Nursing and Palliative Care Research Article ISSN: 2397-9623 The caring encounter between patient and nurse within a mental health and psychiatric care context – as described by nurses working in an emergency polyclinic Hemberg Jessica1* and Lipponen Sofie2* 1PhD, RN, Department of Caring Sciences, Åbo Akademi University, Vaasa, Finland 2MSc, RN (Psychiatric Nurse), City of Helsinki, Finland Abstract Aims: This study aims to explore, from a caring science perspective, what constitutes and creates a caring encounter between the patient and the nurse within a mental health and psychiatric care context. Methods: The study uses a hermeneutical approach. The material consists of interviews with nurses working in an emergency polyclinic regarding their understanding of the encounter between a nurse and a patient. The texts were interpreted through hermeneutical reading. Results: This study shows that love and communion are the basis for the caring encounter between the patient and the nurse. Recognition of the patient is essential. The patients’ first impression is decisive for the caring encounter. The personality of the nurse is the key for establishing trust in communion. The uniqueness of the encounter demands openness in the nurse. The room is the basis for the encounter and for safeguarding the patient’s integrity and vulnerability. Vulnerability is thus in this study seen as the guiding-star in the caring encounter between the patient and the nurse within a mental health care context. Conclusion: Vulnerability as a phenomenon plays a fundamental role in the caring encounter between the patient and the nurse in a mental health and psychiatric care context. Future research should further explore this area regarding vulnerability within a mental health and psychiatric care context, but also in relation to different care contexts. Introduction turn can lead to suffering and anxiety. In addition, people with mental ill-health are reported to be stigmatized [3]. Mental health care in Finland, especially psychiatric emergency care, has undergone great changes from having been free-standing and The 1980s’ experienced great progress within psychiatric care [4]. in 2015 moving to the emergency polyclinics [1]. Concern was raised The international psychiatric diagnostic handbook was published; in public debates about how patients with mental ill-health would be projects for developing health care for patients with schizophrenia treated in this new emergency polyclinic environment and what new were initiated and succeeded in reducing the number of suicides; the challenges this would entail. Other issues that were brought to the fore development of training in psychotherapy began; and new drugs for in connection with this change were: what is a caring encounter with depression appeared on the market [4]. According to the National patients with mental ill-health, what takes place in the encounter and Institute for Health and Welfare in Finland [5], mental health care what are the hurdles and challenges? services refer to such activities that prevent, alleviate and treat psychic disorders and their consequences. Mental health promotion is also Treatment and knowledge of how we approach individuals with included in mental health care. The services include supervision, mental ill-health has greatly improved during the last twenty years, counseling, and, depending on the patient’s need for psychosocial but there is still room for development. Even a fleeting or short support in situations of crisis and examination, treatment and encounter may be significant for patients and pave the way for trust rehabilitation of individuals suffering from psychic disorders. and communion [2]. This qualitative study aims to examine the caring communion between patients and nurses within a mental health caring Deficiencies in encounters with patients are common. The nurse context. needs to be aware of patients’ vulnerability in their life situations and Background Correspondence to: Hemberg, Jessica, PhD, RN, Postdoctoral Researcher, Mental ill-health is a great concern in society and within public University Lecturer, Åbo Akademi University, Faculty of Education and Welfare health in the Nordic countries today. Mental ill-health is a concept that studies, Department of Caring Sciences, P.B. 31165101 Vaasa, Finland. E-mail: is used for different mental disorders. These include for example mental [email protected] illnesses, depression, different panic and anxiety disorders, abnormal Lipponen, Sofie, MSc, RN (Psychiatric Nurse), City of Helsinki, Finland. E-mail: psychic reactions, sleeping difficulties, eating disorders, sexual [email protected] disorders, behavioural and personality disorders as well as addictions. The human being who suffers from mental ill-health experiences a Key words: nurse, mental health, psychiatric care, psychiatric emergency decrease in the ability for action, quality of life deteriorates, which in Received: March 14, 2017; Accepted: April 03, 2017; Published: April 06, 2017 Nurs Palliat Care, 2017 doi: 10.15761/NPC.1000147 Volume 2(2): 1-7 Hemberg J (2017) The