Dignity Respect Mental Health Nursing

Promoting dignity and respect in mental health Recovery

It is universally accepted that health and wellbeing are crucial to human life, and medical interventions have been developed to manage different health conditions. Mental health conditions affect the brain and cognitive functioning often resulting in impaired judgment and reasoning. Patients with these conditions are accorded interventions from psychiatric units and mental health nurses are crucial in their recovery. Many studies have explored the key principles in effective therapy, and this paper evaluates the application of the principles of dignity and respect in mental health nursing. The benefits of upholding dignity and respect in the treatment of mental health are discusses in detail. The paper then presents key recommendations for promoting dignity and respect in mental health recovery nursing.

Bhanji (2013,) defines respect as the state of being esteemed, and words like valuing, liking and caring are often used as synonyms. Dignity, on the other hand, is focused on how people feel, think and behave in relation to the worth or value of themselves and others (Saxena & Hanna, 2015). Dignity and respect are key themes in mental health recovery nursing, and many studies have explored the importance of these principles in the psychiatric environment (Bhanji 2013). Mental health patients and nurses both have a responsibility in promoting dignity and respect. However, the role of the psychiatric nurse has the most significant effect on the recovery of the patients (Bhanji 2013,). This is because psychiatric nurses work within a defined psychiatric code of ethics and the mental health patients benefit from their directions, care and instructions for their successful recovery. Treatment of patients in psychiatric units by the nurses significantly contributes to their recovery, which makes dignity and respect pillars in mental health recovery nursing.

The primary function of the mental health nurses is ensuring the recovery of patients in psychiatric units. Recovery-oriented practice focuses on empowering patients to recognize and take responsibility for their own recovery; however, nurses play a vital role in building self-determination and self-management capabilities among their patients (Knutson et al., 2013; Wieman et al., 2014,). These capabilities empower patients in decision making and collaboratively participating in healthcare programs that ensure their recovery. However, the responsibility for the development of mental health care plans lies with the nurse who provides extensive support to patients through the programs. Appropriate evaluations by nurses provide feedback on the patient's performance and motivates them through the program.

Recovery-oriented practice adopts a person-centred approach that emphasizes the treatment of the whole patient rather than focusing strictly on clinical aspects of treatment (Baker & Buchanan-Barker 2011). This treatment also covers behavioural, cognitive and physical wellbeing, which are equally important in recovery. Therefore, the nurse has a broader role to play beyond the administration of clinical treatment. For instance, nurses encouraging mental health patients to participate in physical activities, such as games and sports, results in patients feeling loved, cared for and valued. The nurses, therefore, are involved in enhancing the comprehensive recovery of patients, but successful recovery equally depends on other principles like dignity and respect, which the nurses champion and foster within the psychiatric unit.

While there are several principles for effective mental health recovery, dignity and respect play an important role and result in positive participation by patients committed to their own recovery. When nurses treat their patients with dignity and respect, patients will feel valued and honoured resulting in their increased eagerness to fully participate in the therapeutic process resulting in their recovery. Therefore, treating a person with dignity and respect can increase the level of satisfaction and confidence to him. On the other hand, disrespecting dignity can result in deterioration in both physical and mental health, a result that can affect the behaviour of the person to be isolated, uncooperative or even aggressive toward the nursing staff (Chambers et al.,2014)

Effective mental health treatment requires that nurses see their patients holistically (Carvanough, 2018), that is, the nurse cares for the client's body, spirit, and mind. This therefore requires involvement of the patients in decision-making regarding care and providing them with Information about their treatment plans (particularly medication).

Mental health problems stem from numerous factors ranging from genetically-related factors to cognitive issues, such as depression and stress, as well as physical issues, such as brain damage stemming from physical injuries and accidents. This necessitates dynamic treatment plans that go beyond clinical diagnosis and include behavioural therapy aimed at boosting the client’s perception of the situation by building their self-acceptance and self-esteem along with other interventions (Coulter et al., 2015; Baker et al., 2013).

Mental health recovery is very demanding, and the psychiatric nurse’s commitment is a critical element. This can be challenging because it is quite common for patients to be isolated and excluded, especially when they exhibit violent behaviour (Coulter et al., 2015; Knutson et al., 2013; Polacek et al., 2015). This isolation and exclusion can lead to attitudes of discrimination in psychiatric nurses for various reasons, such as fear of attack if a patient becomes violent. Tandora et al. (2014) explain that this can significantly hamper the effective recovery of such patients.

