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*Corresponding Author: Danuta Abram, Master of nursing, University of Applied Sciences, Faculty of Medical Sciences, Nysa, Poland.
Citation: Danuta Abram, (2024), Psychological and Educational Support for the Patient as a Nursing Competence Constituting an Introduction and Supplement to Psychotherapy, Clinical Research and Clinical Trials, 11(2); DOI:10.31579/2693-4779/233
Copyright: © 2024, Danuta Abram. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 14 September 2024 | Accepted: 27 September 2024 | Published: 04 November 2024
Keywords: patient psychological support; psychological aid; new nursing competencies; therapeutic conversation
Illness and hospitalization pose a dual challenge—both physical and psychological—for many patients, necessitating specialized support. In the face of these difficulties, the nursing staff plays an invaluable role, addressing medical care and serving as a source of psychological and educational support for patients. This paper focuses on analyzing the competencies of nurses in providing psychological and educational support to patients as an integral element of the treatment and rehabilitation process.
It is emphasized that nurses, through their direct and frequent contact with patients, have a unique opportunity to observe their emotional state, identify needs, and build trust-based, respectful relationships. Such relationships are the foundation of effective psychological support, which can significantly influence the treatment process, patients' quality of life, and their attitudes towards illness and treatment.
Within the scope of nursing competencies, it is important to provide medical care and patient education on managing illness, treatment, and self-care. Through their experience and knowledge, nurses are capable of educating and motivating patients to actively participate in their treatment, which is key to achieving desired therapeutic outcomes.
The article underscores that nurses’ psychological and educational support is valuable not only in the context of direct patient care but also as an important preliminary and supplementary element to professional psychotherapy. Empathy, emotional support, and a positive attitude from nurses can significantly improve patients’ mental state, which positively impacts their recovery.
Special attention is also given to nurses’ developing competencies in psychotherapy. It is highlighted that nurses, upon completing appropriate postgraduate studies and training, are increasingly qualified to conduct psychological therapies. This growing role of nurses as psychological therapists represents a significant step forward in integrating medical care and psychological support, which can bring substantial benefits to both patients and the entire healthcare system.
In conclusion, through their competencies in psychological and educational support and increasing qualifications in psychotherapy, nurses play a crucial role in a holistic approach to patient care, which results in the effectiveness of the treatment process and patient satisfaction.
Illness in humans is a state inconsistent with nature, characterized by unpredictability, which can lead to the emergence of unconventional, stressful events. Patients often have to re-evaluate their lives and goals during illness, as well as assess risk factors. According to Thomas H. Holmes' scale, which measures stress in 'life change units', illness can score up to 53 points out of a possible 100 [1]. Human reactions to stress are often irrational, activating mechanisms and behaviors that would not appear under normal, carefree conditions. Patient stress is often associated with the diagnosis and fear for health and the stay in a clinic or hospital [2].
Hospitalization naturally involves a sense of loss of autonomy and control over one's life. It can also be perceived by patients as a loss of independence, stemming from the necessity to conform to hospital rules and regulations, which can invade privacy and the sense of intimacy. Even though the Patient Rights and Patient's Ombudsman Act imposes an obligation to respect patients' intimacy and dignity [3], every diagnostic or surgical procedure infringes bodily integrity [2].
The growing awareness of the need for psychological support for patients at every stage – from diagnosis, through treatment and hospitalization, to the convalescence period – requires the development of nursing competencies in this area. Mental health is crucial in the process of physical recovery of a patient. Psychological mobilization is essential in combating illness, and nurses, being closest to patients and familiar with their problems and fears, often play a key role in this process. Therefore, it is natural that the ability to provide psychological support should be an element of nursing work [4].
The purpose of this study is to analyze the role of nurses in providing psychological and educational support to patients in the context of their experience of illness and hospitalization. The study focuses on examining how nurses can use their skills and knowledge to help patients cope with stress, anxiety, and other emotional challenges associated with illness and treatment. Additionally, this work aims to show how appropriate training and education can enhance nursing competencies in psychological support, contributing to better treatment outcomes and increased patient satisfaction from care. Specifically, this study aims to investigate the possibilities and effectiveness of conducting psychotherapy by nurses after completing appropriate postgraduate courses and specialized training. Legal, ethical, and practical aspects associated with expanding the role of nurses to therapists will be discussed. The role of training in developing interpersonal and therapeutic skills necessary for the effective conduct of psychological therapy by nurses will also be emphasized. The aim is therefore not only to understand the current state of knowledge and practices in this area but also to identify potential benefits and challenges associated with such an expansion of nursing competencies.
Current Forms of Psychological Support for Hospitalized Patients Administered by Nurses
A nurse, as an integral part of the healthcare system, maintains constant contact with the patient. In her professional activity, it is crucial to combine physical-biological and pharmacological aspects with spiritual and psychological support [3]. It is noted that without psychological support, the effective implementation of the therapeutic process is often impossible, especially when a patient experiences a high level of anxiety that prevents communication with medical staff. In this context, psychological support is essential for alleviating tensions and negative emotions, which is key to the success of therapy and nursing care [5].
