Right There, in the Midst of It: Impacts of the Therapeutic Relationship on Mental Health Nurses
DOI:
https://doi.org/10.11575/jah.v0i0.53272Keywords:
mental health nursing, therapeutic relationship, hermeneutics, narratives, distressAbstract
Mental health nurses are frequently confronted by intense emotions within the therapeutic relationship. In this philosophical hermeneutic inquiry, five mental health nurses were interviewed to extend our understandings of how nurses are impacted by the interplay with the often emotion-laden narratives of their patients. Findings exposed the nurses journeyed between fluctuating needs to separate and protect their private from their work life. In order for this fluctuation to occur, they developed a sense of the world as requiring a sanctuary. This ontological place of home is the extent to which they felt safe and sheltered in order for this process of awareness of self as person and self as nurse to unfold. This research brings to the forefront the ways in which mental health nursing practice, education, and research are reciprocally moved by the practical day-to-day activities of being in therapeutic relationships.
References
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Barker, P. (2003). The tidal model: Psychiatric colonization, recovery and the paradigm shift in mental health care. International Journal of Mental Health Nursing, 12(2), 96-102.
Beal, G., Chan, A., Chapman, S., Edgar, J., McInnis-Perry, G, Osborne, M., & Mina, E.S. (2007). Consumer input into standard revision: Changing practice. Journal of Psychiatric and Mental Health Nursing, 14(1), 13-20.
Beeber, L. (1989). Enacting corrective interpersonal experiences with the depressed client: An intervention model. Archives of Psychiatric Nursing, 3(4), 211-217.
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Bergum, V. (2004). Relational ethics in nursing. In J. Storch, P. Rodney, & R. Starzomski (Eds.), Toward a moral horizon: Nursing ethics for leadership and practice (pp. 485-503). Toronto, ON, Canada: Pearson Education.
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Caputo, J.D. (1987). Radical hermeneutics: Repetition, deconstruction and the hermeneutic project. Bloomington, IN: Indiana University Press.
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Donatelle, R.J., Munroe, A.J., Munroe, A., & Thompson, A.M. (2008). Health: The basics (4th Canadian ed.). Toronto, ON, Canada: Pearson Education Canada.
Dowling, M. (2006). The sociology of intimacy in the nurse-patient relationship. Nursing Standard, 20(23), 48-54.
Dreyfus, H.L. (1991). Being-in-the-world: A commentary on Heidegger’s being and time. Cambridge, MA: Division I. MIT Press.
Evans, A.M. (2007). Transference in the nurse-patient relationship. Journal of Psychiatric and Mental Health Nursing, 14(2), 189-195.
Forchuk, C. (1994). The orientation phase of the nurse-client relationship: Testing Peplau’s theory. Journal of Advanced Nursing, 20(3), 532-537.
Forchuk, C. (2002). People with enduring mental health problems described the importance of communication, continuity of care, and stigma. Evidence Based Nursing, 5(3), 93-97.
Forchuk, C., & Reynold, W. (2001). Clients’ reflections on relationships with nurses: Compari-sons from Canada and Scotland. Journal of Psychiatric and Mental Health Nursing, 8(1), 45-51.
Frank, A.W. (2004). The renewal of generosity: Illness, medicine, and how to live. Chicago, IL: The University of Chicago Press.
Gadamer, H.G. (1989). Truth and method (2nd rev. ed., J. Weinsheimer & D.G. Marshal, Trans.). New York, NY: Continuum. (Original work published 1975).
Gadamer, H.G. (1994). Heidegger’s ways (J. W. Stanley, Trans.). Albany, NY: State University of New York Press.
Gadamer, H.G. (1996). The enigma of health: The art of healing in a scientific age. (J. Gaiger & N. Walker, Trans.). Stanford: Stanford University Press.
Gallop, R., & O’Brien, L. (2003). Re-establishing psychodynamic theory as foundational knowledge for psychiatric/mental health nursing. Issues in Mental Health Nursing, 24(2), 213-227.
Hagerty, B.M., & Patusky, K.L. (2003). Reconceptualizing the nurse-patient relationship. Journal of Nursing Scholarship, 35(2), 145-150.
Handy, J.A. (1991). The social context of occupational stress in a caring profession. Social Science and Medicine, 32(7), 819-830.
Hardin, S., & Halaris, A. (1983). Nonverbal communications of patients and high and low empathy nurses. Journal of Psychosocial Nursing and Mental Health Services, 21(1), 14-20.
Harries, K. (1978). Fundamental ontology and the search for man’s place in Heidegger and modern philosophy. New Haven, CT: Yale University Press.
