therapeutic use of self: Use it or lose it!, The

Mental Health Nursing,  May 2006  by Tummey, Robert

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Clinical nurse specialist Robert Tummey warns that unless nurses in acute care become proactive, a culture will develop that fails to recognise the therapeutic role of the nurse

For mental health nurses, interaction should be the primary focus of care (particularly in adult acute settings). However, Whittington and McLaughlin (2000) found that only 11.8 per cent of acute nurses' time was spent in individual or group therapy. Incredibly, of the 11.8 per cent, only 3.7 per cent was spent in a one-to-one interaction. Although the mean length of time per session was 32.6 minutes, the study did include a five-minute discussion in the corridor as a one-to-one therapeutic encounter.

Whilst this is probably beneficial, and a great deal of therapeutic discussion can occur during these occasions, it is hard to reconcile with the reality that individual time should be extended and private (where possible).

Baker (2000) also uncovered concerns amongst service users of acute inpatient care. They found that only 15 minutes was being afforded them each day and mainly with inexperienced staff. Indeed, therapeutic engagement appears to be the domain of newly-qualified staff (Whittington and McLaughlin 2000). They offer more of their time and seem to engage better with the ward clientele. Possible reasons for this were not offered, explored or considered. However, experienced staff may be 'holding the fort' and having to manage the ward at the expense of service user contact.

The findings of both studies only confirm concerns that resources are stretched within acute mental health care.

Across the UK, and in particular in London, many hospitals are delivering care with bed occupancy above 100 per cent and often for the relapse of existing illnesses (Ford et al 1998). Indeed, some hospitals have anecdotes of placing beds in the group room, study room or converting a lounge. This is all very civilised when one is providing for a relative staying overnight, or as makeshift arrangements following a party. It is not the sort of care and provision we have come to expect in our health service.

Nurses are losing their therapeutic role in response to the competing demands of ward management. This is necessary, but what about nursing? Things do not have to remain this way. Change is needed to improve the situation and to begin to challenge the lack of opportunity for the use of nursing skills. Support is required from management and service providers with a commitment to assist in the provision of care that reduces compromise.

So often, acute nurses are expected to accept poor conditions of work and unsafe staffing levels. Good leadership could condemn the situation, drawing on research evidence and best practice to highlight any shortcomings.

Therapeutic use of self and collaborative engagement seem to be relegated to the fragmented corner of a shift. 'Use it or lose it' springs to mind. Unless nurses in acute care become proactive, there will be a developing culture that fails to recognise the therapeutic role of the nurse.

Each discipline has role definitions and these are often defined by the outside view. Unless the nursing role includes therapeutic engagement it will be lost.

Dare to challenge, dare to change. Psychiatry lost its way by restricting its focus on psychosis and only psychosis (Wessely 1996). Mental health nursing should guard against going the same way with ward management and only ward management.

References

Ford R et al. (1998) One day survey by the Mental Health Act Commission of acute adult psychiatric inpatient wards in England and Wales. British Medical Journal, 317, 1279-83.

Baker S (2000) Environmentally Friendly: patients' views of conditions on psychiatric wards, MIND, London.

Wessely S (1996) The rise of counselling and the return of alienism. British Medical Journal, 313, 158-60.

Whittington D & McLaughlin C. (2000) Finding time for patients: an exploration of nurses' time allocation in an acute psychiatric setting. Journal of Psychiatric and Mental Health Nursing, 7: 259-68.

Robert Tummey is a clinical nurse specialist at the Buchanan Rehabilitation Centre, New Zealand, and was formerly a senior lecturer in mental health nursing at Coventry University, UK

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