Role of Nurses in Promoting Wellbeing

Contemporary mental health nursing is mainly concerned with the understanding of the modern theoretical basis concerning the field of mental health nursing. It also involves the different impacts on the discipline of emerging models of mental health. This paper will explain the ever-increasing complexity of the current health care arena as well as the growing contributions towards the increased understanding of mental health nursing practice. Nurses play essential roles in improving health and wellbeing. For instance, they assist in disease prevention as well as changing the behavior of patients as per their health. This paper will also explain the different roles of nurses in promoting wellbeing which includes clinical nursing practices, follow-up treatment, disease prevention, consultation as well as patient education. Different research works have indicated that for one to be a successful nurse, effective communication skills are required. The ability of a nurse to connect and communicate with healthcare professionals as well as patients helps in developing stronger relationships, mistake prevention as well as provision of higher levels of care. When there is adequate nursing communication, medical errors are highly reduced which leads to positive patient outcomes. Mental health nurses are always responsible for relaying information to different people which mean that they must be in a position to communicate mainly during times of intense stress. This paper will also explain how mental health nurses can maintain or improve their communication skills because they are the hub of communication (Vargo, 2017). Moreover, the paper will refer to a case scenario of Susan who is a 65 years old woman divorced with no children. Susan is deaf and is also registered to have poor mobility, poor eyesight and is always unstable while walking. Since she moves fast, she puts herself at the risk of falling and is also considered a threat to other patients which explains why she was placed under close supervision.

Discussion

Public and professional Expectations of Mental Health Nurses

 The main duty of mental health nurses is to bridge the existing gap between mental health services and general practice for the patients suffering from mental illnesses. Moreover, they work with caregivers as well as patient’s families with aims of educating them on the burdens of mental illness. The general public expects the mental health nurses to always be in a position to cope with the demands of the needs and the roles of their patients. They are also required to be versatile, energetic, and perceptive as well as compassionate (Cherry & Jacob, 2016). They are expected to work around the lives of the patients which in most cases mean long working and unsociable hours as well as traveling between different locations.

Additionally, it is the role of mental health nurses to plan and provide support as well as nursing and medical care to the patients in hospitals who have mental illnesses. For instance, they are expected to combat stigma and to help patients deal with it. They also provide advice and information concerning the conditions of patients to their families as well as other care staff. Moreover, the nurses are expected to administer patient’s treatments and medications and should also monitor and record results (Fortinash & Worret, 2014). In the case of Susan, the nurse should ensure that she is given assistance when moving from one place to another and that she does not put the lives of other patients in danger.

Another public expectation of mental health nurses is working with people from all walks of life. The nurses are expected to make use of advanced behavioral therapies to heal patients both physically and mentally. Moreover, they are supposed to take care of patients suffering from different mental illnesses, disorders as well as dysfunctions like bipolar disorders among others. The nurses should also be in a position to recommend various programs and activities for patients to participate in (Hull, 2016). By so doing they act as patient advocates with aims of ensuring that every patient enjoys the most appropriate treatment for their conditions.

Professionally, mental health nurses are supposed to have a strong emphasis on communication as well as interpersonal relationships. They are expected to have a degree qualification which is offered in institutions of higher learning across the country. The degrees involve different academic contents which prepare the students for the demands of the profession.

Moreover, mental health nurses are expected to be advocates for social justice issues as well as the needs of the marginalized populations within the community. For example, they are expected to be the ones challenging the formal and informal power structures leading to people’s mental distress or barriers to recovery. This can include protecting the rights of their patients, ensuring that high levels of mental health care is available and is also accessible to all people.

The public also expects the mental health nurses to act as crisis workers who provide different crisis services on different levels such as individual, family, and community with aims of meeting the needs of patients suffering from the mental health crisis. For example, they can teach community members different ways of crisis intervention as well as prevention. Additionally, the nurses are expected to deal with distressed patients in a non-threatening way as well as trying their level best to understand the sources of distress (Mullins et al, 2016). For instance, in the case of Susan, the mental health nurse should ensure that she does not do any harm to herself or other patients through monitoring her movements as well as providing support when the patients become aggressive.

Lastly, the public expects the nurses maintain and prepare patient records as well as to offer risk assessments and care plans. They should also provide evidence-based personal therapy like cognitive behavior therapy for anxiety and depression. It is also the role of the nurses to provide patients and their families with information concerning their mental health problems as well as the available treatment options (Williams Ilten & Bower, 2016).

Challenges to Communication Skills in Practice

Communication is not all about exchanging or passing information. Effective communication improves the confidence of a patient and is also an important skill required by healthcare providers to meet the dynamic needs of their patients. In most cases, communication is considered to be a simple process. However, on several occasions, nurses face numerous challenges while trying to communicate with their patients.

