Why it’s important to approach care from a place of compassion and genuine curiosity
All nurses are mental health nurses. By this I do not mean that all nurses work in specialized mental health (or psychiatric services). I mean that all nurses must understand that competent and ethical patient care cannot be delivered unless it is for the whole patient. We cannot nurse the physical body without caring for the mind.
In 1952, Hildegarde Peplau first published her work on relational practice as a means of building understanding of the relationship between nurse and patient as key in enacting good nursing practice. Recent widespread health crises, primarily the COVID-19 pandemic and the opiate overdose crisis, have forced the world to take a hard look at nurses’ integral role in population health, policy development, and emergency response. Outdated medical models focused on problems and cures do not fit with nursing as they fail to embrace the human factors of connection in times of fear and unknowing. This is where nursing and nurses shine.
The COVID-19 pandemic highlighted the significant global impacts that mass illness has on understanding of illness, wellness and health. The physical effects of a disease process cannot be separated from the mental impacts. According to the World Health Organization, the increased mental stress related to the lack of knowledge during a global pandemic, along with the economic impacts of job loss, closure of businesses and schools, and shift to work from home, includes anxiety, fear and worry about the current and future state of our world. Sudden, mass shifts in how people connected, congregated and communicated highlighted the importance of integrating mental health into our current understanding of health.
Although the pandemic is declared over, we continue to feel its impacts. The social isolation that resulted from physical isolation severed the important connections of support and means of resiliency in ways we had never anticipated, and we were not prepared for it from a medical perspective. The door to inclusion of a nursing perspective to address global health crises opened.
Nurses leading change
Certain perspectives are used to shape nursing practice — for example, therapeutic relationships, person- and family-centred care and strengths-based care. Such perspectives are considered foundational to nursing.
However, an integral influence that does not fit with the popular narrative, the oppression by and pressure to adhere to a medical model of care, is often unacknowledged or ignored. Similarly, the nursing profession’s centring of caring, compassion and empathy obscures and ignores opportunities for nurses to critically approach and address significant social issues that impact health, such as systemic racism, social inequity, classism and ableism. Many of these social justice issues were thrust into the spotlight during the COVID-19 pandemic, and we cannot forget about them.
To improve population health, nurses should welcome grappling with the increased worldwide stress of collective confrontation with social injustice and suffering. Nurses can rise as leaders in the future of health care. We can embrace the narrative of helping the hardest to help, the people who are most marginalized, those who are suffering. But a cognitive reframing is necessary to fully embrace conceptualization and delivery of patient care and understanding of health and wellness from a holistic perspective.
Nurses are well positioned to shape the reimagining of health services, policies and practices from a holistic perspective that can break free from the traditional dualism of separate health services and programs for the body and for the mind. These lines are arbitrary. The underlying values of the nursing metaparadigm, which include health, person, environment and nursing, are not just something to learn in nursing school. They are essential to stop perpetuation of the separate silos of health care for the body and for the mind.
Furthermore, nurses are well positioned to take the lead in education and integration of holistic models of care as a means of increasing public understanding of mental health as part of overall health. Nurse leaders are essential in combating the stigma related to the challenges and obstacles people and populations face in widespread crises, particularly those who live with mental illness, use drugs, have a disability, or have been negatively labelled within our health-care system.
The solution is clear: if the goal of mental health care is to combat stigma, then all nurses must champion ways to overcome it. The first way is to conceptualize the patient as a whole person, not a sick/well body distinct from a sick/well mind. The nurse-patient relationship is foundational to providing person-centred care, a goal that defines nursing practice, not only mental health nursing practice.
To accomplish goals such as collaborative care, nurses must champion the development of strategies that encourage understanding of the patient as a person who has varied health needs over time and services. Such strategies must transcend the traditional boundaries of patient and professional. To understand the patient and their experience, all nurses require a comprehensive understanding of how illness impacts the patient. The traditional boundaries of mental health and non-mental health nurse require critical analysis in moving from dualism to holism.
Strategies for change
Nurses in Canada are living in a time of health-care crisis. However, we hold both the power and the privilege to engage in leadership to change the system at all levels, from staff nurses to nurse leaders and managers.
To do this, nurses can role-model courageous conversations asking nurses and other health-care professionals to rethink outdated and harmful policies and practices that do not place the patient at the centre of care. Nurses can collaboratively advocate for patients/clients, approaching care from a place of compassion and genuine curiosity. Most importantly, nurses can create communities of practice to discuss and challenge the status quo and rethink ways to bring multi-professional teams together utilizing each lens to collaborate on care rather than obscuring the strength and approach of each team member.
We are all mental health nurses. This has never been more apparent as we emerge from a time of collective crisis. The COVID-19 pandemic forced a new opportunity to define understanding of nurse identity and the meaning of holistic nursing practice. Important questions that must be contemplated include How do we define nurse identity? How do nurses arrive at their identity, and is this different for nurses who work in mental health areas? Is identity defined by patient needs or care area? The global pandemic has made it startlingly clear that the human connection is integral to health and well-being.
Nurses are experts in building relationships with patients and families. While recovering from the global pandemic, attention must be given to the blurring of the boundaries between the dichotomies that are traditionally upheld, including that of mind and body and caregiver and care receiver.
Michelle Danda, RN, PhD, CPMHN(C), graduated from the bachelor of nursing accelerated track program at the University of Calgary in 2008. She currently lives in New Westminster, B.C. She is a professional practice initiatives lead in Vancouver, B.C., and practised mental health and substance use nursing through the Lower Mainland, B.C. She has four beautiful children with her partner, who also works in professional practice and is a mental health nurse. She completed her PhD in doctoral nursing program at the University of Alberta. Her research focuses on the history of psychiatric nurse education in British Columbia.