Review Article - (2016) Volume 4, Issue 1
Melike Yönder Ertem1* and Fatma Eker2
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Dokuz Eylül University Nursing Faculty,Department of Psychiatric Nursing, Izmir-Turkey
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Düzce University School of Health, Department of Psychiatric Nursing, Düzce-Turkey
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*Corresponding Author:
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Melike Yönder Ertem
\r\nDepartment of Psychiatric Nursing, Dokuz Eylül University Nursing Faculty
\r\nIzmir-Turkey
\r\nTel: +905302528027
\r\nE-mail: melike_yonder@hotmail.com
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Received date: November 28, 2015; Accepted date: January 25, 2016; Published date: January 29,2016
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Citation: Ertem MY and Eker F. Therapeutic Approach in Psychiatric Nursing: Transactional Analysis. Ann Clin Lab Res. 2016, 4:1.
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Aim: The aim of this review is to explain the transactional analysis theory in the context of therapeutic approach in psychiatric nursing.
Background: Psychiatric patients, who are subject to functional disability, cognitive-perceptual changes, orientation disorders, changes in thought content and vice versa, can have difficulty making the right decision for themselves about the treatment and care. In this context, providing quality health care services is firmly bound up with attitude and behavior of the psychiatric nurses. Positive nurse attitudes exhibited during the treatment process relax the patients, promote their integration into the environment and finally facilitate their response to the treatment. In contrast, negative nurse attitudes bring about poor social interactions with the patients leading to problems such as patients progressively disconnecting from their environments and generating high resistance to the treatment. Psychiatry nurses’ awareness of their attitudes towards mental diseases and the patients aids them in establishing early and proper diagnosis of the mental diseases, providing adequate medication and caring which are of great importance in terms of protective treatment, rehabilitation and nursing services.
Conclusion: Psychiatry nurses should be knowledgeable about the transactional analysis theory, in particular the ego states and transactions, which would eventually help them in achieving positive attitudes towards mental patients.
Introduction
Nursing process quality is highly impacted with level of skills in human relationship and interaction capabilities [1- 3]. Amelioration in interaction capabilities and the process management are detrimental to improve the quality of nursing services mutually [2-4]. The studies show that a quality increase in patient caring, which yields a higher patient satisfaction, better patient compliance to disease and treatment, increase in patient motivation for treatment and positive will, is a result of developing effective relationships and interpersonal communication skills. Information about patient concerns, needs and problems can be obtained through a therapeutic interaction [5,6]. Psychiatric patients, who are subject to functional disability, cognitive-perceptual changes, orientation disorders, changes in thought content and vice versa, can have difficulty making the right decision for themselves about the treatment and care [7,8].In this context, providing quality health care services is firmly bound up with attitude and behavior of the psychiatric nurses [9]. Positive nurse attitudes exhibited during the treatment process relax the patients, promote their integration into the environment and finally facilitate their response to the treatment. In contrast, negative nurse attitudes bring about poor social interactions with the patients leading to problems such as patients progressively disconnecting from their environments and generating high resistance to the treatment [10].
There are various models and approaches used as guidelines for the health professionals to show in what ways and under which circumstances the treatment behavior is affected. Transactional analysis theory is an approach which is widely used from the field of psychotherapy to education. Particularly, it is emphasized that this theory is a viable model in helping nurses to have a better understanding of how their reactions and behaviors have impact on the patients [11-14].
Transactional Analysis Theory (TA), established by Eric Berne (1910-1970), is a humanistic approach which incorporates information related to the communication, personality, physiopathology and consulting/therapy fields of psychology [15,16], Berne asserts that patients can actively participate in treatment process, understand what their problems are, and take on responsibility. The key elements of the transactional analysis theory are the ego states, transactions, physiological games and life positions [16]. This review is limited to the evaluation of ego states and transactions in terms of psychiatric nursing.
Ego States
Eric Berne defined an ego state as a consistent pattern of feeling and experience directly related to a corresponding consistent pattern of behavior. The concept of ego states to help explain how we are made up, and how we relate to others was devised by Berne. Words and expressions such as transactional analysis (TA) are understandable to everybody. He offered the hypothesis that “We are all three characters in one shape [16-18]. He stated that the ways we think, feel and behave look like Parent, Adult, and Child. The purpose behind the TA is to discover which aspect of character is the factor of a response or a behavior [18,19].
Parent ego state
Parent ego state determines a set of feelings, thinking and behavior that have been copied from parents and significant others. Parent ego state means nurturing, critical, paternal/ maternal, judgmental, dictatorial, guiding, bossy [19-21].
Adult ego state
Adult ego state exhibits factual, non-emotional, problem solving oriented, informative, analytical and questioning features, the adult ego state is about being spontaneous and aware with the capacity for intimacy [20-22].
Child ego state
Child ego state is a set of behaviors, thoughts and feelings which are derived from our childhood. Child ego state means playful, curious, emotional, creative, joking, inventive, childlike [23,24].
Transactions
Berne states that when two people communicate, one person initiates a transaction with the transactional stimulus. The person to whom the stimulus is directed will respond with the transactional response. The Transactional Analysis theory aims to identify the stimulus and the response ego states respectively. There are three types of transactions: complementary, ulterior and crossed transactions [21-24].
Complementary transactions
In a complementary transaction, the response goes back from the receiving ego state to the sending ego state. According to Dr. Berne, these transactions are healthy and represent normal human interactions [13,18,20] (Figures 1 and 2).
Figure 1: Nurse utilized adult ego state in this interaction by making observation and asking open-ended questions. Patient responds to nurse with the same ego level.
Figure 2: This conversation exemplifies a nurse reasoning with a patient denying to take her pills by using parent ego state aiming the patient’s child ego state. This transaction treats the adult patient as if rewarding a child while showing no interest on examining the reasons causing the treatment rejection or concerns about the medication.
Crossed transactions
Basically, in a crossed transaction, two interacting subjects address from different ego states. Therefore, it may be difficult to maintain a communication with this kind of transaction [13,16,18]. The diagram shows a crossed transaction (Figure 3).
Figure 3: The patient asks for a permission to call her family via the adult ego state. On the contrary, the nurse terminates the communication abruptly via the parent ego state.
Ulterior transactions
In an ulterior transaction, two different messages are conveyed at the same time. One of these is social level message, and the other is psychological level message.
Ulterior or hidden transactions occur when the words seem to be coming from one ego state, but in reality the words or behaviors are coming from another. Ulterior transactions may be manipulative and increase the risk of communication failure and conflict [16,20] (Figure 4).
Figure 4: In this example, the nurse’s reaction is limited to a social level of response to the patient’s question. Further communication with the patient is hindered due to lack of psychological level of response to the patient question.
Conclusion
As a result, psychiatry nurses awareness of their attitudes towards mental diseases and the patients aids them in establishing early and proper diagnosis of the mental diseases, providing adequate medication and caring which are of great importance in terms of protective treatment, rehabilitation and nursing services. Approach of the nurses towards the psychiatric patients structures the quality of the nursing service provided. In this respect, transactional analysis theory, having affected the nursepatient interaction in a positive manner, will lead to establishment of an effective communication with which desired treatment results and the quality in nursing services would be achieved. Consequently, psychiatry nurses should be knowledgeable about the transactional analysis theory, in particular the ego states and transactions, which would eventually help them in achieving positive attitudes towards mental patients.
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