Mental Health Issues in Nursing

Subject: Nursing
Pages: 7
Words: 1673
Reading time:
6 min
Study level: College

How to use Empathy

Most people tend to confuse empathy and sympathy because both concepts are emotionally charged feelings of care towards a patient’s predicament (Erskine 1999, p. 5). However, the two terms are not the same because empathy is characterized by making a patient feel that the nurse is sharing their predicament. The aim of showing empathy is to make patients feel like they are not alone in their predicament. On the other hand, sympathy is feeling sorry for a patient regarding what they are going through. In Karen’s situation, there are several ways that empathy can be used to build a therapeutic relationship (Erskine 1999, p. 2).

The first approach would be explaining to Karen why she cannot be given analgesia (in the simplest terms possible) so that she can understand (without subjecting her to many medical technicalities) why she cannot get medication for her pain. Here, it would be important to discuss the typical outcomes that she should expect if the medication is administered to her. However, ignoring or blatantly refusing to give her medication (without explaining the reasons) would mainly tick her off (Erskine 1999, p. 57).

To demonstrate empathy in Karen’s situation, it would also be useful to share a personal experience (which is similar to her predicament) so that she feels like she is not alone in her predicament. In situations where it is difficult to relate to the patient’s predicament, it would be useful to share the experience of a friend or another person. This would provide emotional comfort for Karen (Elder 2009, p. 5).

It would also be useful to put oneself in Karen’s position and ponder over how we would want to be treated in her position. Through this understanding, it is equally important to highlight the need for care in Karen’s situation. Since Karen was explaining herself to the nurse, it would have been more empathic to seem concerned about her predicament as opposed to making an excuse to leave (even though Karen had many personal issues).

Excusing oneself to avoid listening to a patient’s predicament is not sincere. It would be more empathic to inform Karen that the nurse would be back to talk some more so that she feels like she is not being ignored. At least, in such a situation, the patient would believe she still has an avenue to share her experiences. This is another effective way of demonstrating empathy in Karen’s situation (Erskine 1999, p. 1).

An explanation of Erikson’s theory in Karen’s situation

Erikson’s theory of psychological development is commonly used to understand psychological development in a child’s life. Erikson stated that personality development evolves in five stages, which are characterized by trust and mistrust, autonomy vs. shame and doubt, initiative vs. guilt, industry vs. inferiority, and identity vs. isolation. Erikson’s theory stipulates that the successful completion of one stage is important in completing subsequent psychological development stages (Frisch and Frisch 2011).

Karen’s psychological issues are characterized by Erickson’s fifth stage of personality development (identity vs. role confusion). This stage is characteristic of Karen’s age because Erickson’s theory stipulates that the fifth stage of personality development is normally characteristic of 11-20-year-olds. Karen is 20 years old. The identity vs. confusion stage is also associated with the adolescent stage, which is characterized by great adrenaline rushes, increased energy levels, and the development of new sociological demands (Engler 2008, p. 158). The main objective of people undergoing this stage is to develop a new identity that will fit with the larger society.

Issues of acceptance become very dominant in this stage and adolescents have a strong need to blend in. This observation explains the strong need to belong to groups. Issues of appearance also become very important to people in this stage. Karen strongly exhibits these characteristics because she explains to the nurse that her boyfriend will come to see her although she is in a mess. Here, she exhibits the need to be accepted by her boyfriend (based on her appearance) (Frisch and Frisch 2011).

Karen’s need to explain her predicament to the first nurse exhibits her need to be accepted or cared for. Even though many people may perceive this need to be common among many patients, her strong sense of association with the second nurse is not. She feels like the first nurse understands her and therefore she developed a close relationship with her. Here, she explains that she lives on the same street with the nurse and they share the same problems with their spouses.

This is a clear sign of confusion for Karen. Erikson’s theory stipulates that since many people in the fifth stage of development (identity vs. confusion) have not developed a strong identity, they are often confused and identify with different groups, which gives them a sense of identity. Associating with the second nurse manifests Karen’s need to associate with a specific group. These attributes show that Karen is in the fifth stage of personality development (identity vs. confusion) (Frisch and Frisch 2011).

An explanation of biochemical imbalance in Karen’s situation

Biochemical imbalance is perceived to be a major cause for mental illness because it is categorized with other causes of mental illness such as social and psychological issues (Holford 2011). Normally, people have a normal chemical balance in their brains. However, due to certain internal or external factors, a persons’ brain activity may change because of stress, negative thoughts, anxiety (and the likes) such that the normal range of brain chemicals is distorted and a chemical imbalance is realized (Frisch and Frisch 2011).

When Karen was put under medication for biochemical imbalance, it meant that she was suffering from emotional stress and disturbances attributed to abnormal neurotransmitter activities in her brain. These neurotransmitter activities are categorized as one of the internal or external factors that cause an imbalance in brain chemicals. This imbalance may occur in two ways; there may be an excessive production of brain chemicals or severe depletion of the same (Frisch and Frisch 2011).

