Humanism attempts to take a broader perspective than a reductionalist approach of the individual’s potential and tries to understand each individual from the context of their own personal experiences.
Existentialism is a philosophical approach to understanding life. It’s the belief that thinking begins with the human—the feeling, acting, living individual.
Existentialism emphasises the individual’s free-choice, self-determination and self-responsibility.
Nursing dialogue is when a nurse and patient come together. The nurse presents her/his self as a helper ready to assist the patient. The nurse is open to understanding how the patient feels with the intention of improvement. Openness is an essential quality for humanistic nursing dialogue. Humanistic-based nursing involves more than a technically competent relationship between the nurse and client. Instead, it determines that nursing is a responsible quest, a transactional relation whose mean- ing demands concepts founded in the existential conscience of a nurse as herself and the other (Paterson and Zderad 1988).
According to Paterson and Zderad (2008, p. 3),
Humanistic nursing embraces more than a benevolent technically competent subject-object one-way relationship guided by a nurse in behalf of another. Rather it dictates that nursing is a responsible searching, transactional relationship whose meaningfulness demands con- ceptualization founded on a nurse’s existential awareness of self and of the other.
It envisages the possibility of looking with a different perspective to the one who needs help and to the one who is willing to help; the one who provides care is some- one with a certain type of care available and the one taken care of is someone with certain needs (Wu and Volker 2012), presenting the nursing care as a living and com- municative encounter. Humanistic and person-centred nursing encounters require the nurse to be open to every experience, and he/she needs to go beyond ‘doing with’. It involves a human being helping another in an inter-human and intersubjective trans- action, with the aim of increasing responsible choices, not only in the absence of sickness but in the human possibility of well-being and better-being.
interactions between client/environment. According to Chick and Meleis (1986), the transitions are categorized as within the nursing field when the health/disease or responses to the transition are manifested in the domain of behavioural health.
Examination of the relevant literature suggests that for P/MH nursing (at least), the goal of care provision has morphed beyond addressing pathological issues to the response of the individual to the health and life processes, as well as the transition pro- cesses that happen throughout the life cycle. In a world that is in permanently changing, the human being experiences transitional periods and is frequently put to the test regard- ing his/her capabilities to deal with those changes. Humanistic P/MH nursing then requires consideration of the person’s experiences, as well as the person’s responses to health challenges and consequences of the transitions (Meleis and Trangenstein 1994).
There are several different theoretical and clinical (practical) reasons for consid- ering transitions, and how people react to, cope with and are affected by them, as a matter of P/MH nursing. Nurses spend a great part of their time caring for people who are experiencing one or more changes in their lives which may well have impact and or effect on health (family, social, personal and life cycle transitions).
Some authors (Meleis et al. 2000; Schumacher 1995; Schumacher et al. 1998; Nolan et al. 1995) have led the introduction of this issue into the discourse about nursing.
Meleis et al. (2000, p. 13) highlights the necessity of considering transitions because:
Nurses (…) tend to be the carers who prepare clients for transitions which approach and facilitate the learning process of new competences related to the experiences of health and sickness. (Meleis et al. 2000, p. 13)
According to Meleis (2010), this middle-range theory arose from the analysis of the ‘transition’ concept as a core concept in nursing and aims to provide a structure which allows the description, understanding, interpreting and/or explaining nursing specific phenomena, which reflect and emerge from the practice. These theories aspire to offer a systematic construct of the mission, nature and objectives of nurs- ing (Meleis 2010).
Meleis and her collaborators point out:
Changes in health status may provide opportunities for enhanced well-being and expose individuals to increased illness risks, as well as trigger a process of transition. (Meleis et al.
2000, p. 52)
The Middle-Range Transition Theory (Meleis et al. 2000) includes three main concepts: the nature of transitions (types, patterns and properties), the conditions (facilitators and inhibitors) and the response patterns, perceived as indicators of the process (to feel connected, interact, being located, trust and coping) and result (fluid and flexible identities; mastery) and ‘nursing therapeutics’ (see Fig. 5.3).
The transitions are complex and multidimensional phenomena in which it is pos- sible to identify five features (awareness, involvement, change and difference, tran- sition period and critical points and events), which normally are related among each other (Meleis et al. 2000). The awareness is related to the perception, knowledge and recognition of a transition experience, considered a key feature of the entire process, and the individual, to be in transition, needs to be aware of the changes in
course. Involvement is understood as the degree to which the person appears to be implicated with the processes inherent to the transition. The awareness level influ- ences the level of involvement, since the level of involvement of someone who is aware of the changes that took place, will obviously be different from the one who does not identify them (Meleis et al. 2000; Meleis and Trangenstein 1994).
