Chapter 1: Science & the Therapeutic Use of Self in Psychiatric-Mental Health Nursing

Welcome back to another Deep Dive.

Today we are, we're doing something a little bit different, something that I think is really going to resonate with a very specific part of our audience.

But honestly, the principles we're talking about here are just fascinating.

For anyone who has ever had to care for another human being, we're actually cracking open a textbook today.

Yeah, and it's a bit of a heavy one, literally and figuratively.

We are looking at essentials of psychiatric mental health nursing, specifically a communication approach to evidence -based care.

And we're really zooming in on just chapter one.

Right, chapter one.

The title of the chapter is The Science and Art of Psychiatric Mental Health Nursing.

And I have to say, when I first saw that title, I sort of thought, you know, okay, sure, science and art, it sounds like a nice little marketing slogan for a nursing program.

Right.

But the more I read the chapter, the more I realized this isn't just a slogan at all.

It's almost attention.

It's this battle between two completely different ways of seeing the world that somehow have to exist inside the same nurse.

That is a perfect way to frame it, honestly.

This chapter really is the foundation.

If you are a nursing student listening to this right now and maybe you're just starting your psych rotation or, you know, maybe you're prepping for the NCLEX, this is the roadmap.

Our mission today is to demystify that balance for you.

Do we want to show how the science, the biology, the evidence, the pharmacology and the art, which is the advocacy, the caring, the presence, how they are not opposites?

They're basically two legs of the exact same journey.

And we are going to stick strictly to the roadmap provided by this chapter.

We aren't going to go off -roading into random theories today.

We want to break down exactly what this text says because it is rich enough on its own.

Absolutely.

The target audience here really is the learner.

The student encountering these concepts for the first time.

We want to make sure that when you step onto that psych unit, you aren't just bringing a stethoscope, right?

You're bringing a philosophy.

Yeah.

So let's just jump right in.

The text opens with a concept that it calls a signature of professional identity.

I really love that phrase.

It doesn't start with how to give a shot or how to lock a door safely.

It starts with advocacy.

It does.

And I think that really surprises people because if you ask the average person on the street what a nurse does, they might say, you know, they take vitals, they give meds or they help the doctor.

But this text specifically defines the core identity of the psychiatric nurse as advocacy.

It defines it as this fundamental commitment to the patient's health, their well -being and their safety.

But what does that actually mean in practice?

Because advocacy is one of those buzzwords we use a lot like synergy or wellness can easily lose its meaning.

That's true.

But the text is very specific here.

It's about the ability to speak out assertively, incredibly on behalf of your patient.

And in a psychiatric setting, this is even more critical because quite often your patients may not have the capacity to speak for themselves.

Right.

They might be in psychosis.

Exactly.

Or they might be catatonic or so overwhelmed by severe trauma that they've literally lost their voice.

The text actually gives some really grounded examples of what this looks like, which I appreciated.

It mentions advising patients of their rights.

Right.

And think about that for a second.

You are in a locked unit.

You're scared.

You don't know the rules.

Advocacy in that moment isn't just fighting some grand legal battle in a courtroom.

It's looking at the patient and saying,

hey, here is what you are allowed to do.

Here is what is happening to your body and your care.

It's giving them back a little bit of power.

Another example that really stood out to me was solving prescription problems for homeless patients.

Oh, that is a huge one because it touches directly on the social determinants of health.

You can have the perfect science, right?

The absolute perfect medication that targets the exact neurotransmitter causing the psychiatric issue.

But if the patient is homeless and has no way to pick up that prescription or no safe place to store it, the science just completely fails.

So the advocacy is the art of figuring out the logistics.

Yes, it's removing the barrier.

The text also mentions engaging in public speaking, writing articles and political lobbying.

So it scales all the way up from the bedside to the Capitol building.

It does.

But there's a specific line in this section that I think we really need to pause on.

The text explicitly states that advocacy can take a great deal of courage.

Yeah, I circled that in my notes, too.

Why courage?

I mean, helping people shouldn't be a scary thing.

Ideally, no, it shouldn't.

But the text notes that advocacy often means speaking out against other professionals.

Think about it.

You might be a student or brand new grad nurse.

You are essentially at the bottom of the hospital hierarchy and you might witness a senior physician or an administrator or even a veteran nurse doing something that puts patient safety at risk.

Wow, that is a terrifying position to be in for a new nurse.

It really is.

The text says you might witness behaviors that have serious critical consequences for safety.

Standing up in that moment, being the one to actually say, stop, this isn't right.

That is the ultimate test of that professional identity we talked about.

It's not about being nice.

It's about being an ethical warrior for your patient.

So advocacy is the foundation here.

Now, let's look at the structure the chapter builds on top of that.

The central thesis is that psychiatric mental health nursing uses both science and arc.

And the author makes a point here that I found really comforting for students who might be thinking, you know, I'm going to be an ER nurse.

I don't really need all this psych stuff.

Oh, the author is very clear on that.

This is a specialized area.

Absolutely.

But it is found in literally every other specialty.

