Would you make a good mental health nurse?
Good mental health nurses need at least:
- Excellent Knowledge of Mental Health problems and how to apply it in practice. It’s no good just reading articles, books, leaflets or patient notes. You need to be in the thick of things, working with patients and colleagues, asking relevant questions, asking for and accepting help where necessary, putting all your theoretical knowledge safely into practice in order to support a patient. You need to use your knowledge of a patient to be able to effectively handover to and liaise with the multi-disciplinary teams, families and carers in order to provide continuity of care.
- Empathy and the ability to relate to people of all ages and backgrounds. Nurses need the ability to put themselves in someone else’s shoes, walk a mile in someone’s shoes, to see what they see and feel how they feel. Like when a mother smiles and her baby catches the emotion and smiles with her or when a mother is angry or stressed and the baby catches this and cries, possibly adding to the mother’s angst and negative feelings. Try not to use platitudes i.e. “Time is a great healer.” to someone who’s just lost their mum/dad or “It will all look brighter in the morning.” to someone who is depressed. Don’t offer unwanted advice. Who wants to hear “Oh my mum’s neighbour’s grandson had that and he used to ………..” or “I had depression because ……..” then go on to your own story. It’s not about you or the grandson!
- Be non-judgemental. “Love is the absence of judgment.” — Dalai Lama. Of course it’s in our nature to judge and it can be a good thing, it’s how we make sense of our world. We sometimes make snap decisions about patients based on their colour, sexual preferences, race, religion and even small things like how they’re dressed. However, a nurse mustn’t decide to see someone as being above or beneath them, they have to remain open to different possibilities and options. Being judgemental alienates us from others which is no good in a mental health environment. Nurses need to look beyond the presenting facade and immediate appearance of a patient where they’ll often find very human and tragic struggles. You can disagree with a patient’s choices or strong opinion but do it in a non-judgemental way. You could say something like “I hear what you’re saying and I appreciate your opinion but I see it differently. Tell me why you think …………”
- Communication skills. And I think you need excellent communication skills when working with sometimes confused, angry, sad, depressed or manic, chaotic, aggravated, delusional, psychotic patients and their families. Often there is so much going for a patient and they need support in many areas i.e. housing, finances, childcare, animal at home alone, emotional, physical or mental health. You need to be able to listen mindfully, to stay in the moment with the patient or family and not to immediately start preparing your answer. A patient wants to feel heard. Listen to the end of a patient’s ‘story’. The clue is often there; a small add-on for the patient but it’s actually the problem causing them the most grief. You need to be able to remain calm to speak clearly, concisely and appropriately to the patient and ask if they need further explanation or if they need more time to think. You need to be able to look; observe the patient and sometimes the family dynamics in order to gather information. Observe their facial gestures; whether they’re smiling, nodding, frowning. Observe posture; are they slumped, sagging shoulders and look at clothing appropriate for the weather. You might observe that the patient smells unclean, his teeth haven’t been brushed. You might notice that the patient is sweating or has a fever and take his temperature. The Royal College of Nursing (RCN) states that by using your eyes, ears, nose, touch and knowledge of what is ‘normal’ for the people you care for, you can identify potentially serious changes in mood and mental state and take action early on.
- Compassion is usefully described as a sensitivity to distress together with the commitment, courage and wisdom to do something about it (Cole-King & Gilbert, 2011). It’s a genuine sympathy for hardship or suffering. It’s kindness and the simple act of showing it can make a world of difference in a patient’s day. Nurses often come into people’s lives when they are in distress, pain and vulnerable and how they treat patients, carers and their families can leave a lasting impression. Ignoring differences and finding things in common help you relate to a patient and what they might be going through. Active listening, use of paraphrasing what the patient just said, makes them feel heard and cared for. Leaving your own world at the front door and just being there in the moment with a patient encourages openness and a mutual trust. These small acts all impact on a patient’s emotional responses and their view of the care they are to receive. Sometimes the nurse is the only person they have to listen to them and take their illness seriously, which is why compassion is key; it’s always at the forefront of what we do (www.yourworldhealthcare.com).
- Commitment in nursing is about providing the best care available at all times. You must commit to building positive and trusting relationships with colleagues and patients and their significant others to promote continuity of care. A nurse must be able to make the patient and families feel valued and cared for and feel safe in the nurses knowledge and skills. Therefore nurses must stay up to date with all relevant practice and be committed to lifelong learning which will enable delivery of excellent person-centred, evidence-based care. Education doesn’t stop when a nurse qualifies! Moreover, nurses must commit to taking good care of their own physical, emotional and mental health. If a nurse is not okay how can they expect to look after patients
- Ability to stay calm. If you can keep your head when all about you are losing theirs ………. by Rudyard Kipling comes to mind. Sometimes perhaps because they’re distressed, delusional or chaotic, patients can become angry and insistent on having their needs met immediately. It’s imperative that nurses can remain calm to deal with pressure, emotional outbursts or any other stressful situation effectively. Patience is important in helping you to effectively deal with a crisis as is being a team player skilled in the art of working well with other. Knowing how to effectively interact with different types of people will help to de-escalate or diffuse a potential risk situation and avoid having to use ‘Control and Restraint’ techniques on a patient.
- Emotional intelligence (EI) is how effective we are at behaving and responding in a mature manner, as well as our ability to properly process circumstances around us. As a mental health nurse, you would need to remain calm and use your EI if there was ever a ‘standoff’ situation where a patient becomes aggressive and physically threatening. You’d need to take in everything and everyone around you immediately to ensure the safety of the patient and others. Noticing, understanding, and managing one’s own and other’s emotions can be used to effectively engage the patient and bring calm to the situation. You might say to the patient “I hear what you’re saying……. I can see that your angry. What can I do to help? What would you like me to do?” “Would you like sit with me and I can listen?” What else might you say?
- Resilience enables nurses to cope with their work environment and to maintain healthy and stable psychological functioning. Working in mental health environments can be at best, positive and fulfilling but demanding, tiring and hectic and at worst, negative, exhausting and traumatic which can cause nurses both physical and mental problems, such as irritability, unhappiness and lack of concentration. Resilience is the ability to bounce back and it can be learned and improved upon through good supervision, preceptorship and mentorship programmes provided by the organisation.
- Adaptability is the ability or willingness to change in order to suit different conditions; it’s a necessary quality in an ever-changing work environment, particularly in mental health nursing. A mental health nurse will meet people who are often misunderstood by society, including their friends and family (www.yourworldhealthcare.com) and so need the ability to adapt easily to new patients, different disorders and changes in mood and emotional states together with new students, new nurses, change in Junior Doctors every six months, new procedures and policies…………… The list is infinite end ever changing as is mental health environments, so a nurse has to be flexible, to be curious, to be open minded and to see ahead and have a plan B.
The above attributes are essential though this list is not exhaustive. There are are many more personal characteristics such as being warm and engaging, considerate and so on.
I wish I could say I observed all the above in practice during three years of study and fifteen years of working within mental health.