Free Nursing Dissertations - If We Therefore Consider That This Case Is Proved, Then We Have To Pose The
If we therefore consider that this case is proved, then we have to pose the question why, in the interests of efficiency, could the nurses not identify those patients who would be at greatest risk of suicide so that they could spend the greatest amount of time trying to generate a therapeutic relationship with those particular patients. The Vrale & Steen paper neither addresses nor answers this issue. It is notable that the Sandor paper calls for structure rather than flexibility and observes the fact that:
The development of a positive trusting relationship with a single mental health key worker as early as possible is advisable.. The key worker should avoid a premature confrontation about the explanatory model of the illness and deliver treatment in as flexible a manner as possible.
The importance of the structural element is highlighted in a tangential fashion in a paper by Lester (2001) who points to the fact that notwithstanding the problems that the nurse has with the inpatient, the physician in primary care is expected to build up a therapeutic relationship in a 10 minute consultation and points to the fact that structure has priority over flexibility in these circumstances
If we consider the wider issues we can turn to the paper by Petersen (et al 2005). This contrasted flexibility with control to a greater extent than the Vrale paper. It considered a much larger cohort ( in excess of 540 patients) over a two year follow up. It found a significant difference between a structured (controlled) therapeutic environment and the less effective flexible approach. These differences were still present even at one and two year follow up assessments.
On first principle reasoning, one could make an argument for the fact that depression, even with the comparatively specific symptom of suicidal ideation, is actually the biological endpoint of any number of different psychological and sometimes socio-economic factors. (Spencer et al. 2001)
Anxiety, sadness, and somatic discomfort are part of the normal psychological response to life stress, including medical illness. Clinical depression is a final common pathway resulting from the interaction of biological, psychological, and social factors.
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