caring encounter between patient and nurse within a mental health and psychiatric care context – as described by nurses working in an emergency polyclinic take this into account in the care. A meaningful encounter can awaken the encounter is crucial for the patient [7-9,12-13,18] because it may feelings in both patients and nurses [6]. A true caring encounter has affect the quality of life [10]. Therefore, this study sees it as relevant and the potential for communion between nurses and patients [7-9]. The meaningful to further explore this area. characteristics that express communion include sharing, listening, Aims instilling hope, responsiveness, touching, affirming, encouragement, showing empathy, giving advice, providing comfort and support [10]. This study aims to explore, from a caring science perspective, what constitutes and creates a caring encounter between the patient and the A caring encounter presupposes an invitation of the patient by the nurse within a mental health and psychiatric care context. nurse through openness where the nurse builds a bridge between him- or herself to the patient [11]. The encounter can be seen as an invitation Theoretical framework to communion where the nurse encounters patients in a way that makes Caritative theory is part of the caring science tradition [20,21]. them feel welcome and invited to participate in a caring communion According to the ontological perspective of caring science, health is [12,13]. By being present, the nurse invites the patient to the encounter understood as a “becoming”, which implies a movement towards a [7]. The encounter can take place through a conversation with the deeper wholeness and holiness. A movement occurs, when the human patient or simply through being present in the moment. Patients being’s inner health potential is touched and this may be seen in the often feel that they do not receive enough time for discussing with different dimensions of health. The dimension “doing” implies what the nurses [14]. A caring act can only be caring if the encounter between human being does for his or her health, “being” means the endeavour nurse and patient is characterized by positive interactions, intentions to achieve balance and harmony, and “becoming” pertains to a deeper and attitudes [10] Thus, the caring act can be caring, for instance, level of integration and feeling of wholeness [20-22]. when the nurse is actively engaged in the patients’ lives through understanding and true presence in conversation and shows interest According to Eriksson [23], caring is understood as a natural in their experiences. Patients experience communion when they can human behaviour which implies cleansing and nourishing, and share their burdens with the nurse. Trust is crucial in the encounter spontaneous and unconditional love. All human beings are believed [15]. The encounter reflects a nurse’s attitudes and approach toward to be natural caregivers and natural basic caring is expressed through patients with mental ill-health and whether the nurse is able to create a tending, playing and learning in a spirit of love, faith and hope. The sense of trust in patients [14]. An important factor contributing to the characteristics of tending are warmth, closeness, respect, honesty patients being able to open up and feel trust in the encounter was the and touch; playing is an expression of exercise, testing, creativity and environment in which the encounter took place. In addition, Björkdahl imagination, and desires. Learning implies sharing. Caring attains its [11] indicates that the environment and the nurse’s education are distinctive character through the caring communion [24]. A caring important aspects that affect the encounter. The nurse is responsible communion cannot be taken for granted but presupposes a conscious for creating an encounter with patients that is characterized by trust effort to be with the other. By being involved in the suffering of the and openness, but nurses should also act as “guardians” and make sure patient, by being a co-actor in the drama of suffering, as it were, the the care is safe. The encounter develops through warmth and trust. nurse can support the patient and thereby create a caring communion The first invitation to an encounter is often non-verbal and in the encounter [25]. The act of caring contains particular caring represents a platform for the creation of an encounter. The nurse should elements that invite deep communion. The human being longs to be not view the patient as a passive participant in the encounter, but as loved and to love and can find this through communion [25]. In the someone who can influence its content [11]. In the first encounter, encounter, nurses emerge from their own world and offer themselves the nurse encourages interaction with the patient. This is similar to to patients. The encounter demands of nurses genuine concern for and research by Johansson, Skärsäter and Danielsson [16] who indicate attention to patients because when love becomes evident the human that the encounter is the fundamental category in the art of caring.