PSYCHOLOGY IN NURSING
Psychology in nursing: an inherent part of practice and care In this monthly column, Aysha Mendes explores the many aspects of psychology interwoven into nursing practice.This month, she discusses some of the most commonly encountered from providing patient support to dealing with grief
© 2014 MA Healthcare Ltd
I
t is probably fair to say that most people will recognise the inextricable link between mental health nursing and psychology. However, there is less of an active dialogue around psychology in general and other specialist areas of nursing. Nurses can spend long stretches of time with their patients, listening to their fears and concerns, sharing in their milestones, and offering them a great deal of psychological support alongside the physical nursing care they provide. Psychology is, in fact, inherent in the day-to-day practice of a nurse. The reasons for this are complex and manifold. But, put simply, nurses care for people—and where there are people, there is psychology. All nurses come into contact with patients who have diagnosed mental health conditions, whether this is someone with clinical depression who finds themselves with a chronic wound or someone with schizophrenia who is diagnosed with cancer. Added to this, it is not uncommon for physical health conditions to lead to clinical anxiety and depression. Importantly, however, while most patients may present without a mental health diagnosis, they too are quite likely to experience feelings of stress or anxiety as a result of the condition for which they receive nursing care. They will have unanswered questions and may well have fears around why they are not well, what it will mean for their lifestyle, their loved ones and their perceptions of themselves. The underlying reasons can range from coping with embarrassment caused by leakage from a stoma, catheter or malodorous wound to dealing with the diagnosis of a long-term condition, for which there may or may not be a cure. The very fact that patients with incurable illnesses and those determined to be at the end of life still require nursing care is evidence of the nurse’s role in providing supportive psychological care—rather than physical nursing care with the sole objective of treating and healing a medical ailment. ‘You have to keep yourself emotionally safe, because there’s only so much you can take on,’ advises clinical psychologist, Honey LangcasterJames. ‘But at the same time, it may be that
British Journal of Nursing, 2014, Vol 23, No 17
spending that extra 10 minutes with somebody suffering, and just being there for them, may be of even more benefit than just meeting their medical needs.’ The benefit offered by a nurse’s supportive care cannot be underestimated and the mind– body connection is well established (Barker, 2007). Not only can a patient’s thoughts, feelings and attitudes positively or negatively affect the trajectory of their illness (Vimont, 2008), but they can also affect behaviours, such as a patient’s willingness to adhere to their treatment regimen, or to begin a new health-promotion intervention. Nurses play a significant role in helping to change the way patients think about their conditions and themselves, as well as to change their behaviours in the best interest of their health. Fulfilling this duty of care requires the ability to listen to patients, understand their feelings and motivations, and offer the appropriate support (Nursing and Midwifery Council, 2014). Added to the psychological support nurses offer, and the role psychology plays in the deterioration and promotion of health, is the prominent role of grief in nursing practice. Grief is most commonly associated with the feelings one experiences after the death of a loved one. However, there are many different types of grief that are relevant to nursing, both within and outside bereavement. There is the grief a patient experiences when their health has begun to deteriorate, grieving the loss of their old health, life and self, and the many mixed emotions that can accompany a diagnosis. These emotions can produce seemingly irrational reactions from patients, and nurses can often find themselves at the receiving end. There is also the anticipatory grief that patients and their family members may experience when a patient is nearing the end of life, and of course there is the grief that family members will experience when their loved one actually dies. Compounding all of this is the complex grief nurses themselves can feel when caring for a terminally ill patient. This experience not only brings a nurse face-to-face with his or her own mortality, but can also come with
a rollercoaster of hope and anticipatory grief regarding the patient’s prognosis. All of this is added to a nurse’s regular practice of trying to provide the highest quality, compassionate care while maintaing appropriate professional boundaries. Understandably, nurses can also feel a great deal of grief when a patient they have been caring for ultimately dies. And nurses, too, need appropriate psychological support for the important, difficult and often emotionally taxing work they do. Langcaster-James advocates not only that nurses seek support from their families, partners and friends, or counsellors, but also that, within nursing teams, nurses take the time to ‘offload’ with one another without any guilt or shame. ‘Nurses who are on the frontlines working with very distressing cases need to have some emotional support in their own lives,’ she says. ‘Investing in their emotional welfare by talking to somebody who can help them to carry the emotional burden of the realities they’re facing really helps.’ Nurses offer psychological support as part of their day-to-day duty of care. This first article, which will be the start of a regular series about psychology in nursing, has focused primarily on providing an overview and has delved into the psychological burden nurses can bear while caring directly for patients. However, there are many more aspects of nursing interwoven in the discipline of psychology. The ethical distress of decision-making, the role of personal traumas in work and the caring fatigue a nurse can experience as a by-product of providing continuous compassionate care, are just a few examples of the many aspects of psychology BJN within nursing. Barker S (2007) How does psychology support nursing practice? In: Barker S, Vital Notes for Nurses: Psychology. Wiley-Blackwell, Oxford Nursing and Midwifery Council (2014) The Code. Standards of conduct, performance and ethics for nurses and midwives. Draft revised version. http://tinyurl.com/ ollsoee (accessed 10 September 2014) Vimont C (2008) How to Fight Stress and Ward Off Illness. http://tinyurl.com/op79q4b (accessed 10 September 2014)
Aysha Mendes da Mata Freelance Journalist, specialising in health, psychology and nursing
951
British Journal of Nursing. Downloaded from magonlinelibrary.com by 129.100.058.076 on December 8, 2015. For personal use only. No other uses without permission. . All rights reserved.
