Academic journal article Perspectives in Psychiatric Care

The Human Science Basis of Psychiatric Nursing: Theory and Practice

Academic journal article Perspectives in Psychiatric Care

The Human Science Basis of Psychiatric Nursing: Theory and Practice

Article excerpt

Editor's Note: This article is from the Journal of Advanced Nursing, 25 (1997), 66"67. Copyright 1997 Blackwell Science, Ltd. Reprinted with permission.

Psychiatric nurses in the United Kingdom (UK) have begun to reattend to people with `Serious and enduring mental illness'. At the same time research in the USA and UK has refocused much of its attention on neuroscientific theories and models of serious mental illness. Psychiatric nurses are being encouraged to consider the value of biomedical explanations of serious illness, such as schizophrenia, and to accommodate these theories and models in the practice of nursing. This paper will examine the challenge of biomedical approach for the continued development of psychiatric nursing needs to develop further its own `proper focus', if it is to survive as a key player in the health care field of the 21st century.

BIOLOGICAL ORTHODOXY

Nursing needs to acknowledge that the phenomena dealt with by nurses are human responses to various life problems. Nurses do not deal with now, and have never dealt with, mental illness per se. Concepts such as schizophrenia in particular, and what has `down the ages' been called `madness' in general, are no more than ideas about some people, their behavior and their reported experience, formed through generalizations about the behavior and reported experience of other people. Even if such ideas had validity, nurses have no responsibility to explain people by use of diagnostic concepts such as schizophrenia. Nursing's task is `and has always been' to help people deal with human problems they experience: their responses to what other people call various forms of mental illness. Given this focus, nursing needs to be promoted as a form of human inquiry: in Hilda Peplau's (1990 p. 19) words, to help:

patients [who] are embarked on a search for truth about themselves and their life experiences.

The authors' interest in such human inquiry in nursing is linked to the work begun half a century ago with Peplau's theory of interpersonal relations applied to nursing Weplau 1952). Nursing's exploration of the human context of being and caring is predicated on the potential for growth and development which is inherent within each person-called-patient. In the authors' view, being with and caring with people-in-care is the process which distinguishes nurses from all other health and social care disciplines, and needs to be recognized also as the process that underpins all psychiatric nursing.

In the United Kingdom psychiatric nurses have only begun to give real consideration to such theoretical concepts of nursing practice (Reynolds & Cormack 1990). Much is often made of the so-called theory-practice gap (Chambers 1994). As researchers and educationalists involved directly in the practice of psychiatric nursing, the authors believe that concepts such as being with and caring with people are not philosophical irrelevancies, but represent the language and grammar of what--actually--goes on between nurses and patients when effective caring takes place. Given that nurses have begun to develop such a language and grammar for psychiatric nursing in this country, now is the time for nursing to redouble its efforts. Now is not the time to start doubting the unique professional focus of the discipline.

Refocus

Psychiatric nurses in the UK have been encouraged increasingly to refocus their attention on `people with serious or enduring mental illness in secondary and tertiary care, regardless of setting' (Department of Health, 1994). At the same time, there has been some encouragement to accommodate a largely biomedical orthodoxy at the expense of further professionalization of nursing. This influence of biomedical orthodoxy has been expressed in two forms:

1. the demand for a greater emphasis on biological hypotheses concerning the origin and resolution of various forms of mental distress (Gournay 1995a);

2. …

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