Introduction
The development of a profession depends on the individuals who contribute their skills and research ideas. Therefore, the exchange of experience and knowledge is an essential point for the enhancement of high standards of a profession and the improvement of skills and performance excellence of new generations. Psychiatric or mental health nursing is a field of health care where particular interpersonal and medical skills are of significant importance due to the specific features of the setting. According to Ong et al. (2017), psychiatric or mental health nursing is “concerned with the prevention, treatment, and nursing care of people of all ages who are suffering from mental illness and its effects” (p. 95). The particularities of the profession necessitate specific approaches to working with patients, advancing research, and nursing education. An interview with a pioneer in the field of mental health nursing, Dr. Alexey Sammut, was conducted to discuss the characteristic features of the profession, its challenges, benefits, essential skills, and practices. This report is designed to provide a reflection and critical evaluation of the main points discussed during the interview, identify major mental health nursing skills and practices, and link them to theory.
Reflection on the Interview with Critical Discussion of the Highlights
The interview with Dr. Sammut was conducted via oral communication and was recorded for further transcribing and analysis. The interviewee started his career in nursing in 1999 when he started his education at the Institute of Healthcare. Dr. Sammut obtained a nursing diploma, and then advanced his education to obtain a second degree in mental health nursing. Upon obtaining the degrees, the interviewee worked at different psychiatric wards of Mount Carmel Hospital, completed a Ph.D. level, and started a career as a lecturer with the Department of Mental Health within the Faculty of Health Sciences, University of Malta. Throughout his career as a psychiatric nurse, Dr. Summut advanced from “a newly graduate nurse going into a deputy charge nurse, and being one of the managers of an admission ward” (A. Sammut, personal communication, June 21, 2021). The vast experience of work in various psychiatric words as a mental health nurse, research experience, and academic work as a lecturer makes the interviewee a valuable source of information about the issues relevant to mental health nursing.
When reflecting on the interview, one might emphasize that the interviewee was engaged in the process of communication and willingly shared the personal journey throughout the career advancement, including the difficulties and successes. Indeed, one of the highlights of the interview was the discussion of the benefits and disadvantages of working in a psychiatric setting. As a former nurse, the interviewee stated that the benefits of the work included the ability to engage with patients through interpersonal communication, empathy, and relationship building, which are unique to the mental health nursing profession (A. Sammut, personal communication, June 21, 2021). Indeed, this statement is supported by the findings of several researchers in the field of mental health nursing who justify the importance of interpersonal and inter-professional communication as an integral part of proper mental health care, job satisfaction, and resilience (Fernando et al., 2017; Isobel & Delgado, 2018; Zheng et al., 2017).
Moreover, the ability to engage with patients on a personal level and provide them support individually through a close relationship, unlike other types of nursing, is considered by the interviewee as a benefit of the mental health nursing profession (A. Sammut, personal communication, June 21, 2021). In particular, when working in a geriatric psychiatric ward, Dr. Sammut engaged in close interpersonal communication with patients and their relatives, which necessitated dealing with multiple issues at the same time. Indeed, according to Collet et al. (2018), the combination of psychiatric and psychogeriatric issues in patients requires a specific set of skills in professionals, which constitutes resilience and flexibility in the profession. The issue of resilience which is developed in mental health professionals due to the particularities of the setting has also been identified by the interviewee as a positive feature. As stated by Prosser et al. (2017), “the key to survive and potentially even thrive in practice was through the development of resilience, defined as the ability to adapt and overcome adversity” (p. 171). Thus, the ability to support patients and grow professionally are the benefits of the profession.
On the other hand, several limitations of the profession have been identified during the interview. In particular, Dr. Sammut emphasized the obstacles to maintained and enhanced the professionalism of the nursing staff due to multiple constraining factors. According to the interviewee, at times, the staff is incapable of performing in compliance with the highest standards, with the provision of all policies and with due respect to clients because of “workload burnouts, too much pressure, and little stuff” (A. Sammut, personal communication, June 21, 2021). Indeed, these issues have been repeatedly addressed in research on the current problems in psychiatric nursing. The shortage of nursing staff as a burden to the overall mental health nursing system has been identified by Ong et al. (2017), Delaney and Vanderhoef (2019), Butryn et al. (2017), and others. Indeed, the complexity of the profession, the emotional burden of the responsibilities of providing care to patients with severe mental conditions often associated with violence becomes an obstacle for new entrants to the profession, which is why an insufficient level of stuffing in mental health nursing is detected (Butryn et al., 2017; Delaney & Vanderhoef, 2019; Ong et al., 2017).
In association with the understaffing, the increased workload and a consecutive burnout lead to diminished performance quality and improper professionalism of the psychiatric ward employees, as emphasized by Dr. Sammut (A. Sammut, personal communication, June 21, 2021). Indeed, nursing burnout has been identified as one of the most tentative issues in healthcare leading to decreased quality of the service (Ghavidel et al., 2019). Moreover, research shows that the burden of mental illness is growing on an international scale, with more people disproportionately exposed to multiple stressors and suffering from disorders (Rice et al., 2019). Therefore, the shortage of nursing staff in the mental health care setting and their burnout might have significant negative outcomes for patients. In addition, the emotional pressure that the nature of the profession and the constraining factors impose on mental health nurses constitute a drawback in the profession and cause possible limitations in professionalism, as stated by the interviewee. According to Hagen et al. (2017), psychiatric nurses working with patients in acute care wards or suicidal patients are exposed to an excessive emotional burden that necessitates coping techniques and regulation of the mental state to ensure the quality of care about patients and themselves.
