EFFECTS OF THERAPEUTIC RELATIONSHIP BETWEEN MENTAL HEALTH STAFFS AND BIPOLAR PATIENTS
The question that the effective treatment of bipolar disorder is supported by the joint respects of patients and their service providers, currently mental health care. To achieve a comprehensive way of dealing with care, a corrective relationship must be entrusted to patients and their patients. What this relationship is is not always clear and, therefore, the purpose of this literature review. The purpose of this literature review is to recognize best practices for improving reconstructive relationships in patient well-being and the consequences for treating bipolar disorder and its consequences to nurses.
The effects of using therapeutic relationship to assist patients with bipolar disorder comply with their treatment
1.0 Background
The relationship between patients and caregivers is an important element of mental care (Priebe et al., 2005) and should improve and improve treatment results (Couture et al., 2006; Neale, 1995; Martin et al., 2000 ). The necessary relationship, including, for example, patients with bipolar disorder, together with a therapist, is an essential element of the psychotherapy procedure; there are hardly any fundamental values to help you deal with advice. The findings based on the results and research in psychotherapy recommend that a useful and useful relationship can be useful for patients with bipolar disorder, helping them to agree to treatment. (College of Pennsylvania, 1941)
Bipolar disorder is seen as a serious type of mental problem (Couture et al., 2006). . The normal recurrence associated with the bipolar related issues in patients living with the disorder is approximately nine. Studies have shown that 84% of patients with bipolar disorder experience more than 5 scenes. Therefore, it is not surprising that patients with this problem are admitted to the emergency clinic again, and the turbulence introduces a delay of 5 to 15% of reconstruction in the basics of mental considerations. Untreated bipolar cases, instead of other mental states, are characterized by a high percentage of self-destruction; several studies show that up to 60% of a bipolar battle of two problems with suicidal thoughts in improving the condition (Majid, 2011).
Therefore, the treatment of patients with bipolar disorder who use the latest prescriptions available, along with antipsychotic and stimulant drugs, have little significance for the established. Used equally, although useful are normally used in patients with bipolar disorder, the key situation is a bad consequence in decision making that causes instability. Increased hospitalization, silent discouragement and unavoidable expenses with the help of the National Health Service.
Some factors are cited in literature as consistent effects on treatment. One aspect is the willingness of physicians or medical caregivers to use bipolar disorder to control treatment, as well as the belief that they are being placed in a helpful team. Mental health caregivers show the importance of restoring the connection between the therapist and bipolar patients in the compliance of treatment (Pepe, 2000). The structure of a useful relationship is essential in assessing mental well-being and fruitful assessment of the treatment of patients with bipolar disorder. (Chan, 2007).
2.0. Eclipse systematic exploration tool
The systematic research tool ECLIPSE was used to classify potential studies in writing. The device was arranged to manage consultations on the social approach and association among other issues related to social security (Wildridge, 2002). Because the purpose of this dissertation is to care for mental well-being, and in addition to issues related to emotional well-being strategies, ECLIPSE has created surprising methods to clarify the main reason for this control.
2.1 Study question
What is the most effective form of therapeutic relationship between the mental health team and patients with bipolar disorder?
E (expectations): improvement of the patient’s treatment outcome
C (client): patients with bipolar disorder
L (location): hospital / community
I (impact): improved therapeutic relationships
P (specialists): mental health team
SE (service): mental health environment
The following keywords were used for the research: bipolar disorder, patient outcome, non-adherence or adherence to treatment principles, nurse-patient relationship, nurse-patient communication, nurse-patient communication, therapeutic relationship, therapeutic care, treatment of chronic diseases, team care and psychotherapeutic follow-up
2.2 Search strategy and selection criteria
Search strategies were developed to identify the best evidence available for a problem considered in a literature review that is the result of a therapeutic-patient relationship in patients with bipolar disorder. Most of the evidence examined did not reach the meta-analyzes, and therefore searches were not limited to randomized controlled studies or systematic reviews. Where modest evidence has been obtained, the search has been integrated in related areas and the evidence will be extrapolated. Searches were limited to cases in the United Kingdom.