Studies show a correlation between the progress of the disease and the type of support provided and patient preparation for receiving information about their health status [4]. In the surgical treatment, psychology analyzes the impact of psychological variables on the development, diagnosis, and treatment process of diseases, as well as on convalescence after surgical procedures. Here, it is important to recognize the psychological specifics of the patient and develop individually tailored psychological intervention methods [4].
In this context, nurses' psychological and educational counseling encompasses a range of key elements that help patients cope with anxiety and stress related to illness and hospitalization. As shown in Figure 1, the components of psychological and educational counseling include not only emotional support but also patient education on illness, treatment, and techniques for managing difficult emotions.
However, despite the availability of psychological interventions, many patients hesitate to take advantage of such help. Spiritual and emotional problems often remain taboo, making psychological counselling and support provided by nurses an ideal solution. The nurse’s role in shaping positive attitudes in patients is indispensable, especially considering their closeness to the patient and knowledge about their mental state [6].
New competencies of nurses in the field of educational-psychological counseling pose communication challenges. Nurses providing advice must be trained in therapeutic communication to establish a positive bond with the patient [7]. It is also the task of nurses to support the families of patients who often experience emotional stress in the face of a loved one's illness [8]. In this context, new competencies of nurses in psychotherapy, especially those less advanced forms, aim to equip patients with strategies for coping with stress at the behavioral and cognitive levels [7].
According to foreign literature, such as the works by Peplau (1952) and Travelbee (1966), the role of a nurse as a therapist requires not only specialized knowledge but also the ability to build a relationship based on trust and empathy. Contemporary studies, for example by Benner and Wrubel (1989), indicate the need to integrate spiritual and emotional care into nursing practice, which can significantly affect treatment outcomes and overall patient satisfaction [9][10][11].
In summary, the development of nursing competencies in psychotherapy and psychological counseling is a response to growing social needs. It can contribute to better health management of patients at various stages of treatment.
Contemporary Nursing Privileges in New Competencies Related to Psychological Support for the Patient and Their Family
In the context of modern healthcare, the psychological support of patients and therapeutic conversations, both with patients and their families, before surgical procedures, are gaining importance. The invasiveness of medical procedures, introducing significant changes in the human body, can generate anxiety, which often escalates during prolonged hospitalization. Thus, the role of nurses in reducing patients' anxiety levels becomes crucial, often a prerequisite for an effective therapeutic process [12].
Understanding the human being as a unity of body and mind, in line with the concept of Sherwin B. Nuland, emphasizes that treatment and care should encompass both the physical and the spiritual aspect. In this context, nurses play a key role in alleviating emotional tensions and supporting patients in the treatment process [13]. Their task is also to strengthen in patients a sense of success in combating the disease, which can accelerate the healing process [6].
Nurses, witnessing the emotions and fears of patients, can effectively influence their mental state. Although in extreme cases nursing support cannot replace professional psychological advice or psychiatric consultation, the closeness and continuous presence with the patient make them unique participants in the therapeutic process. Their role in shaping patients' attitudes and beliefs, based on trust and close relationship, can be crucial in the recovery process [12].
Therapeutic advice given by nurses should be based on communication that builds trust and optimism, which is the foundation of effective psychological support [14]. According to studies by Watson (1988) and Roach (1993), the therapeutic relationship between a nurse and a patient is the foundation of a holistic approach to treatment, combining physical care with emotional and spiritual support [15][16].
In summary, the development of nursing competencies in psychological support for patients and their families is not only a response to changing needs in healthcare but also an essential element in the process of treatment and rehabilitation.
Controversies Regarding Naming and Nursing Competencies Related to Psychological Support for Patients
There is significant debate among scholars and specialists in psychology, psychotherapy, and psychiatry regarding the role of nurses in providing psychological support. These controversies focus on terminology and the scope of competencies, especially concerning the labelling of advice and support provided by nurses as "psychotherapy." Many experts believe that this term should be reserved exclusively for specialized psychologists and psychiatrists [17].
An alternative concept, aimed at overcoming these controversies, is the idea of "therapeutic communication with the patient." This interaction between nursing staff and the patient aims to create a therapeutic atmosphere by adding encouragement, fostering optimism, and building a relationship based on kindness and trust. This communication also aims to alleviate tension and anxiety caused by the diagnostic or therapeutic process and support the patient in their therapeutic success, including by highlighting their small but significant achievements [18].
An important element of this therapy is touch, a nonverbal form of communication based on an intimate relationship. In nursing, touch is a fundamental element of nurses' actions, communicating presence, closeness, and support to patients [19].
Communication between a nurse and a patient is a specific type of social relationship in which trust, understanding, and empathy are key. Improper behavior by medical staff can have negative consequences, including hindering the continuation of therapy [20]. Proper therapeutic communication must consider both the content of the information and the way it is conveyed to avoid contradictions and interruption of interaction [18].