The above diagnosis meant that Karen must have been suffering from one of seven probabilities. The first probability is that she suffered the reduced presence of neurotransmitters (for example, dopamine and serotonin) and the second probability is that she was suffering from the increased presence of toxic neurochemicals (Duncan 2011). These toxic neurochemicals may cause a severe chemical imbalance in the brain, thereby influencing her mental stability.

Karen’s chemical imbalance may also mean that she may be suffering from “lower levels of serum magnesium, Zinc or Potassium or an Unhealthy, or deficient levels of essential vitamins like B6, B9, B12 and Vitamin-C” (Duncan 2011, p. 72). Her diagnosis may also mean that she is suffering from an “Undersupply of key cofactors like amino acids that are used to help transport neurotransmitter precursors into the blood-brain barrier or Increased cortisol stress hormone levels” (Duncan 2011, p. 73).

According to the doctor’s prescription, Karen was given a dose of diazepam 2 mg PO TDS to treat her mood disorder because the biochemical imbalance is known to cause mood disorders. However, mood disorder is just one aspect of biochemical imbalances. Duncan (2011) explains that “imbalances in the brain’s chemistry can give rise to mood disorders, learning disabilities, substance abuse and muscle weakness” (p. 75). The above statement is the link between biochemical imbalances and Karen’s mood disorders. Karen’s drug was therefore a corrective measure to stabilize her brain chemicals. This is one method of treating biochemical imbalances but most importantly, it is the most common method of treating biochemical imbalances (Duncan 2011).

An explanation of the boundaries involved when building therapeutic relationships

According to the Australian nursing code of conduct (and other nursing codes of conduct around the world), nurses are required to maintain high ethical conduct by observing professional boundaries in their duties. Erskine (1999) defines professional boundaries “as limits which protect the space between the professional’s power and the client’s vulnerability” (p. 106). The main aim of observing professional boundaries is to secure the integrity of the profession and to create strong patient-nurse trust.

Observing professional boundaries mainly centers on knowing the difference between personal and professional relationships. Often, observing professional boundaries can be challenging for nurses because it involves a tricky balance between the patient’s psychological wellbeing and the patient’s long-term health and recovery process. The failure to observe professional boundaries may lead to distress, frustration, and confusion among the patients. However, many researchers have associated the observance of professional boundaries with the patient’s recovery process. If nurses do not observe the professional boundaries, the patient’s recovery process may be affected negatively. Due to this situation, there is a strong need to establish professional boundaries between nurses and patients.

In Karen’s case, the nurse overstepped her professional boundaries by becoming over-involved in the patient’s personal life. The nurse’s over-involvement is evident from an over disclosure of personal information to Karen. This fact is supported by the nurse’s disclosure of her relationship with her boyfriend. Even though the consequences of such boundary crossings may not be felt immediately, there is a future possibility of the patient suffering from an over-involvement of the nurse in her personal life (like when the nurse leaves) (Jackson and O’Brien 2009).

Therapeutic relationships should therefore be developed within strict professional boundaries. It is only through these professional boundaries that the real advantages of therapeutic relationships may be realized. Besides making the patient feel safe, therapeutic relationships are known to have several advantages in mental health nursing. The main advantage is that it forms the basis for understanding a patient’s actions (Léger 1997, p. 54).

However, if professional boundaries are not observed, therapeutic relationships may bear negative connotations to their application. Like Karen’s case, the main problem associated with therapeutic relationships is that the nurse may become too involved with the patient and overstep her professional boundary. Here, the therapeutic relationship may transform into a social relationship and the nurse quickly transforms into an “omnipotent rescuer”. This is an unhealthy relationship between the nurse and the patient (Jackson and O’Brien 2009).


Duncan, B 2011, The Heroic Client: A Revolutionary Way to Improve Effectiveness Through Client-Directed, Outcome-Informed Therapy, John Wiley and Sons, London.

Elder, R 2009, Psychiatric and Mental Health Nursing, Elsevier, Sydney.

Engler, B 2008, Personality Theories: An Introduction, Cengage Learning, London.

Erskine, R 1999, Beyond empathy: a therapy of contact-in-relationship, Psychology Press, Michigan.

Frisch, N & Frisch (eds), L 2011, Psychiatric mental health nursing, 4th edn, Cengage Learning, Clifton Park, NY.

Holford, P 2011, New Optimum Nutrition for the Mind, ReadHowYouWant. New York.

Jackson, D & O’Brien, L 2009, The effective nurse, 2nd edn, Elsevier, Chatswood.

Léger, F 1997, Beyond the therapeutic relationship: behavioral, biological, and cognitive foundations of psychotherapy, Routledge, London.