Search strategies were structured as follows:
- A comprehensive strategy for exploring the relationship between syndrome and bipolar disorder – including patient and bipolar syndrome perspectives on therapeutic involvement in extensive databases
- Search in other databases to identify relationships of mental health syndrome with patients and information not cataloged in the searched databases
- Thematic search strategy in major databases
- Reference letters of relevant procurement documents have been checked for articles of potential relevance.
- For each therapeutic relationship and related issues, evidence was sought for the relationship between the team and the patient, as well as information on harm and cost effectiveness.
Extensive bibliographic research was carried out using various psychiatric specialties that relate to the topic raised in the topic. The study was conducted in an electronic database using Medline, Cochrane, Scopus, Ovid, CINAHL, Science Direct, psychological information and the ISI scientific network (see Annex A)
2.3 Selection criteria
The inclusion criteria in the literature search were: articles published on the therapeutic relationship between staff and patients with bipolar disorder. Only works are dedicated to therapeutic relationships in primary psychiatric conditions, taking into account the therapeutic relationships between staff and patient in bipolar issues. Non-critical studies with samples of patients with bipolar disorder assessing psychotherapeutic involvement in the team. Editorial articles, narrative reviews, in vitro or in vivo studies and nature studies, as well as correspondence for editors, were excluded. When it comes to assessing patient satisfaction, textbooks, organization reports and government reviews have been considered, since most of the evidence in these sources is reviewed.
Several mechanisms around the study of therapeutic relationships between mental health syndromes and patients with bipolar disorder include assessment of treatment compliance, patient-centered issues that affect compliance or non-compliance, resources related to mental health nurses, in addition to their impact on compliance, and specific methods used to increase compliance with therapeutic recommendations. adherence to treatment principles and successful overall therapeutic relationships between mental health syndromes and patients with bipolar disorder (Aarons, 2009).
Features associated with compliance or non-compliance on therapeutic relationship between mental health staffs and bipolar patients
In addition to therapeutic measures, compliance with treatment and understanding of patients’ diagnoses were studied as variables in a descriptive study by Cleary, Hunt, Horsfall and Deacon (2012). The patients included in this review were adult patients hospitalized in mental health conditions. Patients were qualified to participate in the study after all exclusions, 223 patients agreed to participate in the study. Patients were assigned to assessment tools to assess indulgence in their analysis and treatment strategies (Cleary et al., 2012). The results showed that 70.8% of the patients did not follow the treatment to some extent; the patients were also intentionally or accidentally incompatible (Cleary et al., 2012). Approximately 43.8% of patients recognized which drugs were administered to them and 25% had no idea of their prescriptions. On the contrary, 81.2% of patients said that treatment was important and useful (Cleary et al., 2012). The lack of understanding is an obstacle for the patient to comply with the treatment (Cleary et al., 2012). Mental health nurses should keep in mind the obstacles that patients with bipolar disorder face in accordance with therapy to increase patient satisfaction and improve therapeutic relationships. Compliance was assessed in the form of a questionnaire (Cleary et al., 2012).
A qualitative analysis was conducted to assess compliance with recommendations for the treatment of bipolar disorder (Karlin, 2007). The purpose of this analysis was to document the characteristics of patients with bipolar disorder and their mental health nurses that affect treatment compliance in patients with bipolar disorder, as well as offering interventions to improve compliance. Groups of centers were created from local centers of mental and care in a social environment including patients with bipolar disorder and mental health nurses (Karlin, 2007). these studies have shown that observations of the source of the disease, including individual weakness, life events, in addition to specific causes; observed disease pathway in a patient with bipolar disorder, for example temporary or persistent; propensity to manage therapy, including non-pharmacological and pharmacological; the influence of friends / family, both useful and non-cooperative, are all observations related to compliance with treatment (Karlin, 2007). Other forms recognized in this review included the reflection that mental health nurses do not explicitly assess patient compliance; reasoning known as an attempt to express confidence in patients with bipolar disorder (Karlin, 2007) These results are significant for mental health nurses, because to plan effective interventions to improve compliance, mental health nurses need to work with bipolar patients. feelings In addition, as mental health nurses, we need to look for ways to correctly assess the adherence of our patients with bipolar disorder without showing a lack of confidence.