Psychology in nursing: an inherent part of practice and care In this monthly column, Aysha Mendes explores the many aspects of psychology interwoven into nursing practice.This month, she discusses some of the most commonly encountered from providing patient support to dealing with grief
© 2014 MA Healthcare Ltd
I
t is probably fair to say that most people will recognise the inextricable link between mental health nursing and psychology. However, there is less of an active dialogue around psychology in general and other specialist areas of nursing. Nurses can spend long stretches of time with their patients, listening to their fears and concerns, sharing in their milestones, and offering them a great deal of psychological support alongside the physical nursing care they provide. Psychology is, in fact, inherent in the day-to-day practice of a nurse. The reasons for this are complex and manifold. But, put simply, nurses care for people—and where there are people, there is psychology. All nurses come into contact with patients who have diagnosed mental health conditions, whether this is someone with clinical depression who finds themselves with a chronic wound or someone with schizophrenia who is diagnosed with cancer. Added to this, it is not uncommon for physical health conditions to lead to clinical anxiety and depression. Importantly, however, while most patients may present without a mental health diagnosis, they too are quite likely to experience feelings of stress or anxiety as a result of the condition for which they receive nursing care. They will have unanswered questions and may well have fears around why they are not well, what it will mean for their lifestyle, their loved ones and their perceptions of themselves. The underlying reasons can range from coping with embarrassment caused by leakage from a stoma, catheter or malodorous wound to dealing with the diagnosis of a long-term condition, for which there may or may not be a cure. The very fact that patients with incurable illnesses and those determined to be at the end of life still require nursing care is evidence of the nurse’s role in providing supportive psychological care—rather than physical nursing care with the sole objective of treating and healing a medical ailment. ‘You have to keep yourself emotionally safe, because there’s only so much you can take on,’ advises clinical psychologist, Honey LangcasterJames. ‘But at the same time, it may be that
British Journal of Nursing, 2014, Vol 23, No 17
spending that extra 10 minutes with somebody suffering, and just being there for them, may be of even more benefit than just meeting their medical needs.’ The benefit offered by a nurse’s supportive care cannot be underestimated and the mind– body connection is well established (Barker, 2007). Not only can a patient’s thoughts, feelings and attitudes positively or negatively affect the trajectory of their illness (Vimont, 2008), but they can also affect behaviours, such as a patient’s willingness to adhere to their treatment regimen, or to begin a new health-promotion intervention. Nurses play a significant role in helping to change the way patients think about their conditions and themselves, as well as to change their behaviours in the best interest of their health. Fulfilling this duty of care requires the ability to listen to patients, understand their feelings and motivations, and offer the appropriate support (Nursing and Midwifery Council, 2014). Added to the psychological support nurses offer, and the role psychology plays in the deterioration and promotion of health, is the prominent role of grief in nursing practice. Grief is most commonly associated with the feelings one experiences after the death of a loved one. However, there are many different types of grief that are relevant to nursing, both within and outside bereavement. There is the grief a patient experiences when their health has begun to deteriorate, grieving the loss of their old health, life and self, and the many mixed emotions that can accompany a diagnosis. These emotions can produce seemingly irrational reactions from patients, and nurses can often find themselves at the receiving end. There is also the anticipatory grief that patients and their family members may experience when a patient is nearing the end of life, and of course there is the grief that family members will experience when their loved one actually dies. Compounding all of this is the complex grief nurses themselves can feel when caring for a terminally ill patient. This experience not only brings a nurse face-to-face with his or her own mortality, but can also come with
a rollercoaster of hope and anticipatory grief regarding the patient’s prognosis. All of this is added to a nurse’s regular practice of trying to provide the highest quality, compassionate care while maintaing appropriate professional boundaries. Understandably, nurses can also feel a great deal of grief when a patient they have been caring for ultimately dies. And nurses, too, need appropriate psychological support for the important, difficult and often emotionally taxing work they do. Langcaster-James advocates not only that nurses seek support from their families, partners and friends, or counsellors, but also that, within nursing teams, nurses take the time to ‘offload’ with one another without any guilt or shame. ‘Nurses who are on the frontlines working with very distressing cases need to have some emotional support in their own lives,’ she says. ‘Investing in their emotional welfare by talking to somebody who can help them to carry the emotional burden of the realities they’re facing really helps.’ Nurses offer psychological support as part of their day-to-day duty of care. This first article, which will be the start of a regular series about psychology in nursing, has focused primarily on providing an overview and has delved into the psychological burden nurses can bear while caring directly for patients. However, there are many more aspects of nursing interwoven in the discipline of psychology. The ethical distress of decision-making, the role of personal traumas in work and the caring fatigue a nurse can experience as a by-product of providing continuous compassionate care, are just a few examples of the many aspects of psychology BJN within nursing. Barker S (2007) How does psychology support nursing practice? In: Barker S, Vital Notes for Nurses: Psychology. Wiley-Blackwell, Oxford Nursing and Midwifery Council (2014) The Code. Standards of conduct, performance and ethics for nurses and midwives. Draft revised version. http://tinyurl.com/ ollsoee (accessed 10 September 2014) Vimont C (2008) How to Fight Stress and Ward Off Illness. http://tinyurl.com/op79q4b (accessed 10 September 2014)
Aysha Mendes da Mata Freelance Journalist, specialising in health, psychology and nursing
951
British Journal of Nursing. Downloaded from magonlinelibrary.com by 129.100.058.076 on December 8, 2015. For personal use only. No other uses without permission. . All rights reserved.