Hartrick Doane, G., & Varcoe, C. (2007). Relational practice and nursing obligations. Advances in Nursing Science, 30(3), 192-205.
Hayes, H. (2007). (Be)coming home: An existential perspective on migration, settlement and the meanings of home. Existential Analysis, 18(1), 2-16.
Heidegger, M. (1962). Being and time (J. Macquarrie & E. Robinson, Trans.). San Francisco, CA: Harper (Original work published 1927).
Henderson, A. (2001). Emotional labor and nursing: An under-appreciated aspect of caring work. Nursing Inquiry, 8(2), 130-138.
Hilficker, D. (1994). Not all of us are saints: A doctor’s journey with the poor. New York, NY: Random House.
Jardine, D.W. (1994). Speaking with a boneless tongue. Bragg Creek, AB, Canada: Makyo Press.
Jardine, D.W. (1998). To dwell with a boundless heart: Essays in curriculum theory, hermeneutics, and the ecological imagination. New York, NY: Peter Lang.
Jardine, D.W. (2006). On hermeneutics: “Over and above our wanting and doing”. In J. Kincheloe, & K. Tobin (Eds.). Doing educational research: A handbook (pp. 269-288). Rotterdam, The Netherlands: Sense.
Kearney, R. (2003). Stranger, gods and monsters. New York, NY: Routledge.
Levin, D. M. (1989). The listening self: Personal growth, social change, and the closure of metaphysics. London, UK: Routledge.
Lévinas, E. (1996). Basic philosophical writings (A.T. Peperzak, S. Critchley, & R. Bernasconi, Trans & Eds.). Bloomington, IN: Indiana University Press.
MacDonald, H. (2006). Relational ethics and advocacy in nursing: Literature review. Journal of Advanced Nursing, 57(2), 119-126.
Milton, C.L. (2008). Boundaries: Ethical implications for what it means to be therapeutic in the nurse-person relationship. Nursing Science Quarterly, 21(1), 18-21.
Miner-Williams, D. (2007). Connectedness in the nurse-patient relationship: A grounded theory study. Issues in Mental Health Nursing, 28(11), 1215-1234.
Morck, A. (2009). “Right there in the midst of it with them”: Impacts of the therapeutic relationship on nurses. Unpublished master’s thesis, University of Calgary, Calgary, AB, Canada.
Morse, J.M. (1991). Negotiating commitment and involvement in the nurse-patient relationship. Journal of Advanced Nursing, 16(4), 455-468.
Moules, N.J. (2000). Nursing on paper: The art and mystery of therapeutic letters in clinical work with families experiencing illness. Unpublished doctoral thesis, University of Calgary, AB, Canada.
Moules, N.J. (2002). Hermeneutic inquiry: Paying heed to history and Hermes: An ancestral, substantive and methodological tale. International Journal of Qualitative Methods, 2(3), Article 3, http://www.ualberta.ca/~ijqm.
Moules, N.J., McCaffrey, G., Field, J.C., & Laing, C.M. (2015). Conducting hermeneutic research: From philosophy to practice. New York, NY: Peter Lang.
Oxford English Dictionary (1971) (Compact ed.). Oxford: Oxford University Press.
Peplau, H.E. (1962). The crux of psychiatric nursing. American Journal of Nursing, 62(6), 50-54.
Peplau, H.E. (1988). Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. London, UK: Macmillan Education.
Peplau, H.E. (1989). Interpersonal theory in nursing practice: Selected works of Hildegard E. Peplau (A.W. O’Toole, & S.R. Welt, Eds.). Ann Arbor, MI: Springer.
Peplau, H.E. (1992). Interpersonal relations: A theoretical framework for application in nursing practice. Nursing Science Quarterly, 5(1), 13-18.
Perraud, S., Delaney, K.R., Carlson-Sabelli, L., Johnson, M.E., Shephard, R., & Paun, O. (2006). Advanced practice psychiatric mental health nursing, finding our core: The therapeutic relation-ship in 21st century. Perspectives in Psychiatric Care, 42(4), 215-226.
Raingruber, B. (2003). Nurture: The fundamental significance of relationship as a paradigm for mental health nursing. Perspectives in Psychiatric Care, 39(3), 104-112.
Rashotte, J. (2005). Dwelling with the stories that haunt us: Building a meaningful nursing practice. Nursing Inquiry, 12(1), 34-42.
Reinders, L., & Van Der Land, M. (2008). Mental geographies of home and place: Introduction to the special issue. Housing, Theory and Society, 25(1), 1-13.
