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Jurnal MHCLN Peplau


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Related Interests
 Psychiatry
 Mental Disorder
 Nursing
 Psychiatric And Mental Health Nursing
 Health Care

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Copyright ©
eContent
Management
Pty Ltd.
Contemporary
Nurse
(2010)
34
(2): 158–166.
Volume 34,
Issue 2,
February/M
arch 2010
158
C
N
C
N

Conc
eptua
lising
the
funct
ional
role
of
ment
al
healt
h
cons
ultati
on–
liaiso
n
nurse
in
multi
-
morb
idity,
using
Pepla
u’s
nursi
ng
theor
y
M
ICHAEL
KM
ERRITT
Mental Health
Consultation-
Liaison
Service, Lyell
McEwin
Health
Service,
Elizabeth
Vale, SA,
Australia
N
ICHOLAS
P
ROCTER
School of
Nursing and
Midwifery,
University of
South
Australia, City
East Campus,
Adelaide, SA,
Australia
ABSTRAC
T
This paper
examines
the mental
health
consultatio
n–liaison
nursing
(MHCLN)
role and
links this to
the
interperson
al relations
theory of
nurse
theorist
Hildegard
Peplau.
The paper
argues that,
as mental
health
nursing
care around
the world is
increasingl
y focused
upon
meaningful
therapeutic
engagemen
t, the role
of the
MHCLN is
important
in helping
to reduce
distressing
symptoms,
reduce the
stigma for
seeking
help for
mental
health
problems
and
enhancing
mental
health
literacy
among
generalist
nurses. The
paper
presents a
small case
exemplar to
demonstrat
e
interperson
al relations
theory as
an
engagemen
t process,
providing
patients
with
methodolo
gies which
allow them
to work
through the
internal
dissonance
that exists
in relation
to their
adjustment
to changes
in life roles
pre-
cipitated by
physical
illness.
This
dissonance
can be seen
in the
emergence
of anxiety,
depression
and
abnormal/p
sychogenic
illness
behaviours.
This paper
concludes
arguing for
considerabl
e effort
being
given to
the nurse–
patient
relationship
that allows
for the
patient
having
freedom to
use
strategies
that may
help
resolve the
dissonance
that exists.
Keywords:
consultation–
liaison
nursing;
interpersonal
relations;
mental health;
Peplau
I
NTRODUCTION
I
n
contemporar
y clinical
settings it is
important
that
community
consultation
and liaison
ser-vices
ensure
mental
health
patients have
an active and
meaningful
voice in their
treatment
and care
planning.
This means
ensuring
greater
emphasis on
the valued
involvement
of patients
through
dialogue and
information
exchange
with clini-
cians. At the
same time
there is
growing
interest in
the idea that
mental
health care
should be
delivered
and
administered
across a
range of
prac-tice
settings
within
general
health and
hospital
settings in
particular.It
is within the
above
context that
this paper is
written.
With the
collapse of
the purpose-
built
psychiatric
hospital as
once the
mainstay of
tra-ditional
mental
health care,
it is difficult
to over
emphasise
the
importance
of
community-
based
Conceptuali
sing the
functional
role of
mental
health
consultation
–liaison
nurseVolum
e 34, Issue
2,
February/M
arch 2010
159
C
N
C
N
C
N
C
N
systems and
structures as
key drivers
of contem-
porary
mental
health care.
There is a
now a global
consensus
that mental
health care
should be
undertaken
in
partnership
and
collaboration
with mental
health
patients – no
matter where
they are or
where they
live – and in
the least
restric-tive
environment
(World
Psychiatric
Association,
2009). At
the same
time there is
a vision of a
seamless and
connected
care system
which is
con-sumer
focussed and
recovery
oriented
(National
Mental
Health
Policy,
2008). At the
same time
there is
evidence of
mar-
ginalisation,
oppression
and
incarceration
of people
with a
mental
illness in
certain
societies
(BBC News,
2009) and in
industrialise
d nations.
While
mental
disorders
represent
15% of the
total disease
burden,
people with
severe men-
tal disorders
in low to
middle
income
countries
often fail to
receive
adequate
mental
health care
(World
Health
Organisation
/Wonca,
2008). A
recent UK
Health Care
Commission
report (for
example)
reveals that
of 27,000
people using
mental
health
services,
15% said
they did not
have enough
say in care
decisions
and 44%
only had a
say to some
extent. The
Health Care
Commission
quizzed
300,000
patients and
found that
most wanted
more
meaningful
input into
their care,
