Helena Priest - An Introduction to Psychological Care in Nursing and the Health Professions

The development of caring skills must be the primary aim of any programme preparing students for professional registration

(Royal College of Nursing of the United Kingdom, 2004)

This strong and ambitious statement, in the context of nursing practice, has thrown out a challenge to those involved in healthcare education to explore what is meant by caring skills, and how these skills are developed by those entering and remaining in nursing and health care professions. This book sets out to differentiate between the skills needed to care for peoples physical health needs, and those needed to care for other aspects of everyday human experience, particularly the psychological needs that affect peoples feelings, thoughts and behaviour. In this way, it aims to explain and promote the importance of psychological care for people when they become physically ill and in need of health care services.

Despite increasing evidence from fields such as nursing, medicine and psychology about the centrality of psychological care in illness, it remains a neglected area of clinical research. Indeed, there have been relatively few research studies into the meaning of caring generally. There appears to be little consensus about the precise nature and dimensions of psychological care and how psychological care-giving abilities are acquired. There is also some doubt as to whether such abilities can be taught, or whether they are developed solely through experience, and indeed whether everyone can develop psychological care-giving abilities. This book explores these topics and aims to answer some of these questions.

The idea for the book started many years ago, based on my experiences of teaching and supporting general (adult branch) student nurses from a large teaching hospital, who undertook a statutory three-month placement in a mental health care setting. As well as gaining experience of working with people with mental health needs, these students were to be equipped with some knowledge of human psychological functioning, so that they would be better able to recognise and address the psychological needs of physically ill patients when they returned to practise in adult nursing settings.

These students often arrived with a set of values and priorities which were very different from those whose chosen field was mental health nursing. Their priorities in nursing care were, quite rightly, focused on the relief of physical suffering and on practical, clinical tasks. To them, legitimate work entailed physical activity, being busy, being on the move. They frequently expressed frustration with the nature of mental health nursing work, arguing that in their own care settings they would not have time to spend an hour sitting listening to someones troubles or observing someones mood and behaviour, and that even if they did, this would not be seen as real work by the qualified staff on the ward.

Furthermore, they did not see the relevance of learning about psychological concepts and theories in helping them to care for patients needs. Interestingly, only a few years later, a new curriculum was designed for nurses in the UK (commonly known as Project 2000), which aimed to put a much stronger emphasis on the knowledge base underpinning nursing care delivery. To this end, students from all branches would spend the first eighteen months of their three-year programme developing a firm grounding in behavioural, life and social sciences (UKCC 1989), with very little of that time to be spent in clinical practice settings. As part of this initiative, Project 2000 educational programmes recommended that twenty-two hours be devoted to psychology in the curriculum. My early experiences gained teaching psychology to Project 2000 students again challenged the significance and relevance of behavioural and social science knowledge to the care of people with physical health problems and needs, even when these topics were integrated and applied to practice within the curriculum. It was these experiences that provided the first real motivating factor to undertake the research which led to this book. I quickly came to question the relevance of equipping student nurses with knowledge of psychological concepts, no matter how skilfully applied to nursing. The only reason for doing this, as far as I could see, was if it made any real impact on nursing care. I suspected that it did not. My initial interest, therefore, was in identifying a relationship between what was taught and what happened in practice, and I acknowledge that my expectation that teaching psychology to nurses had little or no influence on care delivery produced an early source of bias that could have impacted on the research. However, Ramproguss (1995) study of Project 2000 students also illustrated deficiencies with this approach emphasising theory and knowledge: