Closing the Education-to-practice Gap in Nursing: A New Approach to Teaching Psychiatric Nursing
Better preparing nursing students for the working world is a goal of all nurse educators… particularly when it comes to the additional challenges in the area of mental health nursing. In this blog post, Mertie L. Potter, DNP, APRN, PMHNP-BC, PMHCNS-BC and Mary D. Moller, DNP, ARNP, APRN, PMHCNS-BC, CPRP, FAAN discuss their approach and their passion for helping students learn how to provide hope and promote recovery using a holistic approach.
Q. Why Psychiatric-Mental Health Nursing: From Suffering to Hope?
We believe it is important to impart the patient’s illness trajectory for students. Patients have lives outside the hospital. We feel it is important for students to see the ‘lifespan’ of the patient experience from initial onset/relapse to recovery to rehabilitation.
Q. How is self-reflection in clinical reasoning important?
There is a great quote from Manday Hale: “People are sent into our lives to teach us the things we need to know about ourselves.” In working with patients we must always be mindful that relationships are at the minimum, dyads. Consider asking students these three questions:
- What am I bringing into this nurse-patient relationship?
- What does the patient bring to the relationship?
- How do both of these affect how I plan nursing care and patient interactions?
In reflecting on each of these questions, students engage in introspection and consider not only their personal role in the lives of the patients for whom they care, but also the patients’ impact in the students’ lives, growth, and development as nurses. These questions can be used in classroom discussion as well as in journal reflections from the clinical area.
Q. What is the value of using perceptions, thoughts and feelings (PTF) in developing communication skills?
Students often wonder, “What do I say to the patient?” Sometimes fearing they will say “the wrong thing” or being overly focused on their own discomfort, they may be unable to focus on the patient’s needs and discomfort. By using their perceptions, thoughts, and/or feelings, students can determine and validate with the patient what the patient’s immediate needs are, and return the focus rightfully to the patient. This model is based on Ida Orlando’s Deliberative Nursing Process. Each interaction with a patient, as Orlando asserted, is unique to the patient and the nurse in that specific situation at that particular moment in time. Another nurse in the same situation with the same patient at the same time might perceive, think, and/or feel something entirely different. By reflecting to the patient what the nurse is perceiving (observing through one of the senses), thinking, and/or feeling, there is a greater likelihood that the patient’s immediate needs will be met and that the patient’s distress will be relieved.
Q. How does looking at suffering help develop nurse empathy?
We recognize there is a great deal of suffering that patients and nurses experience in the provision of nursing care. We want to assist students in identifying this suffering and addressing it within patients and within themselves. Nurses need to address the suffering they carry before caring for patients (and in some cases “from” caring for patients).
Additionally, patients struggling with mental health challenges, whether diagnosed with a mental illness or not, may experience suffering that is even more challenging to recognize. By looking at their own suffering, students may be better able to understand that patients experience suffering in different types of domains (See question 5 below.)
Q. What are the 5 wellness domains and how are they incorporated into care?
Comprehensive psychiatric nursing care requires a holistic approach to patient care. Psychiatric wellness is comprised of much more than just giving medications. The Murphy-Moller Wellness model encompasses five domains of wellness-health (biological), attitudes/behaviors (psychological), environment and relationships (sociological), and a sense of peace (spiritual). The model is balanced on necessary resources, culture supports, and a kinship network. Planning for the provision of comprehensive patient care can be accomplished using a wellness model to implement all aspects of the nursing process.
Q. What is the function of hope and recovery in Mental Illness?
Hope is an underlying theme, because we believe it is a core element in healing and recovery. Hope empowers patients to work through the process of recovery to health. Optimism, a quality inherent in hope, is known to be a factor in the healing process (Jackson, 2009). Nurses can foster optimism in patients by identifying realistic and reasonable goals with patients. The healing process can be enhanced when nurses help patients deal with, for example, stigma, adherence to treatment regimens, access to care, and patients’ beliefs about hope for successful treatment.
Recovery as a concept in psychiatry was actually ‘borrowed’ from substance abuse treatment when those two subspecialties merged throughout various state departments of mental health. It has revolutionized psychiatry into asserting that recovery is possible for most individuals diagnosed with psychiatric disabilities. Recovery and hope are synonymous. We like to focus on hope and recovery —one cannot know dark without knowing light, one cannot experience recovery without relapse, and one cannot experience hope without suffering.
If you would like to learn more about this unique approach to teaching psychiatric-mental health nursing, then click here to listen to a recorded webinar with Dr. Potter and Dr. Moller.
If you are an educator, you may be interested in exploring Dr. Potter and Dr. Moller’s brand new textbook, Psychiatric-Mental Health Nursing: From Suffering to Hope, 1st edition.
About the Authors
Dr. Mertie L. Potter is a Professor of Nursing at Massachusetts General Hospital Institute of Health Professions; a nurse practitioner at Merrimack Valley Counseling Association in Nashua, NH; and a nursing consultant in private practice. She is ANCC certified as a family psychiatric-mental health nurse practitioner and as a clinical nurse specialist in adult psychiatric-mental health nursing.
Dr. Mary D. Moller is an Associate Professor of Nursing at Pacific Lutheran University in Tacoma, WA. From 2009 through 2014 she was the Coordinator of the Psychiatric Mental Health Nurse Practitioner Specialty at the Yale University School of Nursing. She is an attending ARNP at a 16-bed evaluation and treatment unit in Tacoma and in private practice conducting telemental health. Mary is a fellow in the American Academy of Nursing and is dually certified by the ANCC and the United States Psychiatric Rehabilitation Association.