Effective communication skills in mental health nursing are among the essential components of therapeutic interventions. The interpersonal skills used by nurses to communicate are important aspects of assisting people with mental health problems to develop a positive nurse-client relationship. The nurses are therefore required to make use of different communication skills which are familiar to the patients.  Communication challenges between nurses and mental health patients need skills that go beyond the simple supportive techniques like listening and empathy. The communication challenges can only be dealt with through teaching nurses advanced communication skills addressing different problems that are identified by the nurses. Research has indicated that when it comes to the field of mental health nursing, practical communication skills form the basis of different interventions. For instance, in the case of Susan, the nurse has to strive towards being proficient in using the primary communication tools which the patient understands (Williams Ilten & Bower, 2016). The nurse can use sign language when communicating with Susan and should always practice patience when Susan gets aggressive.

The most important and perhaps the most challenging communication skill used by mental health nurses is listening.  Nurses have even indicated that in most cases they are not aware of what they are supposed to say to their patients as well as the questions they are supposed to ask them.  One of the biggest mistakes that the nurses do is talking too much which means that they are not listening well. Listening goes beyond just hearing the words spoken by the patient to involve active listening, which means offering one’s full attention. Most of the mental health nurses are not in a position to do so because they usually listen without the purpose of understanding the patient’s message.

Poor communication between nurses and mental health patients can result from different factors such as lack of understanding including value to proper communication as well as empathy in therapeutic relationships. In most cases patient factors such as harming behaviors and emotional blocks as do not allow nurses to communicate appropriately. How the nurse communicates can lead to anxiety as well as constant aggressions of communication which can even worsen the mental health of the patient.

Different research works have indicated that providing verbal instructions, reassurance, as well as guidance to the psychiatric patients, is vital for nurses. Enlightening patients on ways of coping with their mental disorders makes them feel empowered as well as in control of their lives. The problem comes when mental health nurses lack the communication skills required as well as the right words to make verbal communication efficient. For example, the mental health nurse must communicate to Susan with words that will inform instead of overwhelming. The nurse must also be honest and should always avoid upsetting the patients. In most cases, nurses are not able to use their tone of voice and the volume of speaking in such a way that the patient will respond with a peaceful and calm demeanor (Varcarolis, 2016).Additionally, nurses may not be in a position to differentiate between the times to communicate with an authoritative tone and those to communicate with a soothing voice.

Another challenge that I have encountered while communicating with mental health patients is related to non-verbal communication. Every mental health nurse must be adept when it comes to deciphering body language as this helps in better understanding the patient. The communication barrier occurs when nurses’ fails to be observant of their patient’s posture, grooming habits, clothing eye and hand movements as well as facial expression. For example, in most cases, I was not able to keep track of Susan’s typical non-verbal cues which made it even harder to predict her responses as well as reactions (Williams Ilten & Bower, 2016). Additionally, it was challenging to use some non-verbal communication with Susan such as listening and silence due to her aggressive nature. This type of non-verbal communication would have provided Susan an acknowledgment and a sense of control.

Additionally, some environmental factors within the clinic acted as communication barriers. When one is so familiar with his or her surroundings, it becomes hard sometimes to notice any environmental factor that can lead to communication difficulties. For instance, background noise affected Susan’s ability to hear, and in most cases, she tried to disguise this by appearing to hear as well as nodding. The distractions impeded communication with the patient and it was even made harder by the fact that the patient was deaf.

Another main communication barrier is confusion concerning the information provided by the patient as well as the nurse because lip-reading was mainly hampered by different factors such as the nurse having a different accent or looking at the computer when talking. The result of this was that Susan was not able to get information from the nurse and had to rely on friends who in most cases were left out of the discussion.  Effective communication requires nurses to understand the patient as well as the experiences expressed by them. Additionally, the nurse needs some specific skills and severe attention to realize what concerns the patient. However, it is worth noting that understanding the patient only, is not enough, but the nurse has to deliver the message in a way that the patient understands (Varcarolis, 2016).

Additionally, my communication with Susan was hampered by information overload. According to different research work, human beings struggle to absorb a lot of information at a go, but when overloaded with options and information they easily blank them out. Information overload affected Susan mainly since most of the time she was distressed and anxious. What made it even harder was that Susan had no relative or friend who would help in complex conversations and she never wanted any other person to know about her health condition.