Tandora et al. (2014) suggest that in order to exhibit and build dignity and respect, reorienting care to meet the patient’s personal life goals is necessary. Some patients have personal life goals that include complete recovery from the mental condition. Treatment of patients with dignity and respect enables the nurse to understand these personal goals and collaboratively work with the patient in pursuing their goals. In fact, the existence of such a goal-setting approach will increase the patient's commitment to recovery and provide an avenue for the nurses to direct and guide the behaviour of the patients towards recovery.

Upholding dignity and treating patients with respect builds their strength and formally and informally supports their participation in their own care (Tandora et al., 2014). Autonomy is very crucial in mental health recovery and when patients are supported by nurses they have an opportunity to exercise their autonomy through personal decision making, which is a strategy that facilitates the patient’s commitment to recovery and builds their cognitive capacity. In fact, strong decision making builds the patient’s problem-solving capacity, which may in-turn enables them to recover from mental distress. On the other hand, building support, both formal and informal, enables patients to rely on the nurses for help whenever there is a problem. It also offers nurses an opportunity to understand the client's personal life struggles and the magnitude and the root causes of their mental distress. Support that is characterized by dignity and respect allows patients to develop a friendly relationship with nurses and confide in them, which is vital for diagnosis and recovery. In fact, according to Tandora (2014), person-centred recovery planning and person-centred care planning are crucial elements of recovery-oriented care.

Polacek et al. (2015) found that positive interaction between the mental health nurse and their clients results in effective recovery while negative interactions result in the patient’s resentment of the recovery plan. The knowledgeable and caring nurse plays a key role in determining the positive or negative nature of engagement by working with patients collaboratively and spending quality time with them. Such positive engagement is crucial for mental health recovery (Polacek et al., 2015).

On the other hand, inadequate nurse staffing characterized by favouritism and joking and laughing about the patient’s condition creates isolation and exclusion, which are detrimental to effective recovery (Coulter et al.2015). Psychiatric units often resort to confining patients exhibiting violent behaviour in order to prevent them from causing perceived or real harm. The isolated patients will feel withdrawn from the recovery program, and this will hamper their participation in the therapeutic sessions and recovery (Tandora et al. 2014). Similarly, favouritism from the nurse builds discrimination and can result in acrimony among patients in the facility worsening the client’s mental distress. These negative aspects will significantly hamper the effectiveness of the patient’s recovery. This is why Azeem et al. (2011) emphasized that mental health patients should be perceived, addressed and treated as “normal” people suffering from a condition just as patients with physical conditions are viewed and treated.

Polacek (2015) further identifies reasons that might hinder mental health nurses from promoting dignity and treating patients with respect. Vicarious traumatization, lack of training, violence and fear are common causes for inhibiting the commitment of nurses to the effective recovery of their patients. The psychiatric nurse may have been exposed to previous violent attacks from mentally distressed patients resulting in traumatization and causing the nurses to distance themselves from patients. This keeps them from building friendships that could enable them to understand and address the underlying problems faced by their patients and consequently treat patients with the value they deserve (Mann et al. 2016). The previous experiences may make nurses to be judgmental and thus inhibit their commitment to dignity and respect in healthcare. Lack of training to handle the most complicated cases of mental illness leaves the mental health nurse ill prepared to handle all stages of recovery. For instance, while nurses have specialized training in handling mentally distressed clients, they may lack the training and knowledge to handle violent patients, and they often resort to isolating, secluding and confining such patients. In fact, when patients exhibit continuous violent behaviour, the nurses may lose their patience and mistreat such patients severely diminishing their dignity. This results in strained relations between the patient and the mental health nurse and limits the patient’s freedom and rights (right to dignity and respectful treatment included), which can have statutory implications (Department of Health, Australia, 2010; Mann et al., 2016).

Wale et al. (2011) suggests that to effectively incorporate and uphold dignity and respect in psychiatric institutions, effective leadership is critical. Management should strongly advocate for dignity and provide leadership within the institution and, through organizational policy, require the staff to treat patients with dignity and respect. Nurses, on the other hand, should lead through example by exhibiting behaviours that uphold the dignity of their patients. Furthermore, in corporate culture, change might be necessary where facilities embrace the cultural shift by fostering less coercive and more recovery-oriented systems of services.

The pursuit of recovery from mental health distress is no doubt complex. While the nurses play a vital role in planning and executing recovery programs, it requires the contribution of all the stakeholders to actualize recovery. The nature and magnitude of the mental conditions also contribute to the complex nature of the interventions. The previous discussion, however, highlights a number of recommendations for promoting recovery from mental health conditions.

