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The intention of this essay will be to describe the main features of the therapeutic relationship in terms of the experience between the student-nurse and the service user in a mental health setting.

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Introduction

´╗┐Discuss the challenges of a student nurse in establishing therapeutic engagement with service users; using clinical examples and theoretical frameworks to illustrate points of discussion. Introduction Throughout this essay I will refer to myself as the Student nurse. The clinical example that shall be used, will be based from experiences within a community mental health setting for adults, where a care programme approach was applied. It will describe the settings and the importance of therapeutic engagement of the service user and the student- nurse. The intention of this essay will be to describe the main features of the therapeutic relationship in terms of the experience between the student-nurse and the service user. The essay will present a progressive picture of therapeutic interaction, in the varying stages of the service user?s illness. There will be shared thoughts and feelings about working with clients with mental health problems. It will relate the theoretical framework to the actual hands on experience in a community setting, drawing out the main advantages and disadvanges in relation to practice. The student-nurse will discuss the different stages throughout their developing relationship with the service user. They will also share their thoughts and feelings about their experience and aspects of the service users Illness. There will also be theoretical nursing model applied to the care of the service user. These models include Carl Roger?s person centred counselling(1902-1987), Hildegard Palau?s developmental stages of the Nurse-client relationship (1909 -1999), and also Phil Barker?s tidal model. Hildagard Peplau (1998) defines the therapeutic relationship as the foundation of nursing practice in addition to people who are experiencing threats to their mental health. The therapeutic nurse-patient relationship evolves from. She introduced an interpersonal relations paradigm for the study and practice of nursing that was grounded in clinical experiences of herself and her graduates students (Peplau,H. 1998 in Phil Barker 2003). For the reasons of autonomy and patient confidentiality the patients name will be chosen at random. ...read more.

Middle

This may also help the patient to decide what kind of changes they would like to make. l thought this technique has been criticized by some for its lack of structure and set method. However it has proved to be a hugely effective and popular treatment. One criticism as that delivering the core conditions is what all good therapists do anyway. The core conditions are not the only way to achieve a quality relationship. Rogers technique also appears to be a little schematic, and ignores the patients individuality. It?s like applying a method, rather then really listening to the actual patient, i.e. paraphrases which have been implemented. . Hildagard Peplau?s development stages of the nurse-client realionship Peplau?s(1952) Developmental Stages of the Nurse-Client Relationship include the following phases, which are: the Orientation Phase, working Phase, and the Resolution Phase. This phase of the relationship is when the nurse and patient first meet, and is known as the orientation phase. This is a time when the patient and nurse come to know each other as people and each other?s expectations and roles are understood(Peplau,1952). On the authors and Stuart?s first meeting I asked Stuart to tell me about himself, so I could understand how he was feeling, I also stated to him that it was his time to talk about anything that was unsettling or important to him. I felt Stuart was opening up a little, but was not showing much trust towards me. This can be difficult when a patient has had an extensive experience as inpatient on a ward (Forchuk, c. 1992).MIND (1992) states the importance of the patients being fully informed of the type of psychological approach taken in their care process. So I found it important that Stuart understood the intention of the relationship. Ritter (1989) states that that it?s essential that the psychiatric nurses are clear about the distinction between being a psycho-therapist and behaving in a psychotherapeutic way. ...read more.

Conclusion

Such as when valuing the voice of the patient, this helped me to understand Stuart?s world, also develop genuine curiosity, this established trust in mine and Stuart?s relationship. Using this mmodel it also provided a practice framework for the exploration of the patient's need for nursing and the provision of individually tailored care. Conclusion During the last three decades, numerous theories have been generated with multiple and varying orientations various tools and techniques help identify suitable usage. A number of nursing models relating to therapeutic engagement has been introduced within Stuarts care. Whilst they engender considerable debate there are similarities in the them all. These models focused on how the nurse can manipulate the environment to benefit the patient. Within the therapeutic intervention with Stuart and after conducting a literature search. I generated an initial list of possible theories and models. The tidal model appeared to be the more appropriate model, as it had use in analysis and evaluation. The tidal model used concepts (i.e., words representing reality that enhance our ability to communicate in familiar ways). Other therapeutic models use concepts in unfamiliar ways or introduce new concepts about nursing and nursing care. These are practical issues, which are put into practice and come from the theory. The theories are interrelated, defined, and presented to explain everything. I found that the models can create a level of Discrimination because they have a fixed view of what the client is like. They lack flexibility. They also attempt to prescribe what the nurse can do. For example, the theory can determine whether a nurse is acting as a nurse or a substitute psychiatrist. To clarify some therapeutic techniques deployed in some other traditions depend on the nurses willingness to 'hold back', mentally formulate hypotheses about the client, or conceal their own personal reactions behind a consistent professional face, there is a real challenge in applying these techniques. So to conclude my experience, the theory does not always mach the practice. In mine and Stuart?s case I found time was the key facet in our therapeutic interaction. ...read more.

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