How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 56

This book is in B&W, not color - Print page in Grayscale for Correct view! inpatient care, the anxiety in this case being provoked by the psychic pain and fragmentation of the acutely mentally ill person. This concern and awareness converged with new developments in the organisation of nursing care in the US: nursing models, the nursing process and primary nursing. The order in which these arrived in the UK, and their penetration of psychiatric nursing practice, has varied over time and across the country. However it would be fair to say that the nursing process was the first and most influential of these developments. It was a method of nursing work that sought to systematise and improve practice through the implementation of a cyclical process of assessment of patients’ needs, planning care, implementing that care, and evaluating it. Early nursing research in the UK did demonstrate that when the nursing process was implemented, the quality and continuity of care improved. It was eventually universally used in nursing, forming part of the move towards individualised care (McFarlane & Castledine 1982). The nursing process continues in use today, shaping the documentation and practice of in-patient psychiatric nursing, although the degree to which it has been successful, or as successful as it could be, remains open to question. Amongst community psychiatric nurses, the nursing process has been subsumed within the care programme approach, which is a multidisciplinary commitment to a shared care plan. Nursing models (Meleis 1985) flowed out of a pre-occupation with trying to define what nursing was, and what made it distinct from the activities of other healthcare occupations. Such theorising was associated with the move of nursing education into the University sector and the initiation of degree and higher level degree courses in nursing, coupled with aspirations towards a higher professional status. A multitude of such nursing models were produced, nearly all of which were based upon general nursing practice, with the intention that such models could shape nursing curricula as well as the practice of nursing – particularly the assessments and care plans being formulated through the use of the nursing process. Some of these models, particularly that of Peplau previous mentioned, were imported and applied to psychiatric nursing in the UK, again emphasising the interpersonal nature of psychiatric nursing and individualised care. Models reached the height of their influence in the 1980s, but are now mostly absent from both education and the practice of mental health nurses in the UK, with the exception of the Tidal Model which will be discussed further below. It has been argued elsewhere that any such models have to start from what psychiatric nurses actually do and contribute to acute inpatient care if they are to remain influential, rather than seek to arbitrarily redefine nursing work as something else (Bowers 2005). Primary Nursing was the last of the great US nursing innovations to jump the Atlantic. Associated with the name of Marie Manthey (Manthey 1980), primary nursing was a way of organising the nursing team across shifts so that one qualified nurse was always in charge of the care of a fixed number of patients, whether the nurse was present or not. That nurse carri ed out the nursing assessment, drew up the nursing care plan, reviewed and evaluated that care, and was responsible for interdisciplinary liaison and communication with the patient’s family. When the primary nurse was not on duty, other nurses (who were primary nurses for other patients) acted as associate nurses and delivered the care as prescribed by the primary nurse. This organisation gave the primary nurses considerable autonomy and responsibility, and again enhanced individualised care and strengthened the nurse-patient relationship. Only a small number of wards in psychiatry made a thorough implementation of primary nursing (Bowers 1987;Bowers 1989;Ritter 1985), but reports were generally positive. Before any more widespread implementation could occur, the UK government mandated that every patient should have a ‘named nurse’ (Department of Health 1991). Such allocations were carried out and remain so today, however the specific responsibilities of the ‘named nurse’ were not defined by policy, thus the role became titular and the opportunities presented by primary nursing proper were lost. Sadly, none of these three innovations was specifically elaborated for how individualised care was to be delivered to acutely psychotic patients, or how a nurse-patient relationship was to be built up across the divide of cognitive deterioration, suspicion, delusional beliefs and sometime coercive treatment. So although they thrust nurses into such relationships, they were left to devise on an ad hoc, learn by experience basis, how to actually do it. Outside the mainstream: Laing, Berke, Mosher and Barker Arising out of the phenomenological and existential philosophies of the 1950s and 60s, coupled with general systems theory, Laing argued that psychoses were the product of dysfunctional family communication and upbringing and represented and sane response to an insane society. Leaving mainstream psychiatry, Laing set up For [email protected] Property of Bookemon, do NOT distribute 58