Research has also indicated that the competencies of a nurse can negatively affect the nurse-patient communication. Efficient communication between patients and nurses is multidimensional. Lack of the required knowledge and skills is always considered to be a communication barrier. For instance, I did not have enough sign language skills, so it was hard to communicate with Susan who only understood American Sign Language. The lack of skills negatively affected my confidence which later adversely affected communication with Susan. Self-confidence is a valid measure of the extent to which nurses and other professionals are familiar with their roles. Lack of confidence means that nurses will take technical aspects to be more important than communication which prevents effective communication.

Cultural differences also affected communication between Susan and me. Cultural perceptions of sickness, health as well as medical care of patients may differ with those of nurses or healthcare organizations. For example, Susan had different viewpoints when it comes to death and health. According to the patient talking about death was a taboo which made me avoid any conversation related to prognosis as it would eventually lead to discussions about death. Understanding culture is also not synonymous with the proficiency of a particular language. Additionally being born in the same region or speaking the same language does not mean sharing elements of a specific culture. Cultural nuance in verbal and nonverbal communication can also be a significant communication barrier between a patient and the caregiver (Townsend & Morgan, 2017). Since cultural differences are almost similar to language barriers, I tried to gather some information related to Susan’s culture to have proficiency in her language. I also joined different programs that increase cultural competence in nursing.

Health literacy barriers also negatively affect communication between a nurse and his or her patient. For instance, Susan had poor literacy skills which mean that most health information sometimes challenged her. The Institute of Medicine has indicated that there exists a vast disparity between how patients receive and comprehend health information. The language barrier, in this case, was associated with low health literacy which made it difficult for me and Susan to communicate efficiently. The poor communication led to resentments, misunderstandings, demoralization as well as frustrations not only for Susan but also for the healthcare staff thus negatively affecting the relationship between the patient and other patients (Sarabia-Cobo et al, 2016).

Moreover, Susan was not always in a position to find the right signs or words to express her emotions effectively. This was as a result of her reduced mental capacity as well as the lack of sufficient command of the language she was using to communicate.  The patient was, therefore, unleashing strong emotions which made things even worse because she was always in arguments with other patients as well as different medical staff who she claims failed to provide her with the required support.

Communicating with patients with multiple disabilities is very challenging. Nurses are supposed to have adequate nonverbal communication skills to determine patient’s needs. Being hearing impaired, Susan preferred using lip reading and American Sign Language, and the nurse had no such skills which mean that communication was not always easy. Additionally, the patient was physically disabled which means that she had limited access to care and was finding it difficult to move around.

Another challenge to communication skill is a disconnect that occurs when there is miscommunication between the nurse and the patient leading to frustrations (Shaffer, et al, 2014). Despite having the right frequency as well as the quantity of communication, there sometimes existed a lack of mutual understanding. In most cases, I thought I knew what Susan wanted, but on showing her what I had been working on, she occasionally got disappointed leading to a lot of confusions when communicating with her. Additionally, different languages which include repetitive responses as well as lack of language Consensus negatively affected communication with Susan. This made it hard for me to access and understands her needs which led to disagreements.

Moreover, I lacked adequate knowledge and skills of Alzheimer dementia patients which includes their characteristics, diagnosis as well as treatment. This made it difficult for me to cope more positively with the patient. According to different research works, nurses have misperception concerning Alzheimer in various areas such as etiology, prevalence as well as diagnosis. Most of them have a difficulty of understanding the difference between memory issues resulting from normal aging like in the case of Susan and those that are indicative of Alzheimer’s. The low level of general knowledge concerning the disease and its symptoms led to a communication breakdown between Susan and me.  Lack of proper information in this field comes as a result of low education levels that have been correlated with misinformation about the disease (Shaffer, et al, 2014).

  What I did differently to Cope with Susan and Her Condition

It goes without saying that communication difficulties are among the main upsetting aspect of caring for people with Alzheimer or any other type of dementia. It is frustrating for both the patient and the nurse or the caregiver. Despite the fact that it is difficult to understand why patients with the disease behave the way they do, it is always important to keep in mind that the explanation can only be attributed to their conditions as well as the changes in the brain. It is therefore important for nurses to familiarize themselves with the common situations arising when patients are diagnosed with dementia so that when they say or do something shocking, they will know how to respond (Johnston & Womack, 2015).

High levels of knowledge have always been considered to be essential to most of the mental health nurses. For instance, research has indicated that a caregiver’s sense of competency increases if he or she has increased levels of knowledge and efficiency of communication skills with patients suffering from the disease. As the knowledge of communication with patients with Alzheimer increases frustrations and stress tends to decrease which benefits both the patient and the caregiver. Additionally, well-informed nurses are always active when it comes to their care giving and are also comfortable when making different decisions on behalf of their patients. The nurses with inadequate knowledge have poor coping skills and are not always prepared to deal with the increasing stress and frustrations that appears as the disease progress (Lillyman & Bruce, 2017).

