I am delighted to introduce another guest post – this time from Julie Cresswell an ex-BCU student who recently qualified as a nurse. Julie has promised to do the occasional post to let us know how she is getting on.
(By the way, this space is open to anyone else – we would really like to hear from you)
anyway, here is Julie’s post.
Upon qualifying a year ago and gaining my first Staff Nurse post in an acute setting, I was concerned about two main issues. First, how would I be able to build therapeutic relationships with clients in an environment with a clearly unequal power base and where the ever present threat of enforced treatment loomed? Second, is the acute ward simply a place of containment and control?
Establishing rapport with clients is the cornerstone of building a therapeutic relationship and the techniques that we are taught to do this are invaluable. The one belief that guides me is that each client I work with is a complex human being who has a life outside hospital walls, with a multitude of needs to be fulfilled. This may seem an obvious statement, but when working with the jargon of diagnostic labels, signs and symptoms of mental illness, the client’s role in the wider world can sometimes become overshadowed.
The acute setting I work within actively promotes a ‘recovery approach.’ During their stay, clients are asked to consider how they view themselves in the world and the aspirations they have for their future. Such information forms part of their care record and can be shared with other members of the team. The value of such conversations should not be underestimated as it allows the nurse and client to find activities that are meaningful to the client that they can participate in during their stay in hospital and upon discharge to community services.
There are a multitude of activities that clients can access such as complementary therapy sessions, occupational therapy sessions, art, music and reading groups. Having facilitated reading groups in my work setting, I find that everyone who attended them has a valuable contribution to make, and provides professionals with the opportunity to ‘be with’ clients and explore topics of conversation that may not naturally occur during a shift. Some may argue that these activities are better placed in rehabilitation or community settings, but I have found that spending time with client’s engaging in such activities is a valuable method of building rapport.
An unequal power relationship
I now accept the inevitability of the unequal power relationship between client and practitioner. However, I strive to work positively within this powerful legal framework, by embracing the concept of collaborative care planning (working with the client to agree a care plan, not writing one then implementing it!). The client is therefore, given the opportunity to be pro-active in their recovery, rather than an object that is ‘nursed.’
In stark reality, there are client’s who do not want treatment and will not accept their admission into an acute setting. Some clients are clearly vulnerable in the outside world as they are experiencing acute mental health problems that make their ability to function in the community untenable. In these instances, I agree that we need hospitals that can contain and control clients, most likely to be at the beginning of their admission. However, I believe that acute settings can provide sanctuary for many clients when they need this in order to restore their mental health to an optimal level. Following this stage, professionals begin to do what I consider to be the most important stage of acute nursing,‘*engagement,’ with a view to building relationships with clients in order to work together in their recovery. *The fly in the ointment – the dictionary defines ‘engagement’ as to ‘bind by contract or pledge,’ but more interestingly, ‘to bring into conflict’.………..but that’s another debate altogether !