Rogers, A.G. (1995). A shining affliction: A story of harm and healing in psychotherapy. New York, NY: Viking Books.
Shattell, M.M., Starr, S.S., & Thomas, S.P. (2007). ‘Take my hand, help me out’: Mental health recipients’ experience of the therapeutic relationship. International Journal of Mental Health Nursing, 16(4), 274-284.
Sun, F., Long, A., Boore, J., & Tsao, L. (2006). A theory for the nursing care of patients at risk of suicide. Journal of Advanced Nursing 53(6), 680-690.
Svenaeus, F. (2001). The phenomenology of health and illness. In K. Toombs (Ed.), Handbook of phenomenology and medicine (pp. 87-108). Dordrecht, The Netherlands: Kluwer Academic Publishers.
Tomey, A.M. (2006). Nursing theorists of historical significance. In A.M. Tomey, & M.R. Alligood (Eds.), Nursing theorists and their work (pp. 54-67). St. Louis, MO: Mosby.
Vandemark, L.M. (2006). Awareness of self and expanding consciousness: Using nursing theories to prepare nurse-therapists. Issues in Mental health Nursing, 27, 605-615
Vandusen, W. (1998). Wu wei: No-mind and the futile void in psychotherapy. In A. Molina (Ed.) The couch and the tree: Dialogues in psychoanalysis and Buddhism (pp. 52-57). New York, NY: North Poin Press (Original work published 1958).
Walsh, K. (1999). Shared humanity and the psychiatric nurse-patient encounter. Australian and New Zealand Journal of Mental Health Nursing, 8 (1), 2-8.
Warne, T., & McAndrew, S. (2005). The shackles of abuse: Unprepared to work at the edges of reason. Journal of Psychiatric and Mental Health Nursing, 12(4), 679-686.
Warne, T., & McAndrew, S. (2008). Painting the landscape of emotionality: Colouring in the emotional gaps between the theory and practice of mental health nursing. International Journal of Mental Health Nursing, 17(2), 108-15.
Wiebe, L.M. (2001). Connection in the therapeutic relationship: Sharing a subjective world. Unpublished educational dissertation, University of Toronto, Toronto, ON, Canada.
Woolley, J. (2007). Home truths: The importance of the uncanny for Patrick Suskind’s critique of the enlightenment in das parfum. German Life and Letters, 60(2), 225-242.
Wright, L.M., Watson, W.L., & Bell, J.M. (1996). Beliefs: The heart of healing in families and illness. New York, NY: Basic Books.
Barker, P. (2001). The tidal model: The lived-experience in person-centred mental health care. Nursing Philosophy, 2(3), 213-223.
Barker, P. (2003). The tidal model: Psychiatric colonization, recovery and the paradigm shift in mental health care. International Journal of Mental Health Nursing, 12(2), 96-102.
Beal, G., Chan, A., Chapman, S., Edgar, J., McInnis-Perry, G, Osborne, M., & Mina, E.S. (2007). Consumer input into standard revision: Changing practice. Journal of Psychiatric and Mental Health Nursing, 14(1), 13-20.
Beeber, L. (1989). Enacting corrective interpersonal experiences with the depressed client: An intervention model. Archives of Psychiatric Nursing, 3(4), 211-217.
Belton, N. (1999). The good listener: Helen Bamber, a life against cruelty. New York, NY: Pantheon Books.
Bergum, V. (2004). Relational ethics in nursing. In J. Storch, P. Rodney, & R. Starzomski (Eds.), Toward a moral horizon: Nursing ethics for leadership and practice (pp. 485-503). Toronto, ON, Canada: Pearson Education.
Canadian Nurses Association (2008). RN workforce profile by area of responsibility (2006 ed.) Retrieved from www.cna-aiic.ca.
Caputo, J.D. (1987). Radical hermeneutics: Repetition, deconstruction and the hermeneutic project. Bloomington, IN: Indiana University Press.
College of Nurses of Ontario (2006). Practice standard: Therapeutic nurse-client relationship (2006 rev. ed.). Accessed from www.cno.org.
Davey, N. (2006). Unquiet understanding: Gadamer’s philosophical hermeneutics. New York, NY: State University of New York Press.
Donatelle, R.J., Munroe, A.J., Munroe, A., & Thompson, A.M. (2008). Health: The basics (4th Canadian ed.). Toronto, ON, Canada: Pearson Education Canada.
Dowling, M. (2006). The sociology of intimacy in the nurse-patient relationship. Nursing Standard, 20(23), 48-54.
Dreyfus, H.L. (1991). Being-in-the-world: A commentary on Heidegger’s being and time. Cambridge, MA: Division I. MIT Press.
