the focus of this paper.
Because nursing is such a hands-on profession, it is easy for people - including many who are in the nursing profession themselves - to remember that this does not mean that nursing is or should be devoid of theory. Certainly, nurses work within the theoretical underpinnings of medical knowledge. But they can also bring to bear theoretical models to the practice of their own work that is uniquely suited to providing a broader framework through which to understand their own work.
One excellent model for providing an understanding of the nursing profession is Betty Neuman's Systems Model. Before turning specifically to the issue of how a sense of spirituality can and indeed should be integrated into the perspective of psychiatric nursing, we will briefly examine Neuman's model.
The over-riding point of Neuman's model is that nursing is a unique profession because it requires a wide-ranging set of skills: Nurses are those medical professionals who consistently treat the whole person, and to some extent the members of the patient's support network.
Neuman defines the subject of nursing as encompassing all of those actions that help patients and all the people in the patient's circle that he or she depends upon to help restore and achieve wellness. Nurses seek to establish on-going relationships of trust with patients, which is very much to the patient's benefit, although certainly not without costs in terms of stress to the nurse.
In order to reduce the degree of stress that nurses feel, and so to increase the support that they are simultaneously able to provide to both themselves and to their patients, Neuman developed a model of nursing as a three-stage process (Neuman 1989). The following is a very brief overview of her model.
Stage One: Nursing Diagnosis, which consists of a complete evaluation of the patient, paying specific attention to five variables in three defined stressor zones that Neuman herself defined
Stage Two: Nursing Goals, which must always be determined as part of a cooperative strategy with the patient and which include both the patient's and the nurse's ideas of how the patient is not "well"
Stage Three: Nursing Outcomes, which have three levels (primary, secondary and tertiary) and consist of a series of "interventions" to meet the goals of wellness that the patient and the nurse have defined.
It should be apparent that Neuman's model of nursing owes a great deal not only to general systems models but specifically to Gestalt theory, which stresses the importance of looking at an entire system - or an entire personality. Both of these theoretical perspectives require a holistic approach, which Neuman's most certainly does as well. The integration of a spiritual perspective into nursing helps significantly to achieve such a holistic perspective.
The following is an excellent definition of Gestalt theory as it relates to Neuman's model:
Gestalt theory is a broadly interdisciplinary general theory which provides a framework for a wide variety of psychological phenomena, processes, and applications. Human beings are viewed as open systems in active interaction with their environment. It is especially suited for the understanding of order and structure in psychological events.... Connections among psychological contents are more readily and more permanently created on the basis of substantive concrete relationships than by sheer repetition and reinforcement.
Neuman's model insists that we treat each person as being a multi-dimensional whole who is continually changing because of that person's continual interaction with the environment, which produces a constantly changing constellation of stressors.
The person, with a core of basic structures, is seen as being in constant, dynamic interaction with the environment. Around the basic core structures are lines of defense and resistance (shown diagrammatically as concentric circles, with the lines of resistance nearer to the core).
The model looks at the impact of stressors on health and addresses stress and the reduction of stress (in the form of stressors). A stressor is ANY environmental force which can potentially affect the stability of the system: they may be intrapersonal - occur within person, eg emotions and feelings interpersonal - occur between individuals, eg role expectations extrapersonal - occur outside the individual, eg job or finance pressures, and can occur at any time, in any number or combination.
Spirituality as an Element of a Systems Approach
Neuman's model makes a great deal of sense for anyone who has ever worked as a nurse, but how does it relate to the issue of spirituality? We may answer that question in a number of ways, the first of which is anecdotal. This woman, a psychiatric nurse for the last 12 years who for the last three has worked exclusively with pediatric cases, discusses her own experiences in the field.
I have to admit that I was in nursing school I was turned off by the fact that a lot of the other students were very religious because I'm not. And of course I don't care what people believe in, but I so think that religion is a private thing - not something that you talk about all the time and parade in front of everyone.
And so I guess that I'm a little ashamed to admit it because I really used to make fun of other people, but now I find that I really do understand how they feel. Not that I'm really religious myself now, but certainly I would consider myself to be a spiritual person.
I've done a lot of reading about what I'd guess you'd call "goddess stuff" and I have an altar set up at home. And when I come home from work, every day, no matter how tired I am or what needs to be done, I spend 20 minutes sitting in front of it, being thankful for what I have and thinking what I can do tomorrow to make the world a better place.
And I know that sounds corny. But it makes me a happier person, and it makes me a better nurse because I think that I am in touch with something really deep down inside of myself - that part of all of us that is afraid to die and afraid that life doesn't really mean anything. Once you get used to being in touch with that, then life does mean something. It gives you a sense of each day as a gift.
This nurse's experiences seem to be in many ways typical of the ways that many nurses find that becoming connected to their own sense of spirituality provides them with a sense of greater personal stability that in turn allows them to become better nurses. But the benefits of spirituality in psychiatric nursing extend beyond the hardly insignificant fact that they may help the nurse find the "center" in his or her own life. An understanding of and appreciation for the importance of spirituality to the human condition may help nurses to guide their patients on their own spiritual quests.