Editorial Psychological support: are nurses appropriately prepared to deliver?

Papers presented in this month's Journal of Clinical Nursing illustrate a recurring

theme ± that of nursing staff working increasingly closely with informal carers

and patients to provide high-quality nursing care. The extent to which individual

carers and patients should be involved in developing care plans and selecting

appropriate interventions is considered in several of the papers in this issue.

Consideration is given by Walker (p. 625) as to whether relatives have a right to

witness resuscitation, while Phillips & Woodward (p. 753) explore older people's

views in relation to deciding whether resuscitation is appropriate or not for

certain individuals. The fact that nurses are re¯ecting on relatives' and carers'

rights to be involved and informed in relation to resuscitation issues indicates a

signi®cant change, moving from the paternalistic view that the multiprofessional

team should take responsibility for such decisions without consultation to one of

shared decision-making with patients and their signi®cant others. As a result

`consumers of care' are being much more actively involved than was the case

even a decade ago. However, such consultation requires nursing staff to

demonstrate sensitive interpersonal communication skills in order to explain and

work with carers and patients involved in decisions relating to life-threatening

circumstances. In addition to sensitive and accurate information-giving, nurses

must be able to provide psychological support to carers and relatives involved in

either witnessing the resuscitation process or being involved in sharing the

responsibility of decision-making. In cancer care, Mills & Sullivan (p. 631) also

emphasize that patients need psychosocial support and information about

psychological reactions to treatment. Secker et al. (p. 643) have identi®ed that

primary healthcare nurses are increasingly expected to deliver psychological

support to individuals with mental health problems, and yet those nurses report

little preparation and training for such work.

Two papers re¯ect on supporting elderly people suffering from dementia.

Graham (p. 675) argues that community psychiatric nurses need to develop the

ability to demonstrate emotional competence and carry out self-questioning in

order to provide patient-centred care. Following nursing home placement,

relatives are often antagonistic to professional staff who seek to take over care

of individuals previously supported by a relative (Nolan & Dellasega, p. 723).

It is paramount that nurses understand their limitations and do not feel

undervalued when relatives encourage, and in some cases demand, patient-

centred care that may be dif®cult to achieve in long-term facilities. In other

words nurses need to be taught to recognize their own needs for psychological

support and clinical supervision associated with the demands of individualized

patient care delivery.

In summary, the papers presented in this issue clearly illustrate that nurses

need to be able to give psychological support to carers and patients in a variety of

care settings, be these in cancer care, dementia care, acute resuscitation areas or

primary healthcare. The extent to which nurses are adequately prepared both to

re¯ect on their practice and to interpret the needs of patients, carers and relatives

in terms of psychological support during healthcare delivery needs further

consideration. We need to ask whether all educational programmes leading to

registration as a nurse should be required to prepare nurses who are competent in

Journal of Clinical Nursing 1999; 8: 623±624

Ó 1999 Blackwell Science Ltd 623

recognizing their own needs for psychological support at work and at providing

this for other members of the multidisciplinary team and, most importantly,

meeting these needs for patients and their carers and relatives involved in

collaborative care partnerships.

MARY WATKINSInstitute of Health Studies

University of Plymouth

Ó 1999 Blackwell Science Ltd, Journal of Clinical Nursing, 8, 623±624

624 Editorial