First, mental health nurses should be empowered to decisively and efficiently manage mental health conditions. It is a fact that patients with mental conditions present different behaviours and that mental distress stems from many different causal factors. Therefore, nurses should be well versed in the identification and management of different forms of mental distress and their manifestations. To be empowered, nurses should be properly trained so they can recognize the different forms of mental distress and know how to manage each of these conditions without dehumanizing, isolating and excluding the patients. Nurses should be educated regarding the management of their own behaviours and mental processes that could hamper their service delivery. This includes issues such as discrimination, laughing about the patient’s condition and assessing their own temperaments and attitudes, which could jeopardize the quality of their service delivery.

The nurses should also be provided with appropriate tools and materials to help in efficiently examining and treating their patients. This includes medical equipment such as electroconvulsive (ECT) may be employed to treat symptoms of catatonia. Medicines such as antipsychotic for schizophrenia condition, antidepressant for depression condition, benzodiazepines, muscle relaxants for treating medical conditions like catatonia. Materials for effective mental health assessment and screening. For example, The Kutcher Adolescent Depression Scale (KADS) to identification of young people at risk for depression, and assessment tests such as lab test for blood and urine, magnetic resonance imaging (MRI), an electroencephalogram (EEG) or a computed tomography (CT) should be provided to the psychiatric nurses.

Second, psychiatric units and therapeutic settings for mental health conditions should be constructed and administered respectfully as peaceful environments that provides the ambiance and atmosphere that fosters relaxation and peace of mind. This environment will eliminate some of the environmental factors that may trigger outbursts of mental distress. Noise, for instance, can be reason enough to cause mental distractions of patients in the therapeutic facility, and this can result in violent behaviours. Sometimes, mental distress is accompanied by the use of drugs and other substances, and environments filled with these elements, such as the smell of cigarettes, may distract patients from committing their efforts to their own recovery programs. A peaceful environment offers an opportunity for patients and nurses to interact with dignity and respect. Organizational policies and efforts should focus on observing human rights, which should be equally accorded to mental health patients.

Third, psychiatric nurses should adopt diverse interventions. The recovery-centred therapeutic approach emphasizes person-centred intervention. This means that patients should be treated according to their personal needs. Diversified interventions offer a range of alternatives that can be relied upon in mental health recovery nursing to address the needs of patients on a personal level. This is especially helpful to patients exhibiting violent behaviours and empower nurses to change interventions as need arise in order to align with promotion of dignity and respect of patients. For instance, instead of isolating patients exhibiting violent behaviour, the nurses might calm them down and afterwards politely, empathetically and in a dignified manner counsel the patients. This not only contributes to recovery but also increases the patient’s feeling of being valued.

Fourth, the nature of intervention for mental health conditions is dynamic and may require input from various sources. Therefore, while nurses are the primary players in the therapy, there should be a close working relationship with the patient’s family and community because that support compliments mental health recovery nursing interventions. Among the benefits of this partnership is an increased sense of belonging to patients through increased feeling of being accepted by the family and community members and this support will aid in effective recovery. Additionally, community support reduces the stigmatization of mentally distressed patients eliminating discrimination. Mentally distressed patients accorded family and community support are assured of the preservation of their dignity and respectful treatment.

Finally, the nurse should be active listener to the patient with mental health condition because that provides support to the patients and establishes a cordial relationship with them, prevent them feeling being marginalised and accords them humane treatment. Additionally, Involving the patients in decision-making regarding their care enhance their dignity since they feel valued, confident, comfortable and able to make decisions for themselves. The nurses should further engage the patients in their treatment plan particularly medication by providing briefs about what the type of medication will be provided to them and inquire about their experience, opinion or feelings towards the medication provided.

From the evidence provided in the discussion above, it is clear that principles like dignity and respect are crucial in the mental health recovery nursing. Therefore, it is important that mental health recovery programs adhere to such principles, and psychiatric nurses should be at the forefront of implementing these principles.

Conclusion

Medication, observation and empowerment of patients are crucial elements of enhancing mental health. Nurses provide holistic services to ensure the wellbeing of the patients. The benefits of care on the patients transcends from better health, physical and cognitive strength to improved social awareness through increased self-control and better relations with others. Tailoring interventions to foster dignity and respect of the patients is crucial in encouraging the efforts to their recovery. As has been discussed above, the principles of dignity and respect in mental health nursing results in the commitment of patients to the recovery and increases the capacity of nurses to offer quality care to mental health patients.

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