Being professional and being human: one nurse's relationship with a psychiatric patient

BACKGROUND: The theoretical foundations and professional ideals of psychiatric nursing contain built-in contradictions. One central ideal is that nurses should use themselves as therapeutic instruments. The expectation that nurses should have both a professional and a human function is examined in this study. PURPOSE: The purpose of this study was to find out how nurses experience and interpret the contradictory demands of being both fellow human being and health professional in their work with patients. METHODS: An ethnographic research design including participant observation and narrative interviews with nurses working on an acute ward of a psychiatric hospital was used. The case of one nurse is analysed and discussed. FINDINGS: The study shows that when nurses themselves are 'therapeutic instruments', tensions are created. Contradictory demands produce difficult role conflicts. Nurses vary in the ways in which they interact with patients. The study shows how the nurse's own vulnerability can be a constructive element in patient care. It also shows that although the nurse is aware of this, she is also critical of her performance, feeling that it falls short of accepted professional standards. Her colleagues reinforce these standards. CONCLUSION: The ideal that psychiatric nursing should be a balancing act between intimacy and distance, between human and professional ways of acting, appears to be too harmonious and narrow a one. The study suggests that there is potential for professional development if nurses are able to recognize their own vulnerability. Critical examination and discussion of conventionally accepted ideals can help develop our knowledge of the profession.