Another highlight of the interview addressed the problem of the stigmatization of mental health care as a field and psychiatric patients as a vulnerable population. The interviewee emphasized the importance of psychiatric nurses’ work on the elimination of stigmas associated with mental conditions (A. Sammut, personal communication, June 21, 2021). Dr. Sammut stated that he has worked on addressing stigma in mental health care within his clinical experience and continues pursuing this aspect of his work in his academic and research endeavors. The problem of stigmatization finds its reflection in the current research as well. According to Flaskerud (2018), the issue of mental health stigmatization is two-fold since not only the patients with mental health conditions but also the nurses and other employees of psychiatric wards are considered the recipients of stigma. Much has been done to reduce stigmatization in mental health, including specifically designed educational courses, training, models, and social activities (Bates & Stickley, 2018; Benjenk et al., 2019; Gu et al., 2021; Tambag, 2018). Similarly, with research and social work, including exhibitions and other hospital-based activities, the interviewee strives to stop stigmatization in the psychiatric field (A. Sammut, personal communication, June 21, 2021).
Furthermore, the flexibility of research that is available to the professionals involved in mental health nursing is a benefit recognized by Dr. Sammut since there are multiple opportunities for generating, developing, and disseminating new ideas. Another significant issue that has been discussed during the interview was the opportunity to strive professionally and provide high-quality care and support for patients during their recovery without particular technologies or equipment involved (A. Sammut, personal communication, June 21, 2021). During the interview, addressing the issues discussed above was associated with the application of specific psychiatric nursing practices and skills.
Identification of Advanced Psychiatric Nursing Practices/Skills
The most important skills and practices that were either directly mentioned or implied by Dr. Sammut during the interview include interpersonal communication, therapeutic relationship-building, therapeutic engagement building, establishing rapport with clients, and using empathy. Firstly, the role of interpersonal communication was particularly emphasized by the interviewee who stated that when engaging in a simple therapeutic chat with a patient, one “can help the client feel better, some anxiety issues or concerns may be more resolved to the client, calm them down and support” (A. Sammut, personal communication, June 21, 2021). Indeed, interpersonal communication with the skills of active listening and reflection have been largely addressed in research. For example, Pazar et al. (2017) stated that “effective interpersonal relationships and communication skills of the nurse can have a positive effect on the patient who is experiencing uncertainty and anxiety because of his/her condition (p. 368). Similarly, the essential role of communicative skills in psychiatric nursing was emphasized by Meng and Qi (2018), Vandewalle et al. (2019), Abdolrahimi et al. (2017), and others. The effectiveness of communication constitutes the core of proper psychological support and successful recovery of the patients in mental health wards.
Secondly, through building therapeutic relationships, a nurse is capable of engaging with the patient for sustainable support and recovery effects throughout the treatment process. As the interviewee stated, “the therapeutic engagement and building a therapeutic relationship is the fundamentals of leading to building rapport with your clients so that you can obviously support the client” (A. Sammut, personal communication, June 21, 2021). Indeed, therapeutic relationship building and therapeutic engagement are inherently intertwined and constitute the essence of mental health care delivery executed by a psychiatric nurse. As it was emphasized by Dr. Sammut, this feature qualitatively differentiates psychiatric nursing from other types of nursing since other nursing interventions do not necessitate such a high level of interpersonal information and experience exchange (A. Sammut, personal communication, June 21, 2021). Indeed, according to McAllister et al. (2019), therapeutic engagement is a multifaceted concept that involves understanding the person and their experiences, facilitating growth, therapeutic use of self, choosing the right approach and, using authoritative vs. emotional containment. Similarly, Chachula (2021) indicates that the relationship between patients and nurses in mental health units is the decisive factor for clients’ successful recovery.
Finally, empathy has been mentioned by Dr. Sammut during the interview as an immediate constituent of the professional performance of psychiatric nurses. Indeed, empathic relationships involve trust-building, reflection on the experiences of the patient, and expression of the understanding of their feelings (Chong et al., 2017; Gerace et al., 2018; Lee & Ko, 2017). The interviewee emphasized that the professional psychiatric nursing quality performance originates “from respecting people, from day to day things, from being empathic, being honest, being truthful to others, supporting people” (A. Sammut, personal communication, June 21, 2021). Thus, these principles and identified skills and practices might be embedded in an applicable theoretical framework.
Linkage of the Identified Practices/Skills to Theory
Given the characteristics of the identified skills and practices that the interviewee has emphasized during the interviewee, one might detect that the majority of issues concern the interpersonal relationship between a nurse and a patient as a core of the recovery process. According to Lee and Doran (2017), the social relation model and relational coordination are particularly concerned with the interpersonal relationships domain when theorizing on psychiatric nursing. However, the application of the theory of interpersonal relations might be more applicable since it concerns the empathic and communicative aspects of nurse and patient interaction (Pehlivan & Güner, 2016). This theory entails that “personality and mental health diseases are generated as a result of social powers and interpersonal experiences,” which is why “the aims of therapy are to rehabilitate interpersonal experiences and to ensure positive relationships (Pehlivan & Güner, 2016, p. 101). Thus, the identified skills and practices, including therapeutic communication, engagement, relationships-building, and empathy, align with the core principles of the theory of interpersonal relations.
Conclusion
In summation, the conducted interview with the pioneer in psychiatric nursing, Dr. Sammut, has been an invaluable experience of communication with a renowned professional. The interviewee has shared his vision of the benefits and limitations of the profession as a whole and the possible ways for improving it by addressing the limitations through research and social work. In particular, understaffing, burnout, pressure, and workload have been addressed alongside the stigmatization of both patients and employees of mental health wards. The interviewee emphasized that the most important skills and practices applicable to the field of mental health nursing include communication skills, interpersonal skills, therapeutic engagement, rapport building, interpersonal relationships, and empathy. All these elements align with the principles and core ideas of the theory of interpersonal relations that highlight the importance of communication and relationships between patients and nurses in a mental health setting.
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