The experience of a patient with bipolar disorder was studied in a systematic evaluation of the literature on adherence to antidepressant drugs (Feely, 2009). This study aimed to identify how a patient with bipolar disorder affects treatment adherence. Several databases were examined using the keywords ‘bipolar compliance, depression, antidepressants and patient experience’, producing 179 results, of which 13 were selected as relevant and of high quality (Feely, 2009). Some characteristics that have increased treatment adherence in patients with bipolar disorder include past cooperative experiences, increasing age, awareness that bipolar disorder is an organic disease, thinking about other people suffering from depression and mood imbalance, self-awareness of their symptoms and symptoms of affective disorder, bipolar disorder and therapeutic association with mental health nurses. which reduced adherence to treatment, included the view that drugs were harmful and increased the incidence of side effects (Feely, 2009). In light of the results of the study, Feely calls for support and a patient-centered method in which the patient’s experience with bipolar disorder is a key issue (Feely, 2009. The limitations of this study included many qualitative researches that could increase bias ( Feely, 2009).
To assess adherence behavior in patients with bipolar disorder, Ulrich et al. conducted a cross-sectional study (2007). The patient population with bipolar disorder was carefully selected in social care centers. Patients with bipolar disorder were included if they were adults, women or men and with adequate mental capacity to accept the contribution (Ulrich et al., 2007). Possible contributors were omitted if: they had used drugs in the last three months, were mentally dangerous or were detected with a spine or brain disease (Ulrich et al., 2007). Dialogues were carried out to gather information. The study included 584 patients with mental health, whose demographic result related to compliance was an increase in age associated with an increase in compliance. Clozapine has been associated with improved adhesion (Ulrich et al., 2007). Understanding the disorder did not interpret the compliance agreement. Encouraging approaches have been linked to compliance. 2 antagonistic effects of the drug were associated with reduced adhesion and memory (Ulrich et al., 2007). Such results can help prepare for the care of patients with bipolar disorder. An optimistic approach to therapy can reduce obstacles to compliance with therapeutic recommendations. Nursing tasks aimed at improving compliance should therefore take into account the attitude of patients with bipolar disorder. Compliance was analyzed in 145 patients with bipolar disorder using a variety of tools with the expectation of detecting the circumstances that led to compliance (Hopkins, 2009). This study concerned all connections between sociodemographic features. Patients with bipolar disorder who were confident in their treatment approaches, those with low outcomes in terms of injury and less signs of mood swings, had higher compliance rates (Hopkins, 2009). Reported nonadherent patients added side effects; it remains uncertain why they did not comply with them if it was due to other unnoticed influences.
Interventions must be established to ensure adherence to treatment that corresponds to the approach of patients with bipolar disorder, along with the observed treatment risks (Stuart, 2014). Drug adherence in bipolar cases was reported in the review with a general desire to clarify motivational cross-testing as a commitment to increase drug adherence. This assessment was enlightening in nature. The capabilities of patients with bipolar disorder were reported in an opening section of this instructional commentary (Geanellos, 2004)
Patients expressed therapeutic support and care they received, but mainly from other patients with bipolar disorder (Shattell et al., 2008). The nurses’ reports included the inability to work as a therapeutic skill, since the organization’s procedures and rules that had priority over the relationship with patients. Partly repeatedly, the team was not present and patients were abandoned in the corridors, in other places without supervision. Long periods of absence from the patient, both mentally and physically, can have a fundamental impact on the patient’s well-being. In addition, the presence in the patients’ physical and mental space can reduce feelings and negative results (Edvardsson et al., 2012).
