This series is reprinted with permission from my friend and fellow mental health nurse Felicity Stockwell. Her complete writings can be found on her website at http://www.felicitystockwell.com/

I’m grateful to Felicity for agreeing to let me publish her work here.<BLOG_BREAK)

In the psychology section it was explained that ‘time’ and ‘attention’ are the two most important things that are given and received in social relationships, and these are both problematic in unbalanced groups.

The patients have a lot of time to give, but they have to be there and it is of no social value to the nurses. The nurses time is limited and has high social value, but in social terms it is devalued, because it is paid time, but is also worth more to the patients, because the amount available is fixed (by duty rosters) and has to be shared, not only with all the other patients, but with innumerable other people who come and go. Every patient will be evaluating how much individualised time they are receiving, compared with everybody else, and it is unlikely that anyone receives as much as they feel they need.

With this in mind, it is the nature of the attention that is paid to each patient that becomes most important, alongside carrying out the necessary tasks and routines. Natural eye contact and a friendly smile of themselves allay anxiety, and friendly chat that brings in things the nurse remembers about the person will meet Social Needs. You have to ‘listen’ in order to find things to remember, and this is the ‘time’ factor of the sharing. It does not have to take long and it is the remembering the small particulars in an unobtrusive way that is most effective in enhancing feelings of worth and belonging.it is important to distinguish between the ‘time’ that is given carrying out the tasks of care, and ‘time’ that is given by choice, just to be friendly. I call these interactions ‘unsolicited time’ and it can be for as little as a few moments, and should not be too long. They are friendly listening chats that are nothing to do with ‘duty’ tasks, and by using the ‘time’  to elicit things to remember and then showing you have remembered  them by making reference to them later, you will have provided the ‘attention’  aspect of meeting Social Needs.  In a ward it is important that ‘unsolicited time’ is given, just in passing, to all the patients, because they will each be monitoring who gets what.

When caring for people with mental health problems, the nature of the care is most effective when it is given in an ‘informal’ group setting, with the staff adopting a parental style role. This is where the individuals are nourished and kept safe, while enabling the development of all physical, mental and social attributes. Along with this they will gain self-confidence and self-reliance. The explanation about ‘unsolicited time’ above is of central importance in Mental Health nursing. There is a word of warning about how ‘teaching people social skills’ is very different from ‘enabling sociability’ because it does not provide the experience of earning approval and acceptance.

In a person’s home ‘unsolicited’ time is equally important, because the carer may be the only, or one of a few people to be able to help the person to feel valued and acceptable. Some relaxed ‘switch off’ time should be given, where some topic or activity can provide opportunity for the client to give something of themselves that can lead to a rewarding sharing relationship, even if it is only in the short term. If it can lead to some shared smiles or laughter, that will be an added bonus.

When this attentive way of relating to a patient becomes habitual, it can be termed a ‘therapeutic’ relationship – because, besides meeting Social Needs and allaying anxiety, it ensures that all other treatment ’inputs’ are more effective.

The interpersonal relationships play a large part in ensuring the well-being and safety of the patients, but they are dependent on the morale and skills of the nursing team as a whole. This is dependent on a variety of factors, both physical and psychological, within the organisation, that can be more, or less, enabling. The team must be well resourced, in terms of having knowledge and skills and adequate numbers and equipment, and then they must have acknowledgement that their work is approved and appreciated by the organisation. When this is the case it enables the ward to be run in a way which instils hope and inspires confidence for patients, visitors and the staff.  Where morale is low over time, individuals turn to each other for the meeting of their social needs and form a ‘deviant group’. This is a joint expression of the reflex ’attention seeking’ behaviour of individuals. In the same way, it will not be changed by punishment or sanctions, but only by improving the overall morale of the situation.

All of this applies equally to community teams but it is much more difficult to make the social aspects effective.

Caring for patients has been the focus in this paper but the principles are equally important for Teaching in all situations, because it is most effective when pupils are self-confident, well motivated and cooperative. This occurs when the teachers and learners have their Social Needs adequately met within and outside the organisation. Where learners come from ‘socially deprived areas’ it is useful to remember that punishment exacerbates the problems, and strategies to enhance esteem and enable sociability are likely to be effective in the long term.

20 commandments 5: Thou shalt reconsider your ‘professional distance’ if it makes your client feel he stands alone

Professional boundaries are vital. If we lose sight of the professional distance that we need to maintain we risk ‘over-involvement’. This is one of the most damaging things that we can inflict upon our service-users or clients.

Part 20 of The Mental Health Workers' Guide considers the role of sympathy in mental health care. Don't forget that you can download the podcasts and video clips that accompany this series here.

This series is reprinted with permission from my friend and fellow mental health nurse Felicity Stockwell. Her complete writings can be found on her website at http://www.felicitystockwell.com/

I’m grateful to Felicity for agreeing to let me publish her work here.