Abstract
“This one moment with this one person may be the reason you are here on earth at this time.”
Connection Paradigm (working version)
I recently had an opportunity to hear Dr. Jean Watson, developer of the Theory of Human Caring, present the work of the Watson Caring Science Institute at a powerful nursing conference in New York. Several times she mentioned how we as psychiatric-mental health nurses already understand, and in many cases are doing, much of what she was presenting; however, every individual I spoke with afterward said the presentation was transformative for them. At one point during the presentation, Dr. Watson repeated her quote above from years past. The room went silent as we all contemplated the possibility that, unbeknownst to us, our purpose on this earth could indeed be manifesting in the precious moments we have with individuals.
My last column proposed that psychiatric-mental health nurses are experts at connection and responsible for honing this skill in both ourselves and those we serve. A Connection Paradigm was introduced as a way of organizing our collective thoughts around connecting with others, ourselves, spiritually, and with our senses. You were invited to contribute to the development of the paradigm by sharing what connection means to you, reflecting on how you rate your ability to connect in all four dimensions of connection, and sharing your thoughts on important qualities of human connection and what indicates to you that your connection has had an impact. 1 We are now ready to dive deeper into connecting with others, or human connection, and consider how we can make the most of every moment we have with others to realize the full potential or purpose of those moments.
Human Connection Is Essential for Healing
Human connection is at the core of our work as psychiatric-mental health nurses. Hildegard Peplau proposed that human connectedness is essential to health and that effective connection forms the basis for a “therapeutic” relationship. In her theory of interpersonal relations, Peplau (1997) describes six primary roles of a nurse. The first role of “Stranger” occurs when a nurse and client first meet. The goal of the Stranger role is to build trust and establish the relationship. In Peplau’s description of the Stranger role, she stresses the critical nature of achieving this goal and posits that successful implementation of the role is the “foundation for development of a therapeutic relationship” upon which the success of all the other roles the nurse will play depend (Courey et al., 2008, p. 2). Those are high stakes!
While caring as a concept has been described as the defining attribute of the nursing discipline (Watson, 1985), relationships have been identified as the unifying construct (Newman et al., 2008). The precursor to the establishment of caring relationships is connection, for when “patients feel a connection, they begin to trust, and their healing begins” (American Association of Colleges of Nursing, 2021, p. 56). This information is not new to us, but as in the case of Dr. Watson’s presentation on caring, it is important and even restorative for us to take time to fully appreciate and explore the vital nature of connection.
Connection Is Hard Work and Requires Competence
Humans are born with a primal need for connection and will even feel threat or danger when experiencing loneliness (Murthy, 2020). Despite this inherent need, forging connection still requires hard work! No one reaches their full connection potential naturally, without any effort. Therefore, thinking about connection as a competency characterized by specific knowledge and skills can help us organize our thoughts around how to learn and strengthen our connection ability. The American Association of Colleges of Nursing (AACN, 2021) defines competency as “the array of abilities (knowledge, skills, and attitudes) across multiple domains or aspects of performance in a certain context” (p. 56) and recommends that nursing education programs measure students’ ability to “demonstrate attainment of competencies in multiple and authentic contexts over time” (p. 16). Equipping nurses with the knowledge and skills fundamental to connection competence and measuring our ability to demonstrate this competence align with this approach to nursing education.
So, what do psychiatric-mental health nurses need to know and be able to demonstrate related to connection competence? As a starting point, Table 1 below identifies 16 core attributes inherent in an effective approach to human connection along with expected outcomes in those we serve. All attributes have been endorsed by one or more theory and practice experts in the field, including Florence Nightingale (Clements & Averill, 2006), Hildegard Peplau (1997), Jean Watson (1985), Irvin Yalom (2011), Vivek Murthy (2020), and others. The core attributes can to some extent be observed, and the outcomes can minimally be measured by simply asking the individual whether these outcomes were achieved. Importantly, effective human connection is the precursor to a therapeutic relationship, which facilitates healing (the ultimate outcome) and has been described as the joining construct for the defining attribute of the nursing discipline – caring (American Association of Colleges of Nursing, 2021). Standard indicators of healing include remission from symptoms, reduction in symptoms, reported or demonstrated growth in coping mechanisms, etc.
Two core attributes warranting closer examination are being “fully present” and “cultivating meaning.” Florence Nightingale suggests that meaningful connection requires full presence, as it is necessary for empathizing with someone and truly knowing them (Clements & Averill, 2006). Viktor Frankl (2014), author of Man’s Search for Meaning, describes the cultivation of meaning as foundational to the human condition and critical for wellness. Notably, meaninglessness is one of four existential concerns that can contribute to mental health symptoms (Yalom, 1980).
Figure 1 above represents integration of 1) the core attributes of an effective approach to connection, 2) expected outcomes in others, 3) the therapeutic relationship, and 4) the ultimate outcome of healing into the Connection Paradigm. As we explore the other dimensions of connection (spiritual, sensory, and self), we will continue to build and shape the Connection Paradigm with relevant attributes and outcomes for consideration.
Connection Competence Should Be a Priority for Psychiatric-Mental Health Nurses
It is not unknown to us that an ability to connect with others is important. It may even seem silly to discuss. But ask yourself—is effective connection with others an established priority in your daily life at work, home, or elsewhere? Irvin Yalom (2011) suggests the life of a mental health provider is a “life of service in which we daily transcend our personal wishes and turn our gaze towards the needs and growth of the other” (p. 179). He further describes the full potential of that approach, recognizing that the beneficial effects of meaningful connection are not just for those we serve but also for those they then “touch in life.” The opportunity cost for potential impact is high if we do not prioritize our ability to connect with others and develop connection competence. Perhaps a complementary way of looking at this is through the lens of prevention and cost avoidance. In many ways, as a precursor to the development of caring and therapeutic relationships, connection IS prevention. While the impact and cost savings of preventive interventions often are hard to measure, we fortunately have a breadth of literature demonstrating the impact of connection on mental health.
Below are simple truths about making human connection a priority:
We can always improve our human connection ability.
Just like mastering a skill, competence in human connection requires readiness, commitment, motivation, knowledge, skill, application, self-reflection, and feedback.
If we can teach those we serve how to connect with others in the same way, then we will have achieved connection competence.
Achieving and maintaining competence in connection is the equivalent of learning how to play a Chopin Nocturne on the piano versus learning how to play Mary Had a Little Lamb. In college, I spent several months learning how to play a Chopin Nocturne. After I performed it, my piano instructor walked up to me, grabbed my hands, looked me straight in the eyes, and said, “Don’t ever let your fingers lose that piece. Play it at least a couple of times a week for the rest of your life.” She was referring to muscle memory and the relationship my fingers had developed with the musical piece and the piano. I did not realize how important her words were at the time. Sadly, it would take me several months again to master the same Chopin Nocturne, but I can sit down today and play Mary Had a Little Lamb without much thought. Both pieces are music and beautiful in their own ways, but only one demonstrates readiness, commitment, motivation, knowledge, skill, application, and competence in music AND leaves an impression on those who hear it. Therefore, I conclude this column with a similar sentiment to that of my piano instructor 25 years ago—Don’t ever lose the ability to connect with others. Sharpen your connection competence at every opportunity life throws your way.