Psychiatric nursing: principles and practice

Psychiatric Nursing Care Delivery

The objective of this work is to examine nursing care delivered in an in-patient psychiatric ward at a hospital in terms of how care is precisely delivered and to define therapeutic milieu, therapeutic communication and how these are used in the in-patient hospital setting.

THERAPEUTIC MILIEU

The inpatient hospital psychiatric unit is a unique health care setting. The work of Charles a. Robbins, M.D. entitled: "A Therapeutic Milieu in a Continued Treatment Service" states that continued treatment at state hospitals meet some of the requirements for developing a harmonious sociotherapeutic environment." (1963) Robbins states that since the employees generally stay longer in these positions and the patients generally stay for extended period as well that comprised is a therapeutic milieu or a 'community'. Milieu is defined by Merriam-Webster Dictionary (2008) as "...the physical or social setting in which something occurs or develops: environment" therefore it can be understood that a therapeutic milieu is a therapeutic 'environment' or one that is fertile for treatment of a therapeutic nature. Specifically 'milieu' therapy is defined as "psychiatric treatment manipulation of the environment for therapeutic purposes." (Merriam-Webster Medical Dictionary, 2008)

II. THERAPEUTIC COMMUNICATION

Communication can be understood to be "all the modes of behavior that one individual employees, conscious or unconscious, to affect another: not only the spoken and written word, but also gestures, body movements, somatic signals and symbolism in the arts." (Jurgen Ruesch, 1972; as cited in Zychowicz, nd) Communication is influenced by factors such as culture and perceptions or values of the individual as well as social class, relationships, setting and the context of the message. (Zychowicz, nd) Zychowicz states that therapeutic communication skills include the follow:

1) facilitative questions and statements;

2) providing feedback;

3) stating observations; reflection;

4) connecting islands of information;

5) restatement;

6) confrontation;

7) focusing;

8) clarifying;

9) conveying information;

10) summarizing;

11) silence; and 12) humor. (nd)

Facilitative statements are those which are either open-ended questions or those which encourage the patient to relate something from their own view. Reflection is relating something to the patient in a form of speaking and mirroring the statement of the patient and restatement is much the same method of restating what the patient has said. Clarifying is communication that makes clear the point made by the patient to make sure that no misunderstanding occurs. Conveying information is a simple sharing with the patient of information relevant to his or her health status. Providing feedback is the provision of information that is constructive to the patient in relation to how the nurse has perceived what the patient has stated. Stating observations may be used in communication with patients in a manner that defuses anger while at the same time acknowledging their stress or anger. Confrontation is a method of calling attention to the discrepancies stated by the patient and specifically the discrepancy between what the patient has to say and their actions. Summarizing is the provision of feedback to the patient concerning generalities from the nurses' point-of-view. Silence can be used to convey concern or support and enables the patient in thought-organization and self-reflection. (Zychowicz, nd; paraphrased) Humor can be used as a communication tool in defusing a charged situation however, one must be careful how and with whom humor is used.