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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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.


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. (Nursing and midwifery council,2004). I will refer to

the patient as Stuart. Stuart is a thirty-two African-Caribbean year old male

with a diagnosis of paranoid schizophrenia. He lives on his own and is

currently unemployed. He was first admitted to hospital nearly five years ago.

He has a history of suffering from depression and delusions involving the

pope plotting against him. On a daily basis he is prescribed an oral medication

of Flupenthixol (Nice,2006).  By now the student-nurse had met Stuart on

several occasions through ward rounds and home visits with CPN’s of the

community, which the stuart-nurse was based on. As time went on and into

the third week of the  student- nurse’s nine week placement, her

mentor decided to give her the opportunity to take Stuart as one of their

case loads. During this placement my aim was to achieve an engagement of

an therapeutic relationship with Student within a nine week placement . This I

personally felt this was going to be quite challenging because of the time

factor and also because of my status as a student nurse i.e. Stuart found it

hard to accept me. As he stated to me, I was another in a long line of student

nurses and what was the point of opening up to me.

Supervision begins and end with a relationship (P, Barker,1992).

A therapeutic relationship had gradually developed between the student-nurse

and Stuart. The student -nurse now began to feel as though Stuart

understood the purpose of their therapeutic interventions on a weekly basis.

Peplau (1994) states that the most therapeutic potential is

when a nurse and a patient meet together for a regular individual interaction

sessions which is what was intended here.   

Every week Stuart and the student-nurse would meet, to discuss how he was

feeling and review how things were going with him.  By now the student-nurse

and Stuart had met and spoken on several occasions, the student-nurse was

gradually exploring Stuart’s fears and issues within his mental health. On

Stuart’s and the student-nurses first initial visit they went for a walk to his

local shopping area. Stuart became anxious at this point, saying that he felt

people were  staring at him, so I re-assured him that everything was ok and

people were’t looking at him. He then started to settled and seem happy

enough to continue his outing. Once Stuart was back in his own home

environment, he appeared more at ease within himself and seemed to be

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talking more logically and to be more in control of his thoughts.They spoke

about how he was coping since leaving the unit. He seemed to be coping

quite well on an independent level, other than still feeling a little paranoid.    

On my following visit, Stuart complained of not sleeping very well. I asked

why and he replied that he thought the pope was talking about him on the TV,  

plotting against him, and didn’t want to take any sedatives, as he believed

they were addictive.  He seemed paranoid and tired. The student-nurse


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