What I needed to understand the disease and to have smooth communication with Susan was interventions as well as other services which are important for increasing the knowledge of the disease. The interventions include learning new and improved ways of recognizing as well as confronting negative thoughts that hinder the caring responsibility thus increasing the burden of the disease.

What I did differently to acquire the required skills of handling Susan and her condition was to ensure personal-centered care. This involved focusing on Susan as an individual patient with respect to her unique experiences, abilities, personality as well as culture. For instance, I had to learn the basic skills of American Sign Language which made communication easier. Additionally, because Susan was mostly unstable while walking, I had to support her and to warn her against moving fast which put her and other patients at risk. Moreover, I tried to understand the fact that people dementia patients had the ability as well as right to communicate their preferences likes and dislikes when given the suitable platform to do so (Forsgren et al, 2016). Moreover, I ensured that the care I was giving Susan was growth-and-caring centered which involved helping Susan to grow and develop. This caring process also included the acknowledgment of her personal needs as well as putting her under close supervision with aims of ensuring that she does not cause any harm to herself or other patients.

Secondly, I ensured that the environment was always suitable and supportive. This is mainly because research has indicated that the social and physical environment plays a critical role in almost all care settings (Coleman& Asiri, 2017). I ensured that the environment fostered independence, socialization as well as meaningful activities that offered a sense of safety, community, privacy, comfort, and dignity for her. Through this, I was able to build a strong relationship with Susan because interactions were taking place naturally.

Additionally, I ensured that the hospital hired a bilingual staff who acted as an interpreter between Susan and I thus bridging the existing communication gap. The interpreter had appropriate sign language skills as well as knowledge of different medical terminologies which ensured that our communication did not compromise Susan’s confidentiality. I also used universal Healthcare symbols that made it possible for Susan to navigate around the hospital. The information included nonverbal cues such as maps and signs as well as use of patterns and different colors (Johnston & Womack, 2015).

Moreover, I tried as much as I could to remember that the verbal and physical aggression displayed by Susan was not on purpose. For example, I was able to understand that most of her aggressions were as a result of different factors such as physical discomfort, poor communication as well as environmental factors like being in unfamiliar situations. In other cases, the aggression came from pure fear, and most patients with dementia are more apt to bite, kick and hit while responding to the feeling of helplessness or being afraid (Blais, 2015). As the disease progressed, Susan developed mood swings where at one time she could be perfectly fine and the next she is getting physical and yelling. Since I was in a position to understand her condition, I easily determined the reasons for being aggressive and tried to shift the focus to something else while being calm and reassuring the manner.

I also utilized my little knowledge and experience in the field of dementia to deal with Susan’s confusion about place and time. After her condition deteriorated, Susan had to be admitted to the care home, and in most cases, she used to make statement such as “why are we here?”, ”I want to go home!” among others. Research has indicated that wanting to go home is among the primary reactions of patients suffering from Alzheimer as well as those living in memory care facilities (Ammouri et al 2015). This is so because Alzheimer leads to damages in the cognitive functioning creating confusions as well as memory loss. The patients want to go back to the places where they had control of their lives. Using the little knowledge I had, I was able to give Susan simple explanations as to why she was in the care facility using different photos as well as other tangible reminders.

Another thing that I did to cope with Susan and her condition is seeking advice from my superior on how to deal with poor judgments. In most cases, Susan had unfounded acquisitions where she could falsely accuse other patients of stealing or messing with her belongings. This came as a result of deteriorations of brain cells which is a major culprit in behaviors showing errors in thinking leading to delusions. From the advice, I got from my colleagues I was able to assess the extent of the problem as well as to be encouraging and reassuring. I was also able to reduce embarrassments and frustrations through helping Susan in small ways such as being organized.

Conclusion

It is evident from the above discussion that despite the numerous programs aimed at lessening the barriers that result from lack of a common language, nurses still experience errors as well as negative outcomes when communicating with their patients. Lack of communication skills lead to disparities in quality and access to health care given to patients with dementia and other diseases.  To reduce the communication barriers and disparities nurses can engage in microscopic as well as macroscopic activities. Microscopically, the nurses are always supposed to be aware of their client’s culture and language because both are integral parts of their identity to be ignored. Macroscopically, nurses need to be up-to-date with the current rules and regulations concerning language services within health care. Additionally, it is clear that dealing with the dementia behaviors portrayed by patients such as angry outbursts is among the primary stressful parts of being a nurse or a caregiver for such patients. However, following the new approaches to the condition, nurses are now finding is easy to deal with dementia patients.

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