especially
those with
mental
illness.
Similar
sentiment
has been
expressed
elsewhere in
the UK
(BBC News,
2004) and in
Australia
(Mental
Health
Council of
Australia,
2006). In
addition and
contrary to
recommende
d national
standards,
less than half
of mental
health
service users
surveyed in
the UK had
access to
crisis care,
and only
have had
been given
or offered a
written care
plan (Health
Care
Commission
UK, 2008).
Such
conditions
are
experienced
by patients
as de-
humanising
and de-
personalisin
g, placing
interpersonal
relations at
the fringe
rather than
as central
interactions
between
patient, carer
and mental
health
professional.
People with
co-existing
physical and
mental
health
problems
are also at
risk of
marginalisa-
tion. People
with chronic
physical
illnesses
also
experience a
sense of
being de-
humanised
and de-
personalised
by the health
system
(Barker,
2009; Jones,
1998). The
emphasis is,
in this
sense, on the
physical,
potentially
reducing the
patient to a
collection of
systems and
ignoring the
holism and
the person or
patient’s
journey to
this point in
time.
Australian
studies have
shown that
whilst
depression,
anxiety or
psy-
chological
distress is
identified in
patients with
chronic
physical
illness, 75%
do not
receive
psychologic
al treatment
or
counselling
(Kelly &
Turner,
2009).Clearl
y, there is
cause for
examining
the deeper
structures of
engagement
in mental
health
between
clinicians
and patients
to advance
recovery in
mental
health. It is
for this
reason that
the authors
draw upon
the Peplau
Model, as
the
underlying
theoretical
construct
used by
Hildegard
Peplau
emphasises
the crux of
the
therapeutic
relation-
ships as a
partnership
between the
nurse and
the patient,
and with it a
notion of
shared
humanity
between the
nurse and the
patient
(Peplau,
1952, 1991,
1997).
Whilst the
model has its
genesis in
psychodyna
mic and
psychodram
atic theories
giving rise to
looking
more deeply
at the
reasons for
individual
thought and
behaviour
(Sullivan,
1953), it has
been long
utilised by
mental
health nurses
in clinical
practice
(Barker,
1993, 2009;
Price, 1998).
Barker
(2009) in
particular
empha-sised
the person
rather than
the problem
to be the
focus of
mental
health
nursing. This
underlines
that,
according to
Peplau, the
therapeutic
rela-tionship
is a central
platform of
mental
health
nursing
practice.
Shattell,
Starr, and
Thomas
(2007)
adapted
Peplau’s
theoretical
approach to
described
patient’s
views of the
therapeutic
rela-tionship
as being
expressed in
three figural
themes:
‘relate to
me’, ‘know
me as a
person’ and
‘get to the
solution’.
The
therapeutic
relationship
is by its
nature and
scope
primarily
about the
creation of a
shared
experience.T
he next
section
outlines
steps taken
to review
literature
pertaining to
the
functional
role of the
MHCLN
informed by
Peplau’s
nursing
theory. The
utilisation of
this theory in
multi-
morbidity is
then
discussed.
Michael K
Merritt and
Nicholas
ProcterVolu
me 34, Issue
2,
February/M
arch 2010
160
C
N
C
N
C
N
C
N
M
ETHOD
A search of
electronic
data was
undertaken
using the
following
databases;
CINAHL,
Medline,
PsycINFO
and the
Cochrane
Library.
Searches
were for
articles
published in
English and
several
search
themes were
used as
follows:•
Australian
and
International
literature
since 1990
about
Mental
Health
Consultation
–Liaison
Nursing
using a
variety of
descriptors –
see Tunmore
and Thomas
(1992). 1990
was used as
a starting
point and
can be
considered a
focal point
in the
transition
from asylum
to
community
care within
South
Australia.
Australian
literature
was used to
provide his-
torical and
current
context of
practice,
whilst
international
literature
was used to
look for dif-
ferences in
operationalis
ation of
MHCLN
prac-tice,
which may
have
informed or
influenced
the
Australian
context of
practice.
Some early
Australian
literature
from the
1980s
provides a
firmer
historical
context.•
Literature by
Hildegard
Peplau and
others
describing
interpersonal
relations
theory.•
Literature
about
utilisation of
interpersonal
relations
theory in
psychiatric-
mental
health
nursing
practice.•
Literature
about multi-
morbidity
and psycho-
logical
outcomes. A
dditional
exploration
was
conducted
by hand
utilising
reference
lists from
retrieved
articles.
T
HE