Studies have shown that people using mental health centers repeatedly believe that they have helped by staying in a health center. However, they are not respected by teams and high rates of bed use, along with a small number of employees, indicate that usually interaction between employees and patients with bipolar disorder is usually limited (Stickley, 2012). In the new investigation, mental health doctors measured bipolar disorder only in 14% of consultations with patients with bipolar disorder; formal mood measures used are only 3 of 399 exams (Karlin, 2007). The complication of detecting bipolar disorder in primary care shows that somatic indications are similar to those in medical disorders or common effects of aging, and patients with bipolar disorder are usually not sure if they need psychotherapy for dipolar disorders.
Mental care nurses have the opportunity to care for patients with bipolar disorder during travel, from hopelessness to a peaceful life. Their therapeutic relationships, along with the features of individual care, in addition to skills, affect the result of a painful journey in a connected and positive way (Feely, 2009). The practice of mental nursing as a health department is guided by the principles and ethics of practice in which these values must be authenticated and supported by verification (Chan, 2007). A common foundation for high-quality psychological care can be considered by establishing a strong patient-nurse relationship in addition to a well-planned therapeutic environment.
Creating decent patient-nurse relationships is considered significant in most nursing settings related to mental health; however, in therapeutic nursing, interpersonal relationships are a central part of the practice, creating a therapeutic relationship as an essential element of psychiatric care. A therapeutic association that deals with mental health has been associated with successful therapeutic results in several psychological clinical situations (Dziopa, 2009). Paradoxically, although therapeutic relationships are critical to treatment outcomes, the development of excellent therapeutic relationships between mental health nurses and patients with bipolar disorder is not a consensus and requires enormous skill.
Cleary et al. (2011) describes twelve topics of mental nurse practice. These topics, ordered in order of appearance, include influential relationships; practicality; therapeutic use of the unit; nursing responsibility; nurses performing in practice and nurses working together. Others include non-therapeutic self-use; optimistic reformulation of mental health practice; studying complexity; permeability configuration; individual patient supervision by risk; and offering medicine. Nurses are used therapeutically in many circumstances, including making decisions about their language, calm and pace of reaction and physical proximity to patients (Hannes, 2010).
There is convincing evidence supporting the effectiveness of therapeutic relationship care for bipolar patients, rather than only psychotherapy. On the foundation of a systematic review of 97 therapeutic relationships studies, one research panel (Flood, 2009), strongly recommended therapeutic relationships based on the management of bipolar disorders model in bipolar patients. Common aspects include diagnosis of bipolar disorders using authenticated screening tools and offering psychiatric therapy or antidepressant medication by evidence-based practices (Flood, 2009).
Literature has repeatedly repeated the importance and value of a nurse-patient relationship in mental health conditions. The atmosphere and structure of the hospital environment may be one of the most important factors in the patient’s experience, and more specifically the attitude and attitude of the nurse to care were seen as the main factors affecting the atmosphere of the ward (Stickley, 2012)
Finally, researchers who assessed the time bipolar patients spent and psychiatric syndrome during regular shifts determined that nurses and other mental health teams spent most of their time documenting, administering medication, observing the environment of patient conferences and offices; even satisfied with their work, providing direct care to patients. (Hanrahan, 2008) also found that 40% of the mental health team is dissatisfied with their work, and 34% of the psychiatric team was not sure if their patients would be able to control their management after discharge from the hospital. Regenerative movement and internal inconsistency in relation to the quality of therapeutic treatment and dissatisfaction experienced by the patient and bipolar nurses may be a chance to change the approach in which therapeutic assistance is provided to a patient with bipolar disorder. Devoting sufficient time to the psychiatric team and therapeutic relationships of patients with bipolar disorder is an approach that can lead to successful results and a significant improvement in the care of patients with bipolar disorder (McCrae, 2014).The CASP assessment tool was used to assess evidence-based practices in all studies related to a specific mental health issue (see Annex C). (See Annex D)
