Running head: PERSON CENTERED APPROACH TO PSYCHIATRIC NURSING PART II 1

The Relevance of Person Centered Approach to Psychiatric Nursing Practice Part II Dermot Connolly Stenberg College 0312 PSYN 201-3 Introduction to Counseling May 2013

PERSON CENTERED APPROACH TO PSYCHIATRIC NURSING PART II The Relevance of Person Centered Approach to Psychiatric Nursing Practice Part II As we age, our bodies undergo many physical and mental changes which can impact the amount of control we have over our lives. Such changes impact our level of independence and affects how much we depend on others for help and assistance. (Field n.d.). Many of the elderly

residents in a long term care facility for example depend on others to dress, feed and bathe them. Many have no families and others have no means of communicating. With increased dependence comes decreased self-esteem and dignity resulting in what Carl Rodgers described as an altered self concept which defines the values, ideas and perceptions held by an individual. (Palmer 2008). Within this discussion, we will focus on the application of a person centered approach to the treatment plan of a long term care resident. The resident under discussion, presents with chronic low self esteem as a result of early onset Alzheimers which impacts her ability to perform many of her activities for daily living (ADL). The effectiveness of this therapeutic approach is explored using evidence based research, while expected outcomes are also discussed. This paper will conclude with a discussion on the relevance of the person centered approach to the field of geriatric nursing care and the role it plays in promoting self-esteem and self worth. The client under discussion is a resident of a long term care facility since December 2011. She was admitted after fears from her family that she was no longer able to take care of herself. She has being diagnosed with early onset Alzheimers disease which causes her to feel agitated and at times frustrated. She frequently wanders at night causing her confusion and distress to other residents. Her decreasing levels of cognition and loss of ADLs have contributed to her chronic low self esteem which has impacted other aspects of her life. During 1:1 interactions, she would frequently cry as she struggled to remember pieces from her past. She

PERSON CENTERED APPROACH TO PSYCHIATRIC NURSING PART II would often voice her concerns of being alone which translated into feelings of low self worth which she verbalized through her interpretation of being a burden to others. Central to person centered therapy are the three concepts of genuineness, unconditional positive regard and empathy (Palmer 2008). Adapting these approaches involves the use of active listening to determine what the client has to say while also identifying their hopes, fears

and wishes. (Field n.d.). For the person centered approach to be successful in the older adult, the implementation plan must first recognize how each of these values impact the resident before fully engaging her in the process. (Field n.d.). Through active listening and engagement, resident participation is encouraged, helping to promote self esteem and self worth. The aging process requires a lot of adjustment for many. The consequences of a depleted health can have far reaching implications. Family and social roles carved out for the older adult such as grand parenting and sports are determined by the level of health and activity enjoyed. (Humboldt & Leal 2012). Feelings of powerless are often felt by the older adult client of person centered therapy. These feelings can have a negative impact on the older adults feelings of self concept. These feelings are best countered by the safe environment offered through person centered therapy where the client feels protected in an environment that promotes acceptance to their physical limitations. (Humboldt & Leal 2012). Through guided exploration, the resident will develop a greater awareness of her own feelings and will be encouraged to become more involved in activates around her residence while being given verbal encouragement for doing so. (Schultz & Videbeck, 2009). Empathy will also play an important role in addressing the residents chronic low self esteem. Studies have shown that older adults who participate in person centered therapy display fear and uncertainty over their future. (Humboldt & Leal 2012). Empathy will therefore play an

PERSON CENTERED APPROACH TO PSYCHIATRIC NURSING PART II important role in alleviating the residents fears towards her declining health and future. Empathy also fosters personal growth as it can facilitate the integration of the residents fears towards her health and its relationship to her chronic low self esteem. (Humboldt & Leal 2012). Indeed person centered therapy can help the resident see that life can still be fulfilling despite early onset of Alzheimers. This can be achieved by first addressing the residents defense

mechanisms and through engagement in activities that promote cogitative stimulation and social interactions. (Humboldt & Leal 2012). While the person centered approach to therapy does not work to achieve particular outcomes, certain patterns of progress prevail through the therapeutic process. (Palmer 2008). As counseling continues, the client will explore new ways of looking at themselves and their circumstances. (Palmer 2008). Using the long term care resident as an example, her altered self concept can present itself in many ways. Positive outcomes would be demonstrated though engagement in social and physical activities such as increased interaction with younger adults and children where past experiences can be passed on. (Humboldt & Leal 2012). Participation in group activities that promote intellectual thinking and humor would also increase the residences confidence in social situations. This in turn allows for the development of a sense of empowerment through self recognition, control and peer respect. (Humboldt & Leal 2012). Other outcomes center on the residents ability to verbalize her increased feelings of self worth and evaluate her own strengths realistically. (Schultz & Videbeck, 2009). In fact studies carried out on the effects of person centered therapy on older adults suffering from chronic low self esteem suggest that such therapeutic interventions can have a positive effect on self esteem. (Leal & Humboldt 2012).

PERSON CENTERED APPROACH TO PSYCHIATRIC NURSING PART II Part 1 of this discussion focused in the history and development of person centered therapy and its important implications to the field of psychiatric nursing. Focus was given to its recommended uses in the palliative and long term care settings paying particular attention to the

requirements needed to ensure its successful implementation into these nursing sectors. In part 2 of this discussion, the implementation of the person centered approach into the treatment plan of a long term care resident is explored in greater detail. Its implementation into the field of psychiatric nursing is also investigated by addressing its effectiveness against chronic low self esteem. Studies have shown that person centered therapy is an effective way to treated chronic low self esteem within the older adult, making it an effective therapeutic tool to be used in the residential care setting. This discussion also showed that the use of genuineness, unconditional positive regard and empathy can have a positive impact on a clients self concept resulting in improved self esteem and self worth.

PERSON CENTERED APPROACH TO PSYCHIATRIC NURSING PART II References: Field (n.d.). Disability sector case studies. Retrieved from: http://www.field.org.au/sector/case_study/person_centred.html Humboldt, S. & Leal, I., (2012). Building bridges, person centered therapy with older adults. European Journal of Business and Social Sciences. 1,8. 23-32. Retrieved from: http://www.ejbss.com/Data/Sites/1/novemberissue/ejbss-12-1169-buildingbridges.pdf Leal, I. & Humboldt, S. (2012). Person-centered therapy and older adults self-esteem: A pilot study with follow-up. Studies in Sociology of Science. 3,4.1-10. Palmer, S. (2008). Introduction to Counselling and Psychotherapy The Essential Guide. Sage Publishing London.

Schultz, J. M & Videbeck, S.L. (2009). Lippincotts Manual of Psychiatric Nursing Care Plans (8th ed.) Lippincott Williams & Wilkins