MENTAL

HEALTH
CONSULTATION

LIAISON

NURSE
The
MHCLN has
become an
established
part of
contemporar
y nursing in
Australia
(Sharrock,
Grigg,
Happell,
Keeble-
Devlin, &
Jennings,
2006), the
United
Kingdom
(Cullum,
Tucker,
Todd, &
Brayne,
2007),
Canada
(Brinkman,
Hunks,
Bruggencate,
& Clelland,
2009) and
United States
(Yakimo,
Kurlowicz,
& Murray,
2004). The
role is
variously
described as
‘psy-chiatric
consultation–
liaison
nursing’
(Sharrock &
Happell,
2000;
Yakimo et
al., 2004),
‘liaison
psychiatric
nursing’
(Cullum et
al., 2007;
Ryrie,
Roberts, &
Taylor,
1997),
‘psychiatric
liaison nurs-
ing’ (Chiplin
& Geraghty,
1990),
‘mental
health liaison
nursing’ and
Liaison
Mental
Health
Nursing
(Roberts &
Whitehead,
2002). The
predominant
terminology
is
‘psychiatric
consultation–
liaison nurse’
which is a
naturalistic
outcome of
the growth of
these
positions out
of
psychiatric
consultation–
liaison
services and
the
biological-
psychiatry
model. These
terms are
used both
simultaneous
ly and
interchangea
bly to
describe the
work of
men-tal
health nurses
within a
general
hospital
setting. The
fluidity of
this
terminology
can be seen
as an
outcome of
the
underlying
dichotomy
that exists
within the
mental health
nursing
profession
around the
world.
Barker
(2009, p. 5)
argues that
mental health
nurses
including
MHCLNs
work within
a highly
fluid
continuum
between
psychi-atric
nursing and
mental health
nursing, and
thus between
problem- or
situation-
focused and
holism or
life-
focused.In
the 1980s
Meredith
and
Weatherhead
(1980),
Anderson
and Hicks
(1986) and
Hicks (1989)
described
early roles in
Sydney,
Australia.
This early
literature
described a
traditional
structure in
the style of
Caplan
(1964, 1970)
in Tunmore
and Thomas
(1992), that
has its roots
in the work
of
psychosomat
ic medicine
as described
by Lipowski
(1981). The
literature
since 1997
describes
two different
models; that
of the
traditional
consultation
–liaison
nursing
model
(Sharrock &
Happell,
2000, 2001a,
2001b), and
an emerging
emergency
mental
health
nursing
model
within
emergency
departments
(Wand,
2004; Wand
& Happell,
2001)
alternatively
called the
‘emergency
department
mental
health team’.
These roles
show the
advanced
mental
health
nursing
development
that has been
accel-erating
in recent
years with
some of
these roles
being
developed
into ‘mental
health nurse
prac-titioner’
positions
(Wand,
White, &
Patching,
2007).
Further,
McNamara,
Bryant,
Forster,
Sharrock,
and Happell
(2008) and
Sharrock,
Bryant,
McNamara,
Forster, and
Happell
(2008)
describe the
outcomes of
a survey of
CL nurses
within
Australia,
which
provides
valuable
data
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