Conclusions and recommendations
The balance of evidence on the therapeutic relationship between a team and a patient with bipolar disorder leads to increased satisfaction between the team and patients with bipolar disorder, and can also result in lowering treatment costs and improving mental and physical health. A therapeutic relationship is always desirable for bipolar therapy; however, in the context of the increasing complexity of services, its performance is a difficult task. To improve relationship care, patients with bipolar disorder required the visit of the same psychotherapist or nurse if necessary. However, continuity is a prerequisite for continuous therapeutic relationships and should be supported (Majid, 2011). However, this does not guarantee success. In this case, it is suggested that patients with bipolar disorder should not be forced to seek the same therapist in mental practice, but on the contrary, it is a matter of choice. Patients with bipolar disorder appear to view union therapy as difficult to perform, while the mental team finds it a challenge. Meanwhile, several improvements in practice, along with public policy, have experienced the unintended consequences of building a therapeutic relationship that is more difficult to achieve (Hatti et al., 1982). To improve the quality of the therapeutic relationship in any dimension, it should be measured. This still requires continuity of relationship care. Even assessing the frequency with which a patient with bipolar disorder visits the same therapist presents technical problems in compiling data, selecting indicators, and interpreting results. Since existing practice data structures do not provide robust regular statistics on guidelines for patient contact with psychiatric specialists, they critically limit the ability of practices to investigate the relationship between admission to continuous treatment, progress is needed here. The measure of understanding a patient with bipolar disorder offers a direct way to assess patient observation on the quality of the therapeutic relationship between the patient and the team. The development of this resource for understanding patients can be supported by important care policies that recognize the commitment of care relationships with the quality of general practice.
Many questions remain unanswered. Improved measurement depends on understanding the relationship care systems and the degree of progress and involvement. EBP can help therapists and patients with bipolar disorder to seize opportunities to create and strengthen relationship therapy. In the meantime, you can learn faster, thanks to easy and inexpensive tools and methods, such as analyzing patient experiences, patient records and testing a high frequency in practice (Fitzpatrick, 2013). It is recommended to combine existing potential measurement techniques and encourage combining in mental health practice. It is also necessary to encourage or prioritize, along with other improvements in mental health research measures, to assess the care relationship that can be used in practice to improve quality.
References
Aarons, G., Wells, R., Zagursky, K., Fettes, D., & Palinkas, L. 2009. “Evidence
based practice in community mental health agencies: A multiple stakeholder analysis”. Journal of Public Health, 99(11), 2087-2095.
Baker, S. 2013. Environmentally friendly? Patients’ views of conditions on
Psychiatric wards. London, England: Mind.
Chan, S. 2007. Commentary on Schröder, A., Ahlström, G. & Larsson, B. (2006).
Patients’ perceptions of the concept of the quality of care in the psychiatric setting: A phenomenographic study. Journal Of Clinical Nursing, 16(9), 1782 – 1785.
Couture, M. S., Roberts, D. L., Penn, D. L., Couture, M. S., Roberts, D. L., Penn, D.
L., et al 2006. Do baseline characteristics predict the therapeutic alliance in the treatment of schizophrenia. Journal of Nervous and Mental Disease Journal of Nervous and Mental Disease, 94, 10-14.
Cleary, M., Hunt, G., Horsfall, J., & Deacon, M. 2012. Nurse-patient interaction in
acute adult inpatient mental health units: A review and synthesis of qualitative studies. Issues in Mental Health Nursing, 33(2), 66-79.
Dziopa, F. & Ahern, K. 2009. What makes a quality therapeutic relationship in
psychiatric/mental health nursing: A review of the research literature. Journal of Advanced Nursing Practice, 10(1), 1-19.
Fitzpatrick, J. J., & Tusaie, K. R. 2013. Advanced practice psychiatric nursing:
integrating psychotherapy, psychopharmacology, and complementary and alternative approaches. New York : Springer Publishing Company.
Feely, M. & Long, A. 2009. Depression: A psychiatric nursing theory of connectivity.
Journal of Psychiatric and Mental Health Nursing, 16, 725-737.
Flood, M. & Buckwalter, K. 2009. Recommendations for mental health care of older
adults: Part 1 Overview of depression and anxiety. Journal of Gerontological Nursing, 35(2), 26-34.
