The emancipation of nursing practice: Applying anti‐psychiatry to the therapeutic community

Abstract

This paper raises issues about the process and conduct of clinical relationships with people diagnosed as mentally ill who live in therapeutic communities. This clinical work is of particular importance in the late 1990s due to the changing socio-cultural climate of interaction with people living with mental illness. This climate has a focus of care on recovery in the community and not on long-term hospitalization. The paper takes the position of anti-psychiatry as a preferred model of intervention because it is person and not diagnosis oriented. The nature of the therapeutic community is explored in relation to its importance in the context of destigmatizing mental illness, its structure, and in its ability to empower the person from a philosophically driven and experiential perspective.

Emancipation in decision‐making in women's health care

“…Several studies have explored the emancipatory role of the nurses in direct patient care, suggesting that it leads to improved decision‐making skills for patients or an increase in autonomy, a related concept. This limited exploration of emancipation in clinical practice may reflect the idea that patients are an oppressed group when confronted with health care options (Lehmann 1982, Burks 1999, Jairath & Kowal 1999, O'Brien et al. 1999, Henshaw 2001, Leino‐Kilpi & Luoto 2001).…”

An Observational Study of Providing Structure as a Psychiatric Nursing Intervention

“…Based on the literature review and closer inspection of the included studies, three elements of providing structure could be discerned, namely to impose and maintain rules and limits, to assess the condition of the patient, and to interact with the patient (Voogt, Nugter, Goossens, & Van Achterberg, in press). With regard to the imposing and maintenance of rules and limits, two continua could be distinguished: (a) the continuum from general to specific structure (Garritson, ; Ransohoff, Zachary, Gaynor, & Hargreaves, ; Sebastian, Kuntz, & Shocks, ; Silver Curran, ; Vatne & Fagermoen, ; Yonge, ), and (b) the continuum from least to most restrictive forms of structure (Caplan, ; Delaney, ; Kozub & Skidmore, ; Morales & Duphorne, ; O'Brien, Woods, & Palmer, ; O'Brien, ; Vatne & Fagermoen, ).…”

“Providing Structure” as a Psychiatric Nursing Intervention: A Review of the Literature

“…The second goal of PS, namely to make mutual expectations explicit within the treatment relationship, was also highlighted by eight authors (Benfer & Schroder, ; Delaney, ; Lowe, ; O'Brien et al., ; Vrale & Steen, ). Nurses try to build a trusting relationship with the patient and make the expectations of nurse and patient sufficiently explicit.…”

“…At the one end of the continuum of least to most restrictive forms of structure (i.e., the second continuum of rules and limits), there are interventions such as verbal interventions and redirection; at the other end are seclusion and the use of restraints (Caplan, ; Delaney, ; Kozub & Skidmore, ; Morales & Duphorne, ; O'Brien, ; O'Brien, Woods, & Palmer, ; Vatne & Fagermoen, ). According to Vatne and Fagermoen, limit setting revolves around the nurses' exertion of weak to stronger power in a given nurse–patient situation.…”

“…Barriers between nurses and patients appear to be lowered when nurses try to put themselves in the shoes of the patients (Björkdahl et al., ; Hopkins et al., ). When the mutual expectations of patient and nurse are made sufficiently explicit within the patient–nurse relationship, the focus in the relationship can be placed on meaningful participation in treatment and personal growth on the part of the patient (Benfer & Schroder, ; Delaney, ; O'Brien et al., ; Yonge, ). On the basis of explicit mutual expectations, agreements between nurse and patient can also be made to avoid the occurrence of unacceptable behavior (Lowe, ).…”