Transitions are the result of changes and result in changes (Meleis et al. 2000), so change and difference are considered essential properties of transition. The exis- tence of changes (physical, social, personal, emotional and environmental) is another property of transitions, some related with the ongoing transition process, others not. All transitions feature changes through time. Any process starts with the first signs of change and goes through a period of instability with advances and withdrawals till a potential end, where the individual acquires a new concept of stability. Transition time is, thus, variable and many times indefinite, which requires a continuous evaluation of the results though time, alert nonetheless to the fact that this evolution is not blindly considered linear, as it might be difficult or even impos- sible to define time barriers (Meleis et al. 2000).
In a first approach to the person who has been diagnosed with so-called mental illness, it is important that the nurse evaluates the insight, recognised as the capacity to gain an accurate and deep understanding of someone or something. In case the client does not possess an insight, he/she could never experience a transition.
Nevertheless, the transition theory could be utilised in the approach to the family member who is providing care, in which the nurse evaluates the different fields associated to a transition. Besides this, and in line with the humanistic theory, it is important that the nurse seeks to find an interpersonal relation of proximity and trust with the client himself/herself.
Nature of Transitions Types
Patterns
Community Personal
Society
Properties Developmental Situational Health/Illness Organizational
Single Multiple Sequential Simultaneous Related Unrelated
Awarness Engagement Change and Difference Transition Time Span Critical Points and Events
Nursing Therapeutics Meanings
Cultural beliefs & attitudes Socioeconomic status Preparation & knowledge
Transition Conditions: Facilitators & Inhibitors Patterns of Response Process Indicators Feeling Connected Interacting
Location and Being Situated Developing Confidence and Coping
Outcome Indicators Mastery
Fluid Integrative Identities`
Fig. 5.3 Transitions middle-range theory Meleis et al. (2000)
Conclusion
In this chapter, we aimed at highlighting the main concepts of three theoretical foundations of P/MH nursing; we seek for anchors that connect them to the cul- tural and scientific specifications of Europe. P/MH nursing has adopted, in the formation of its theoretical references, concepts which do not completely adapt to the history of the professionals and psychiatric institutions in Europe, neither to the specialist professionals training. It is our belief that theoretical basis of broaden social, cultural and clinical should be more adapted to the European reality. People are different, culture are different, history are different, mental health problems and challenges are different, P/MH nursing history is different, so must be different today’s approach to so-called mental illness. Although today we have a cross-cul- tural overview of world, our habitat remains special and foundation of our ecologi- cal balance, especially in an imbalance table between us and the world, in the context of mental health. A theoretical foundation for the framework in mental health nursing in Europe should always consider its history and cultural diversity, its history in the care of the mental illness and the history of its education in general nursing and particularly in specialised P/MH nursing. We do not point out a theo- retical orientation. That would be too bold. But we say clearly: P/MH nursing in Europe needs to have a humanist look of the person, see it at all stages of their life cycle with all the inherent transitions discovering and constantly rediscovering the advantages of developing interpersonal relations as a therapeutic interaction field.
This is the humanist framework for P/MH nursing in Europe.
References
Alligood M, Tomey A (2010) Nursing theorists and their work, 7th edn. Elsevier, Mosby
Caldas de Almeida JM, Killaspy H (2011) Long-term mental health care for people with severe mental disorders. European Commission. (Last accessed on 2016 Oct 30). Available from:
http://ec.europa.eu/health/mental_health/docs/healthcare_mental_disorders_en.pdf
Chick N, Meleis AI (1986) Transition a nursing concern. In: Chinn PL (ed) Nursing research - methodology, issues and implementation. Aspen, Rockville, pp 237–257
Cutcliffe JR, Lakeman R (2010) Challenging normative orthodoxies in depression: Huxley’s Utopia or Dante’s Inferno? Arch Psychiatr Nurs 24(2):114–124
Cutcliffe JR, Santos JC, Kozel B, Taylor P, Lees D (2015) Raiders of the lost art: a review of published evaluations of inpatient mental health care experiences emanating from the United Kingdom, Portugal, Canada, Switzerland, Germany and Australia. Int J Men Health Nurs 24(5):375–385
