Conceptualising the functional role of mental health consultation-liaison nurse in multi-morbidity, using Peplau's nursing theory
Michael K. Merritt
Mental Health Consultation-Liaison Service, Lyell McEwin Health Service, Elizabeth Vale, South Australia
Nicholas G Procter
Professor and Chair: Mental Health Nursing, School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, Adelaide SA
PP: 158 - 166
Abstract
This paper examines the Mental Health Consultation Liaison Nursing (MHCLN) role and links this to the interpersonal relations theory of nurse theorist Hildegard Peplau. The paper argues that as mental health nursing care around the world is increasingly focused upon meaningful therapeutic engagement, the role of the MHCLN is important in helping to reduce distressing symptoms, reduce the stigma for seeking help for mental health problems and enhancing mental health literacy among generalist nurses. The paper presents a small case exemplar to demonstrate interpersonal relations theory as an engagement process providing patients with methodologies which allow them to work through the internal dissonance that exists in relation to their adjustment to changes in life roles precipitated by physical illness. This dissonance can be seen in the emergence of anxiety, depression and abnormal/psychogenic illness behaviours. This paper concludes arguing for considerable effort being given to the nurse-patient relationship that allows for the patient having freedom to use strategies that may help resolve the dissonance that exists.
Keywords
Consultation-Liaison Nursing, Interpersonal Relations, Mental Health, Peplau
Article Text
In contemporary clinical settings it is important that community consultation and liaison services ensure mental health patients have an active and meaningful voice in their treatment and care planning. This means ensuring greater emphasis on the valued involvement of patients through dialogue and information exchange with clinicians. At the same time there is growing interest in the idea that mental health care should be delivered and administered across a range of practice settings within general health and hospital settings in particular.
It is within the above context that this paper is written. With the collapse of the purpose built psychiatric hospital as once the mainstay of traditional mental health care, it is difficult to over emphasize the importance of community based systems and structures as key drivers of contemporary mental health care. There is a now a global consensus that mental health care should be undertaken in partnership and collaboration with mental health patients - no matter where they are or where they live - and in the least restrictive environment (World Psychiatric Association 2009) . At the same time there is a vision of a seamless and connected care system which is consumer focussed and recovery oriented (National Mental Health Policy, 2008).
At the same time there is evidence of marginalisation, oppression and incarceration of people with a mental illness in certain societies (BBC May 8 2009) and in industrialised nations. While mental disorders represent 15% of the total disease burden people with severe mental disorders in low to middle income countries often fail to receive adequate mental health care (World Health Organisation/ Wonca, 2008). A recent UK Healthcare Commission report (for example) reveals that of 27,000 people using mental health services, 15% said they did not have enough say in care decisions and 44% only had a say to some extent. The Healthcare Commission quizzed 300,000 patients and found that most wanted more meaningful input into their care, especially those with mental illness. Similar sentiment has been expressed elsewhere in the UK (BBC August 4 2004) and in Australia (Mental Health Council of Australia, 2006). In addition and contrary to recommended national standards, less than half of mental health service users surveyed in the UK had access to crisis care, and only have had been given or offered a written care plan (Health Care Commission UK, 2008). Such conditions are experienced by patients as de-humanising and de-personalising, placing interpersonal relations at the fringe rather than as central interactions between patient, carer and mental health professional.
People with co-existing physical and mental health problems are also at risk of marginalisation. People with chronic physical illnesses also experience a sense of being de-humanised and de-personalised by the health system (Jones 1998; Barker 2009). The emphasis is, in this sense, on the physical, potentially reducing the patient to a collection of systems and ignoring the holism and the person or patient's journey to this point in time. Australian studies have shown that whilst depression, anxiety or psychological distress is identified in patients with chronic physical illness, 75% do not receive psychological treatment or counselling (Kelly & Turner, 2009).
Clearly, there is cause for examining the deeper structures of engagement in mental health between clinicians and patients to advance recovery in mental health. It is for this reason that the authors draw upon the Peplau Model as the underlying theoretical construct used by Hildegard Peplau emphasises the crux of the therapeutic relationships as a partnership between the nurse and the patient, and with it notion of shared humanity between the nurse and the patient (Peplau 1952, 1991, and 1997). Whilst the model has its genesis in psychodynamic and psychodramatic theories giving rise to looking more deeply at the reasons for individual thought and behavior (Sullivan 1953), it has been long utilised by mental health nurses in clinical practice (Price 1998; Barker 1993 and 2009). Barker (2009) in particular emphasized the person rather than the problem to be the focus of mental health nursing. This underlines that, according to Peplau, the therapeutic relationship is a central platform of mental health nursing practice. Shattell, Starr & Thomas (2007) adapted Peplau's theoretical approach to described patient's views of the therapeutic relationship as being expressed in three figural themes: 'relate to me', 'know me as a person' and 'get to the solution'. The therapeutic relationship is by its nature and scope primarily about the creation of a shared experience.
The next section outlines steps taken to review literature pertaining to the functional role of the MHCLN informed by Peplau's nursing theory. The utilisation of this theory in multi-morbidity is then discussed.
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