Geanellos, R. 2004. Nursing based evidence: moving beyond evidence-based practice in mental health nursing. Journal of Evaluation in Clinical Practice. 10, 177-186.
Gunderson, J. 1978. Defining the therapeutic process in psychiatric milieus. Psychiatry, 41, 27-335.
Hanrahan, N. & Aiken, L. 2008. Psychiatric nurse reports on the quality of psychiatric
care in general hospitals. Quality Management in Health Care, 17(3), 210–217.
Hannes, K. 2010. Exploring barriers to the implementation of evidence-based practice
in psychiatry to inform health policy: A focus group based study. Community Mental Health Journal, 46, 423-432.
Hopkins, J., Loeb, S. & Fick, D. 2009. Beyond satisfaction, what service users expect
of inpatient mental health care: A literature review. Journal of Psychiatric and Mental Health Nursing, 16, 927-937.
Hatti S, Dubin WR, Weiss KJ. (1982) A study of the circumstances surrounding patient assaults on psychiatrists Hosp Community Psychiatry.; 33:660-661
Karlin, B. & Duffy, M. 2004. Geriatric mental health policy: Impact on service
delivery and directions for effecting change. Professional Psychology: Research and Practice, 35(5), 509-519.
Majid, S., Foo, S., Luyt, B., Xue, Z., Yin-Leng, T., Yun-Ke, C., & Mokhtar, I. 2011.
Adopting evidence-based practice in clinical decision making: Nurses’ perceptions, knowledge, and barriers. Journal Of The Medical Library Association, 99(3), 229-236.
Martin, D., Garske, J. & Davis, M. 2000. Relation of the therapeutic alliance with
outcome and other variables: a meta-analytic review. Journal of Consulting and Clinical Psychology, 68, 438-450
McCrae, N. 2014. Protected engagement time in mental health inpatient units.
Nursing Management – UK, 21(1), 28-31.
Moyle, W. 2003. Nurse-patient relationship: A dichotomy of expectations.
International Journal of Mental Health Nursing 12, 103–109.
Neale, M. & Rosenheck, R. 1995. Therapeutic alliance and outcome in a VA intensive
case management program. Psychiatric Services Psychiatric Services, 46, 719-721
Pepe, V.L, and Castro, C.G, 2000. The interaction between prescribers, dispensers
and patients: shared information as a possible therapeutic benefit. Cad Public Health , 16 (3), pp.815-22.
Priebe, S.,Watts, J., Chase, M., Priebe, S.,Watts, J., Chase, M., et al 2005. Processes
of disengagement and engagement in assertive outreach patients: qualitative study. British Journal of Psychiatry, 187, 438-443
Sainsbury Centre for Mental Health 1998. Acute problems: A survey of the quality
of care in acute psychiatric wards. The Sainsbury Centre for Mental Health. London, England.
Shatell, M., Andes, M., & Thomas, S. 2008. How patients and nurses experience the
acute care psychiatric environment. Nursing Inquiry, 15(3), 242-250.
Stahl, S.M, 2002. Psychopharmacology: neuroscientific basis and practical
applications . Medsi.
Stickley, T., & Hui, A. 2012. Arts in-reach: Taking ‘bricks off shoulders’ in adult
mental health inpatient care. Journal Of Psychiatric & Mental Health Nursing, 19(5), 402-409.
Stuart, G. W. 2014. Principles and Practice of Psychiatric Nursing. London, Elsevier
Health Sciences
Ulrich M. Junghan, Morven Leese, Stefan Priebe and Mike Slade 2007.Staff and
patient perspectives on unmet need and therapeutic alliance in community mental health services British journal of Psychiatry, 191, 543-547
University of Pennsylvania, Strecker, E. A., Brill, A. A., Lewis, N. D. C., & Ruggles,
- H. 1941.Therapeutic advances in psychiatry. Philadelphia, University of Pennsylvania Press.
Wildridge, V., & Bell, L. 2002. How CLIP became ECLIPSE: A mnemonic to assist
In searching for health policy/management information. Health Information and Libraries Journal, 19(2), 113-115.
.