Evans, A.M. (2007). Transference in the nurse-patient relationship. Journal of Psychiatric and Mental Health Nursing, 14(2), 189-195.
Forchuk, C. (1994). The orientation phase of the nurse-client relationship: Testing Peplau’s theory. Journal of Advanced Nursing, 20(3), 532-537.
Forchuk, C. (2002). People with enduring mental health problems described the importance of communication, continuity of care, and stigma. Evidence Based Nursing, 5(3), 93-97.
Forchuk, C., & Reynold, W. (2001). Clients’ reflections on relationships with nurses: Compari-sons from Canada and Scotland. Journal of Psychiatric and Mental Health Nursing, 8(1), 45-51.
Frank, A.W. (2004). The renewal of generosity: Illness, medicine, and how to live. Chicago, IL: The University of Chicago Press.
Gadamer, H.G. (1989). Truth and method (2nd rev. ed., J. Weinsheimer & D.G. Marshal, Trans.). New York, NY: Continuum. (Original work published 1975).
Gadamer, H.G. (1994). Heidegger’s ways (J. W. Stanley, Trans.). Albany, NY: State University of New York Press.
Gadamer, H.G. (1996). The enigma of health: The art of healing in a scientific age. (J. Gaiger & N. Walker, Trans.). Stanford: Stanford University Press.
Gallop, R., & O’Brien, L. (2003). Re-establishing psychodynamic theory as foundational knowledge for psychiatric/mental health nursing. Issues in Mental Health Nursing, 24(2), 213-227.
Hagerty, B.M., & Patusky, K.L. (2003). Reconceptualizing the nurse-patient relationship. Journal of Nursing Scholarship, 35(2), 145-150.
Handy, J.A. (1991). The social context of occupational stress in a caring profession. Social Science and Medicine, 32(7), 819-830.
Hardin, S., & Halaris, A. (1983). Nonverbal communications of patients and high and low empathy nurses. Journal of Psychosocial Nursing and Mental Health Services, 21(1), 14-20.
Harries, K. (1978). Fundamental ontology and the search for man’s place in Heidegger and modern philosophy. New Haven, CT: Yale University Press.
Hartrick Doane, G., & Varcoe, C. (2007). Relational practice and nursing obligations. Advances in Nursing Science, 30(3), 192-205.
Hayes, H. (2007). (Be)coming home: An existential perspective on migration, settlement and the meanings of home. Existential Analysis, 18(1), 2-16.
Heidegger, M. (1962). Being and time (J. Macquarrie & E. Robinson, Trans.). San Francisco, CA: Harper (Original work published 1927).
Henderson, A. (2001). Emotional labor and nursing: An under-appreciated aspect of caring work. Nursing Inquiry, 8(2), 130-138.
Hilficker, D. (1994). Not all of us are saints: A doctor’s journey with the poor. New York, NY: Random House.
Jardine, D.W. (1994). Speaking with a boneless tongue. Bragg Creek, AB, Canada: Makyo Press.
Jardine, D.W. (1998). To dwell with a boundless heart: Essays in curriculum theory, hermeneutics, and the ecological imagination. New York, NY: Peter Lang.
Jardine, D.W. (2006). On hermeneutics: “Over and above our wanting and doing”. In J. Kincheloe, & K. Tobin (Eds.). Doing educational research: A handbook (pp. 269-288). Rotterdam, The Netherlands: Sense.
Kearney, R. (2003). Stranger, gods and monsters. New York, NY: Routledge.
Levin, D. M. (1989). The listening self: Personal growth, social change, and the closure of metaphysics. London, UK: Routledge.
Lévinas, E. (1996). Basic philosophical writings (A.T. Peperzak, S. Critchley, & R. Bernasconi, Trans & Eds.). Bloomington, IN: Indiana University Press.
MacDonald, H. (2006). Relational ethics and advocacy in nursing: Literature review. Journal of Advanced Nursing, 57(2), 119-126.
Milton, C.L. (2008). Boundaries: Ethical implications for what it means to be therapeutic in the nurse-person relationship. Nursing Science Quarterly, 21(1), 18-21.
Miner-Williams, D. (2007). Connectedness in the nurse-patient relationship: A grounded theory study. Issues in Mental Health Nursing, 28(11), 1215-1234.
Morck, A. (2009). “Right there in the midst of it with them”: Impacts of the therapeutic relationship on nurses. Unpublished master’s thesis, University of Calgary, Calgary, AB, Canada.
Morse, J.M. (1991). Negotiating commitment and involvement in the nurse-patient relationship. Journal of Advanced Nursing, 16(4), 455-468.