D’Antonio P, Beeber L, Sills G, Naegle M (2014) The future in the past: Hildegard Peplau and interpersonal relations in nursing. Nurs Inq 21(4):311–317
Howk C, Brophy GH, Carey ET, Noll J, Rasmussen L, Searcy B, Stark NL (1998) Hildegard E. Peplau: psychodynamic nursing. In: Tomey AM, Alligood MR (eds) Nursing theorists and their work, 4th edn. Mosby, St. Louis, pp 335–350
Jacobson GF (1980) Crisis theory. New Dir Ment Health Serv 1980:1–10. https://doi.org/10.1002/
yd.23319800603
Jones A (1996) The value of Peplau’s theory for mental health nursing. Br J Nurs 5(14):877–881 Kleiman S (2001) Josephine Paterson and Loretta Zderad: humanistic nursing theory with
clinical applications. In: Parker ME (ed) Nursing theories and nursing practice. F.A. Davis, Philadelphia, pp 151–168
Kralik D, Visentin K, Van Loon A (2005) Transition: a literature review. J Adv Nurs 55(3):320–329 Lakeman R, Cutcliffe JR (2009) Misplaced epistemological certainty and pharmaco-centrism in
mental health nursing. J Psychiatr Ment Health Nurs 16:199–205
Lakeman R, Cutcliffe JR (2016) Diagnostic sedition: re-considering the ascension and hegemony of contemporary psychiatric diagnosis. Issues Ment Health Nurs 37:125–130
Lego S (1999) The one-to-one nurse-patient relationship. Perspect Psychiatr Care 35:4–23 McCamant KL (2006) Humanistic nursing, interpersonal relations theory, and the empathy-
altruism hypothesis. Nurs Sci Q 19:334–338
Meleis AI (2010) Transitions theory: middle-range and situations specifics theories in nursing research and practice. Springer Publishing Company, New York
Meleis AI, Sawyer L, Im E, Messias D, Schumacher K (2000) Experiencing transitions: an emerg- ing middle-range theory. Adv Nurs Sci 23(1):12–28
Meleis A, Trangenstein P (1994) Facilitating transitions: redefinition of the nursing mission. Nurs Outlook 42(6):255–259
Nolan M, Ready J, Grant G (1995) Developing a typology of family care: implications for nurses and other service providers. J Adv Nurs 21:256–265
O’Connor N (1993) Paterson and Zderad: humanistic nursing theory. Sage, Newbury Park Page LJ (1998) The crisis in mental health theory. Int J Men Health 27(1):33–61 Parker ME, Smith MC (2005) Nursing theories and nursing practice. FA Davis, p. 128 Paterson JG, Zderad LT (1988) Humanistic nursing. National League for Nursing, New York Paterson JG, Zderad LT (1976) Humanistic nursing. John Wiley & Sons, New York
Paterson J, Zderad LT (2008) Humanistic nursing. Project Gutenberg eBook. Available from:
http://www.gutenberg.org/files/25020/25020-8.txt
Peplau HE (1991) Interpersonal relations in nursing: offering a conceptual frame of reference for psychodynamic nursing. G.P. Putnam’s Sons, New York
Rogers C (2004) On becoming a person. Constable and Robinson Ltd., London
Schumacher KL (1995) Family caregiver role acquisition: role-making through situated interac- tion. Sch Inq Nurs Pract 9:211–271
Samele C, Frew, S., Urquia N (2013) Mental health systems in the European Union Member States, Status of Mental Health in Populations and benefits to be expected from investments into mental health. A report prepared on behalf of the Institute of Mental Health, Nottingham for the EU Executive Agency for Health and Consumers. (Last accessed on 2016 Oct 30).
Available from: http://www.ec.europa.eu/health/mental_health/docs/europopp_full_en.pdf Schumacher KL, Stewart BJ, Archbold PG (1998) Conceptualization and measurement of doing
family caregiving well. Image J Nurs Sch 30:63–69
Teixeira J, Meireles J, Carvalho JC (2010) A teoria das transições em saúde mental (The theory of transitions in mental health). Revista Portuguesa de Enfermagem de Saúde Mental (Port J Ment Health Nurs) 4:45–52
Trahar S (2004) Models of counseling. Guidance and counseling in education. Unit handbook WHO European Office (2005) Mental health action plan for Europe: facing the challenges,
building solutions. WHO European Ministerial Conference on Mental Health, Helsinki.
(EUR/04/5047810/7)
Wu HL, Volker DL (2012) Humanistic nursing theory: application to hospice and palliative care.
J Adv Nurs 68(2):471–479
59
© Springer International Publishing Switzerland 2018
J.C. Santos, J.R. Cutcliffe (eds.), European Psychiatric/Mental Health Nursing in the 21st Century, Principles of Specialty Nursing,
https://doi.org/10.1007/978-3-319-31772-4_6 J. Swan
Division of Neurosciences and Medical Education Institute, College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, UK
G. Sloan (*)
Consultant Nurse in Psychological Therapies, Psychological Services, NHS Ayrshire and Arran, Ayr, Scotland, UK
Psychological Therapies Training Coordinator, NHS Education for Scotland, NHS Ayrshire and Arran, Ayr, Scotland, UK
e-mail: [email protected]