Andrew Rogers Model Of Care

Throughout the care of Andrew, one of the most important factors is the building of a therapeutic relationship with Andrew. O’Brien & Fanker (2005, p.441) state that “the formation of a therapeutic alliance with the person with a mental illness and their family is crucial to positive outcomes of treatment”. The therapeutic alliance is an alliance based on listening to the client without being judgemental. To build this relationship, Roger’s core conditions were applied: unconditional positive regard, genuineness and empathic understanding. Rogers (1980) argues that these core conditions must be present for therapeutic change. Rogers (1980) explains this therapeutic change by stating that, as “persons are accepted and prized, they tend to develop a more caring attitude towards themselves”. These core conditions are necessary for Andrew to realise that he is unwell as “Andrew feels there is nothing wrong with him”.

However, although these core conditions were present in each interaction with Andrew, Rogers’ work is specific to counselling where there are no time constraints, where as on a busy ward, it is not always possible to apply the core conditions and nurses must adopt a more proactive approach. In
response to this argument, Bett (2003) argues that “time spent using counselling skills may actually be less demanding of resources in the long run”. In addition, Bett (2003) argues that it is beneficial to negotiate the actual time available at the outset. This helps to set the boundary for the client to say what they want to say. Although there are time constraints on a busy acute ward, the nurse should make time throughout a shift to spend some 1: 1 time with patients.

Ways of maintaining the therapeutic alliance was also practised in the PBL session where we practised interviewing techniques in the form of role play. The scenarios highlighted issues and complexities that occur during therapeutic engagement. One issue that occurred was that I had difficulty getting the right information from the client as the client had a tendency to drift into a flight of ideas. I had a decision to make, either respond to the person’s need to talk about other worries or to stick to the agenda of the interview. Barker (2005, p.57) suggests that the nurse could “turn the decision over to the person, thereby ‘empowering’ his or her decision making.” In future, I will deal with this issue by asking the client what they want to talk about. Also, I would have negotiated the time available at the outset so the client will be able to decide what they want to talk about in the allocated time. allowed me to be a patient, the nurse and an observer of interviewing techniques. The session gave me the opportunity to explore and practice my interviewing techniques and also reflect on my interviewing techniques.

Barker, P.
J, (2001) The Tidal Model: Developing a Person-Centred Approach to Psychiatric and Mental Health Nursing. Perspectives in Psychiatric Care, 37 (3): 79 - 87

Barker, P. J, (2005) Assessment in Psychiatric and Mental Health Nursing: In search of the whole person. Cheltenham: Nelson Thornes Ltd.

Barker, P. & Rolfe, G. (2000) Therapeutic nursing care in acute psychiatric wards: engagement over control. Journal of Psychiatric and Mental Health Nursing. 7: 179 – 184 Barker, P & Whitehill, (1997) The craft of care: towards collaborative caring in mental health. IN Tilley, S. (Eds) (1997), Views from education and practice. Oxford: Blackwell.

Barry, P. D & Farmer, S. (2002) Mental health and Mental illness 7th Edition. Philadelphia:
Lippincott

Betts, A, (2003) The Counselling Relationship Chapter 7 IN Ellis, R.B, Gates and Kenworthy (Eds) (2003) Interpersonal Communication In Nursing: theory and practice,

Cardell, R & Pitula, C. R (1999) Suicidal inpatients’ perceptions of therapeutic and non-therapeutic aspects of constant observation. Psychiatric Serv, 50 (8): 1066 – 70