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Nursing Essay Sample
Changes in the hospital practice of psychiatry have also had an impact on psychiatric nursing practice. In settings where the prevailing philosophy of treatment has been the traditional one-to-one psychotherapy or psycho-analysis, the role of nursing tended in the past to be custodial—the "other twenty-three hours." Within this framework in the mid-twentieth century, nurses struggled to be recognized as more than just caretakers. They tried to do this by becoming more or less traditional one-to-one therapists, following the medical model. "Milieu therapy" also had its beginnings within the framework of psychoanalytically-oriented inpatient psychiatry. The importance of the interaction with the nursing staff became obvious in treatment programs that recognized the importance of the impact of the total milieu on the individual patient. Nursing personnel are the conveyors of the culture; in very large part, they constitute the milieu of the patients. In milieu-conscious programs, nursing came to be recognized for the significant roles it plays in providing therapeutic care.
The "therapeutic community" concept opened further doors to the development and recognition of therapeutic nursing roles in hospital psychiatric treatment. The development of psychiatric nursing in therapeutic communities was described by Holmes and Werner.37 Concerning psychiatric nursing in a therapeutic community, they said that it is "an exciting adventure, marked by loss of traditional nursing roles, blurring of roles of all disciplines, increased responsibility for therapy on the part of both patients and staff, more intense staff—patient relationships, and a whole complex of problems for nursing that we are just beginning to explore." The development of the therapeutic community concept did a great deal for the development of psychiatric nursing, by providing a framework in which nurses could participate more actively and utilize their skills in many more ways. The distinctive features of the therapeutic community are: (1) patients are included in practically all information-sharing processes on the ward; (2) patients' opinions are included in decisions about other patients' readiness for such things as passes and discharges ; and (3) such inclusion of patients in a democratic community process is considered treatment. One can readily see that such a framework fosters open communication and responsibility. In such a setting nurses as well as patients become more responsible members of the society. Psychiatric nursing, while still interpersonally oriented and concerned primarily with relationships, is extended beyond the one-to-one or formal group setting to the total milieu. The therapeutic-community framework applies to part-time treatment situations such as day or evening care programs as well as to full-time inpatient units. In many situations where the concept has been implemented, such as therapeutic communities for drug addicts and alcoholics, nurses are involved and are active contributors to the total treatment program.
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