What are the Essential Personal Qualities Required? For Success in Mental Nursing?
- Author:
Leonard S. Heal
Staff Nurse, Herrison Hospital, Dorchester Winner of the 1945 ” Lord ” Memorial Prize and Medal (awarded by The National Council for Mental Hygiene) Professor Joad continually emphasizes that the answer to any problem ” all depends upon what is meant by ” the terms of the question. In this case the expression ” success in mental nursing ” calls for discussion and definition before the personal qualities of the nurse can be considered.
What then is meant by success in mental nursing ? Is it rapid promotion from student nurse to matron or chief male nurse ? No, for this may be the fruit of skilful Place-seeking rather than good nursing. Is the achievement of brilliant recoveries, especially when the prognosis js unfavourable, to be regarded as success ? No, brilliance rather for the psychiatrist and the research specialist than for the nurse. Again, is the avoidance of accidents, of untoward incidents, and the prevention of sickness by vigilance and foresight to be regarded as the criterion ?f success ? Not entirely, for, commendable as these may be, successful mental nursing is more than this. . There are many more pointers to success and fields which the nurse must succeed. There is the nurse ?f whom every patient speaks well and whom the visitors Praise, but popularity is not the only hall mark of sound w?rk. Another may have the gift of being able to Manage a difficult case, but this is success in one field only. Is good administration, cleanliness and order, a quiet ward and disciplined patients the standard of efficiency ? Surely not, for these attributes alone do not necessarily mean happiness and well being. The ability induce patients to employ themselves usefully, to benefit from occupational therapy and thus assist their ?wn recovery is but one form of treatment.
Remembering that sick nursing is an important part 01 mental nursing, a good nurse can help to ease suffering and prolong life when one less skilled may have let tie patient slip beyond human help. He should prevent soreness and complete degeneration in the case of a erminal dementia or dementia paralytica. He may have nursed the patient through a severe illness and back to good physical health. A potential suicide has perhaps een treated for some self-inflicted injury and then j^’Ped back on to the road to complete physical and Rental recovery. The mental illness is sometimes ssociated with some physical disorder which, if carefully Ul?ed and treated in co-operation with the medical sl^n ‘eac* to cornP’ete relief. Technical nursing tL11 under medical direction in the use of insulin shock yerapy, prolonged narcosis, induced hyper pyrexia, ectro convulsant therapy or post-operative care in Pre-frontal leucotomy, or participation in some other ?rm of modern mental treatment may be contributory 0 the success of the medical staff. Important as these Accesses may be, they are still only one aspect of success’menta, nursing.
of. .Ur objective cannot be limited to any one field or set 1 C|rcumstances. No one method or group of results, ven the recovery of some patients, can be rightly described s complete success. Indeed a 100 per cent, success may never be apparent, for the achievement of alleviation of the severity of the illness or the remission of the signs and symptoms must be regarded as good and successful nur^pg. This achievement is a multiple one which includes all the partial and individual successes we have discussed, and which perhaps seem impossible of attainment, yet there are mental nurses who are able to secure some success in all these fields and claim the title of a successful mental nurse. What personal qualities then are required for the attainment of this goal ?
St. Matthew and St. Mark record the details of an incident when the disciples of Christ were asked to cure a sick boy. The boy had some violent recurrent mental illness and his father in the absence of Jesus asked the disciples to help, but they were quite unable to do so. Jesus himself however, upon his return was immediately able to calm the boy. Now the disciples having failed were anxious to know the secret of success and were told by their Master that ” this kind can come forth by nothing but by prayer and fasting “. In this story there are perhaps many things that we cannot understand, but one thing is perfectly clear and that is that the disciples lacked those elements in their character that could only be nurtured by “prayer and fasting”. Now what the ancients described as ” prayer and fasting ” we would call character training and self-discipline. For the modern mental nurse, as well as for the ancient disciples, success is only assured by character that is well balanced, disciplined and unshakeable. Tt is well known that the mental nurse requires nearly all of the virtues, but any one, or all of them without their counterpart are insufficient and in fact, if carried to their limit, can be a fault.
A detailed consideration of the qualities involved will reveal this. Perhaps, first and foremost, tact is required, but the time comes when patients must be told truth which they do not realize, and helped to face facts as they really are. Conversely, however desirable truth may be it can be hard and cruel if met too suddenly. For example, there seems to be a most undesirable practice among general practitioners, public assistance officers and others of deliberately deceiving patients in order to get them to the mental hospital and accordingly causing considerable mistrust and suspicion in the minds of patients when they discover the real situation. This is tact carried beyond its right and useful purpose, when a kindly explanation of the real facts is needed.