Moules, N.J. (2000). Nursing on paper: The art and mystery of therapeutic letters in clinical work with families experiencing illness. Unpublished doctoral thesis, University of Calgary, AB, Canada.
Moules, N.J. (2002). Hermeneutic inquiry: Paying heed to history and Hermes: An ancestral, substantive and methodological tale. International Journal of Qualitative Methods, 2(3), Article 3, http://www.ualberta.ca/~ijqm.
Moules, N.J., McCaffrey, G., Field, J.C., & Laing, C.M. (2015). Conducting hermeneutic research: From philosophy to practice. New York, NY: Peter Lang.
Oxford English Dictionary (1971) (Compact ed.). Oxford: Oxford University Press.
Peplau, H.E. (1962). The crux of psychiatric nursing. American Journal of Nursing, 62(6), 50-54.
Peplau, H.E. (1988). Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. London, UK: Macmillan Education.
Peplau, H.E. (1989). Interpersonal theory in nursing practice: Selected works of Hildegard E. Peplau (A.W. O’Toole, & S.R. Welt, Eds.). Ann Arbor, MI: Springer.
Peplau, H.E. (1992). Interpersonal relations: A theoretical framework for application in nursing practice. Nursing Science Quarterly, 5(1), 13-18.
Perraud, S., Delaney, K.R., Carlson-Sabelli, L., Johnson, M.E., Shephard, R., & Paun, O. (2006). Advanced practice psychiatric mental health nursing, finding our core: The therapeutic relation-ship in 21st century. Perspectives in Psychiatric Care, 42(4), 215-226.
Raingruber, B. (2003). Nurture: The fundamental significance of relationship as a paradigm for mental health nursing. Perspectives in Psychiatric Care, 39(3), 104-112.
Rashotte, J. (2005). Dwelling with the stories that haunt us: Building a meaningful nursing practice. Nursing Inquiry, 12(1), 34-42.
Reinders, L., & Van Der Land, M. (2008). Mental geographies of home and place: Introduction to the special issue. Housing, Theory and Society, 25(1), 1-13.
Rogers, A.G. (1995). A shining affliction: A story of harm and healing in psychotherapy. New York, NY: Viking Books.
Shattell, M.M., Starr, S.S., & Thomas, S.P. (2007). ‘Take my hand, help me out’: Mental health recipients’ experience of the therapeutic relationship. International Journal of Mental Health Nursing, 16(4), 274-284.
Sun, F., Long, A., Boore, J., & Tsao, L. (2006). A theory for the nursing care of patients at risk of suicide. Journal of Advanced Nursing 53(6), 680-690.
Svenaeus, F. (2001). The phenomenology of health and illness. In K. Toombs (Ed.), Handbook of phenomenology and medicine (pp. 87-108). Dordrecht, The Netherlands: Kluwer Academic Publishers.
Tomey, A.M. (2006). Nursing theorists of historical significance. In A.M. Tomey, & M.R. Alligood (Eds.), Nursing theorists and their work (pp. 54-67). St. Louis, MO: Mosby.
Vandemark, L.M. (2006). Awareness of self and expanding consciousness: Using nursing theories to prepare nurse-therapists. Issues in Mental health Nursing, 27, 605-615
Vandusen, W. (1998). Wu wei: No-mind and the futile void in psychotherapy. In A. Molina (Ed.) The couch and the tree: Dialogues in psychoanalysis and Buddhism (pp. 52-57). New York, NY: North Poin Press (Original work published 1958).
Walsh, K. (1999). Shared humanity and the psychiatric nurse-patient encounter. Australian and New Zealand Journal of Mental Health Nursing, 8 (1), 2-8.
Warne, T., & McAndrew, S. (2005). The shackles of abuse: Unprepared to work at the edges of reason. Journal of Psychiatric and Mental Health Nursing, 12(4), 679-686.
Warne, T., & McAndrew, S. (2008). Painting the landscape of emotionality: Colouring in the emotional gaps between the theory and practice of mental health nursing. International Journal of Mental Health Nursing, 17(2), 108-15.
Wiebe, L.M. (2001). Connection in the therapeutic relationship: Sharing a subjective world. Unpublished educational dissertation, University of Toronto, Toronto, ON, Canada.
Woolley, J. (2007). Home truths: The importance of the uncanny for Patrick Suskind’s critique of the enlightenment in das parfum. German Life and Letters, 60(2), 225-242.
Wright, L.M., Watson, W.L., & Bell, J.M. (1996). Beliefs: The heart of healing in families and illness. New York, NY: Basic Books.
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