Conversations with patients are one of the most challenging aspects of nursing work. Unfortunately, traditional educational programs for nurses often do not include the need for training in conducting therapeutic conversations, which has become a mistake in light of growing social needs [20]. Despite the lack of specialized training in providing psychological advice, patients often a desire to communicate in such discourse with nurses, with whom they have established a relationship based on mutual understanding, empathy, and respect.
According to foreign literature, such as the works of Parse (1998) and Swanson (1993), emotional and informational support is crucial in the treatment process. Nurses, accompanying patients on their way out of illness, play a fundamental role, not limited to therapeutic communication but also encompassing other aspects of psychological support [21][22].
Communication is part of the complex process of patient psychological support; it includes both verbal and nonverbal elements that contribute to therapeutic success within the framework of nursing psychological and pedagogical counseling [23].
Rys. 1. Components of psychological and pedagogical nursing advice.
Source: Own study.
Justification and Guidelines for Organizing Postgraduate Psychotherapy Studies by Universities Offering Nursing Master's Degrees
The contemporary role of the nurse extends far beyond traditional duties related to the physical care of the patient. In the context of psychological support for patients, nurses play a key role, thus developing their competencies in the field of psychotherapy is becoming increasingly important. In Poland and abroad, postgraduate training programs enable nurses with a master's degree to gain specialized knowledge and skills in psychotherapy.
An exemplary action plan for a nurse in Poland to acquire psychotherapeutic qualifications:
The above plan is only an example and may vary depending on the specifics of the particular training path and requirements of specific accredited programs in Poland. It is important for a nurse interested in obtaining psychotherapeutic qualifications to familiarize themselves with the current requirements and procedures applicable in the chosen training institution.
Sample Psychological Approaches and Training Centers in Poland Available to Nurses with a Master's Degree
Psychodynamic Approach
Training Center: Laboratorium Psychoedukacji
Address: ul. Katowicka 18, 03-932 Warsaw
Admission Requirement: A higher education degree at the master’s level. Specialized education is not mandatory.
The training center offers contact with supervisors, enabling participants to obtain recommendations for certification. From the third year of study, participants can sign contracts with National Health Fund centers as psychotherapists. The certificate obtained after training meets the certification requirements of the Polish Psychological Society and the Polish Psychiatric Association, and it also provides the opportunity to apply for certification from the European Association for Integrative Psychotherapy and the European Association for Psychotherapy. The duration of the training is four years [29].
Cognitive-Behavioral Approach
Training Center: CBT-EDU Center
Address: ul. Wołodyjowskiego 74a, 02-724 Warsaw Admission Requirement: Completion of higher education at the master’s level in psychology, pedagogy, resocialization, nursing studies, and/or a psychiatrist's degree, and passing the entrance exam. The examination procedure verifies candidates' predispositions for working within the cognitive-behavioral approach.
Completing the study program entitles participants to apply for certification from the Polish Society of Cognitive and Behavioral Therapy, whose qualifications are recognized by the National Health Fund and are members of the European Association for Behavioural and Cognitive Therapies. The training lasts four years [29].
Systemic Approach
Training Center: Wielkopolskie Towarzystwo Terapii Systemowej
Address: ul. Marcelińska 62B/19, 60-354 Poznań
Admission Requirement: Completing higher education at the master’s level in psychology, pedagogy, medicine, or nursing. Participation in the course is divided into basic and advanced stages, and completion of both is a step towards obtaining the Systemic Psychotherapist and Counselor Certificate as well as the Systemic Psychotherapist Certificate following the regulations of the Ministry of Health. The duration of the training is four years [29].
Systemic-Ericksonian Approach
Training Center: Polish Association for the Development of Psychotherapy
Address: ul. Sołtysowicka 65A, 51-168 Wrocław
Admission Requirement: A higher education degree at the master’s level in medicine, psychology, pedagogy, nursing, rehabilitation, and other humanities, as well as employment in a health care facility where psychotherapy is practiced.
The course is recommended by the Scientific Section of Psychotherapy of the Polish Psychiatric Association and the Psychotherapy Section of the Polish Psychological Society. The certificate obtained after training serves as the basis for applying for psychotherapeutic certification [29].
Nurses play a key role in patient contact, particularly during hospitalization and outpatient care, even though they do not make direct decisions regarding the patient's treatment. As the closest caregivers to patients, they create an atmosphere of trust and respect, which serves as the foundation for effective healthcare [30]. Nurses also have a significant impact on the emotional state of patients, helping them cope with their illness. Even in cases where recovery is not possible, the presence and actions of nurses can alleviate negative emotions and contribute to improving the patient’s quality of life [31].
The competencies of nurses extend beyond simple therapeutic communication, encompassing an interdisciplinary process that supports both the body and spirit of the patient. In the context of psychological and educational counseling, rather than focusing on terminological debates (e.g., "therapeutic communication" vs. "elementary psychotherapy"), it is essential to recognize and appreciate the wide-ranging contributions of nurses to the therapeutic process. Their efforts translate into tangible benefits for both patients and the entire healthcare system, highlighting their integral role in the treatment process [32].
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