Patience, that supreme virtue of all nurses, can outstay its uses, for there are times in the treatment of a patient when he can realize that his caprices will not be endured by a right minded society and must not be inflicted upon his fellow patients and nurses. Take for example a case of hypomania ; the bustling activity and interference in the affairs of others should not always be endured with patience, but checked for his own good and that of his fellows. Similarly tolerance cannot stand alone, for although mental nursing would be impossible without an almost inexhaustible fund of tolerance for the idiosyncrasies and special needs of those being nursed, there is at times behaviour that is intolerable and that must be rebuked and stopped. Now to take a few of the many other highly to be desired virtues, necessary as they are none of them can stand alone and none of them can be used without the limitations of their own opposites. The mental nurse must usually persist upon a given course, whatever hindrances or abuse may be met, but there are occasions when the nurse should curtail these activities and allow the patient to continue upon his own way for the solution of his own problems, in other words, persistence must not degenerate into obstinacy. Cheerfulness is often regarded as a characteristic of a good nurse, yet a becoming dignity and seriousness of manner can sometimes be more encouraging than a facile optimism. Sympathy is not always solely desitftble, especially in the case of the self-centred hypochondriac and the hysteric. Ingenuity, ability in games, music and handicrafts have an important part to play, but they do not tell the whole story. Vigilance is necessary, but patients do not like to feel that they are being watched continuously. Versatility must be balanced by stability. Co-operation among hospital staffs is highly necessary and the ability to co-operate readily is a valuable gift, but even so individuality and independence are equally necessary. The present generation often regards poise and personality as being the most desirable personal qualities in any walk of life. In mental nursing these qualities are exceedingly valuable, and in fact a considerable amount of success depends upon the personality of the nurse, but unless it is based upon sound character it can be but a hollow mockery. Thus it becomes apparent that as success in mental nursing is a composite achievement, however brilliant some of its triumph may be, complete success cannot be claimed without including many and various humble jobs well done ; so the essential personal qualities are many and varied, no one quality standing alone or taking pre-eminence, but depending upon sound well-balanced mind and character.
There are two other very important aspects of mental nursing. A nurse is not completely successful if her personal life is adversely affected by her work and unusual environment. A woman who herself becomes depressed, neurotic, hysterical or even sour, embittered, coarsened and frustrated has not made a success of mental nursing, for her own character and personality have suffered and she herself has become a minor casualty. It is highly important that the mental nurse should ‘?maintain her own sweetness and integrity of character, and soundness and vigour of mind by the routine methods known to her and by full and free association with normal society away from the hospital and its staff. This applies equally of course to the male nurse. The man who, however well controlled he may be on duty, goes home and lets out his pent-up anger and irritation upon his family in not himself a personal success. The man who has allowed his horizon to become limited by the mentality of his patients, his outlook on life cynical and his mind and body too exhausted by the strain of his work to take his proper place as an active citizen of his town or community, has not made a success of his vocation, but has rather become a victim of it. If, when retiring after thirtythree years, he himself has acquired a slightly warped personality, success has eluded him and also the administrators of our mental hospitals. And so again the qualities demanded for success are balance and stability; in other words, the essential personal quality demanded of the successful mental nurse is sound mental health.
The other important factor in mental nursing may best be described as public relations. This is the day of opportunity for developing the voluntary system, and the attitude of the voluntary patient, and of the certified patient too, depends a great deal upon public opinion and its general attitude towards mental hospitals and mental illness. The man who is on the verge of mental illness sometimes avoids having anything to do with the mental hospital, or even the out-patient clinic, because he fears the ” stigma of insanityThe certified patient in hospital fears to face the world again because he has been in a mental hospital. Relatives too feel that a major disaster has descended upon the family. Even the mental nurse himself is not always regarded as a quite desirable member of society. Now this attitude is very slowly being dispelled and it is very important for the successful nursing of mental illness that these ideas should be quickly and completely removed. The prevailing attitude towards the mentally sick must change, mental illness generally must be better understood by the public, research and treatment must be better supported and psychiatrists and mental nurses accorded a more proper recognition of their work. The persons most numerous and best able to effect this change are mental nurses themselves. The success of mental nursing depends upon their being good ambassadors of their vocation, on their advocacy of balanced living and enlightened judgement on matters of health, both mental and physical, above ail on their own essential sanity.
HEADLEY BROTHERS, 109 KINGSWAY, LONDON, W.C.2 J AND ASHFORD, KENT
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