The One-to-One Nurse-Patient Relationship

Article excerpt

Reprinted from Perspectives in Psychiatric Care, Volume XVIII, No. 2, 1980, pp. 67-89; originally printed in "Psychiatric Nursing 1946 to 1974: A Report on the State of the Art," by F. L. Huey, pp. 1-14. Reprinted by permission of the American Journal of Nursing Company.

The question of nurses doing psychotherapy is no longer whether, but how. Here is a discussion of the history and trends, an assessment of published research, and a summary of patterns in the literature which have reflected and promoted this direction in one-to-one psychiatric nursing.

Change and growth within a profession do not come easily. Nursing, a relatively young profession, is still--as it has been almost since its inception--in a state of tremendous flux and uncertainty.

The purpose of this paper is to explore in depth the theory and practice of one kind of psychiatric nursing--one-to-one nurse-patient relationships--from 1946, when the National Mental Health Act was passed, to the present. This paper will present a critical assessment of what theory and practices psychiatric nurses have reported and where nurses should extend their efforts, in the foreseeable future, toward further development of the theory and practice of one-to-one nurse-patient relationships.

Because of the tremendous breadth and scope of the area of psychiatric nurse-patient relationships presented in the literature, it was necessary to carefully delimit the topics to be covered. Therefore, such areas as psychiatric nursing with children and adolescents, geriatric patients, and the mentally retarded; the application of psychiatric nursing in the care of the physically ill patient and in the care of the dying patient; and the use of behavior modification in psychiatric nursing will not be discussed.

For the purpose of this paper, the individual (one-to-one) psychiatric nurse-patient relationship is defined as the relationship between a psychiatric nurse and his/her patient, formed for the purpose of brief counseling, crisis intervention, and/or individual psychotherapy. The emphasis is on the interpersonal relationship between the nurse and the patient, with all its vicissitudes, as opposed to physical care of the patient.

History and Trends

The psychiatric nurse-patient relationship was used as a therapeutic tool long before 1946, the historical point at which this paper begins.(1) But 1946 marks the start of what Dr. Sills has called "The Years of Fulfillment" (1).

In 1947, eight programs for the advanced preparation of nurses to care for psychiatric patients were initiated.(2) It was in these graduate programs that the first psychiatric nursing leaders (those who were to "set the stage" in the 1950's for the importance of the one-to-one nurse-patient relationship) were prepared. In the same year that these programs came into being, Render published Nurse-Patient Relationships in Psychiatry, a textbook for psychiatric nurses. This text emphasized the nurse-patient relationship and contained no psychiatry except that related to nursing.

For the remainder of the 1940's and early into the 1950's, psychiatric nurses began to write in very vague terms about how nurses were to participate in one-to-one relationships with patients. In 1947, Naranick pointed out that the nurse should have a "personality which allows her to adjust to difficult situations" (2). Weiss, a pioneer psychiatric nurse-author, wrote about the importance of seeing the patient as a person, unlearning "mechanical" nursing, and using kind firmness with suicidal patients (3,4). Kimball wrote of the need for the nurse to understand psychodynamics and psychosexual development in order to care for psychiatric patients (5). And, in 1949, Santos and Stainbrook wrote that the nurse must understand certain concepts underlying such occurrences in psychotherapy as transference in order to help the patient (6). They stated further that the nurse should perform "psychotherapeutic tasks" with supervision; however, they were vague about what these tasks were. …