If you are in the ICU, you are dealing with patients with extreme delirium or anxiety.

If you are in labor and delivery, you have postpartum depression or postpartum psychosis.

If you are in oncology, you are dealing with profound grief and existential crisis.

The mind goes wherever the body goes.

Exactly.

So the tools we are discussing today, the science and the art, these are universal nursing tools.

They benefit every nurse.

Let's break down the dual nature.

Then on the science side, the text lists things like neurobiology, psychopharmacology, evidence based practice or EBP, the recovery model, trauma informed care and QSEM.

That is the head knowledge.

That's the real rigor of the profession.

And on the art side, we have caring, attending and advocacy, which is the heart knowledge.

But as we'll see as we go through the chapter, the text argues that the heart part is actually a highly disciplined skill, not just a warm, fuzzy feeling.

Let's start with the science side,

specifically the evolution of evidence based practice.

Now, whenever we talk about nursing history, we have to talk about Florence Nightingale.

And the image everyone has in their head is the lady with the lamp.

Very soft, very angelic, very art over science.

And that image is true to an extent, but it's wildly incomplete.

The text cites McDonald to paint a very different picture.

Nightingale wasn't just walking around comforting six soldiers.

She was a data scientist, a data scientist in the 1850s.

Absolutely.

She was a pioneer of the evidence based framework.

She didn't just want to provide care.

She wanted to actually prove what worked and what didn't.

She advocated for the best possible research and for access to governmental statistics.

She essentially realized that if you don't count the outcomes, you can't improve them.

The text mentions that in 1860, she made a proposal that really blew my mind.

It eventually led to the International Statistical Classification of Diseases.

The ICD, yes.

That massive coding system that is used globally today to track diseases and billing.

Its DNA traces directly back to Nightingale.

She proposed the first model for systematically collecting hospital data.

She wanted to know who is dying, why are they dying?

Is it infection?

Is it poor nutrition?

She was a major stats nurse.

She was the original nurse informaticist.

And speaking of codes, the text brings up a really interesting alignment here.

Historically, mental health has sort of been in its own separate silo.

We use the DSM, the Diagnostic and Statistical Manual of Mental Disorders, while the rest of medicine use the ICD.

Right.

It felt like two completely different worlds of health care.

Exactly.

But the text notes that in 2013, the DSM codes and the ICD -10 codes were finally aligned.

This is incredibly significant because it symbolizes the integration of psychiatry into general medicine.

It's effectively saying that mental illness is an illness, just like diabetes or heart disease.

And it belongs in the exact same tracking system.

Moving forward in history, we meet another titan mentioned in the chapter, Hildegard Piplo.

Yes.

If Nightingale is the mother of nursing, Piplo is the mother of psychiatric nursing.

What was her specific contribution that sets her apart?

She professionalized the field.

Before Piplo, psychiatric care was largely custodial.

Custodial meaning like just maintaining them?

Yeah, in the sense of pure maintenance.

You feed the patients, you wash them, you lock the doors to keep them from hurting themselves or others, but you aren't really treating them.

It was containment.

Hefklo changed that entirely.

She introduced the concept of advanced nursing practice.

She believed that a scientific approach was essential to mental health.

How did she apply that?

She argued that the relationship between the nurse and the patient wasn't just a friendly chat to pass the time.

It was a deliberate scientific tool for healing.

She believed that if you truly understood the theory of communication, you could use your conversation to alter the patient's actual trajectory.

She brought scientific rigor to the talking cure.

But the text notes that despite these massive pioneers, for a very long time, everyday nursing practice wasn't really based on science, was it?

No, it wasn't.

And this is the dark age the text refers to.

While psychiatry as a medical field adopted randomized controlled trials way back in the 1950s, testing new drugs like Thorazine nursing care really lagged behind.

For a long time, dead side care was just based on tradition.

Like we do it this way because we've always done it this way.

Exactly.

Or it was based on trial and error.

Let's try this and see if the patient calms down.

It was very subjective.

And that is exactly what evidence based practice or EBP is designed to replace.

So let's define EBP because it's a huge buzzword, but the text gives it a very specific definition with three distinct prongs.

And you really need all three.

Think of it as a stool with three legs.

Prong one is available evidence.

That's the literature, the peer reviewed research studies, the cold hard data and prong to clinical experience.

This is your expertise as a working nurse.

The textbook can tell you what happens in a perfect sterile world.

But your clinical experience tells you what actually happens on your specific unit with your specific patient population.

And prong three.

This is the one I think probably gets overlooked the most in practice.

Patient preference.

This is huge.

You can have the absolute best psychotropic drug in the world supported by a mountain of level A evidence.

But if the patient hates the side effects or if the treatment violates their cultural or religious values and they refuse to take it, then it is not the right intervention for them.

EBP is the complex art of balancing the data, your skill and the patient's own desires.

The text then gets really practical about this.

It gives us a process called the five A's of integrating EBP.

I want to walk through these step by step because it makes the whole concept actionable for a student.

Let's do it.

It's basically the scientific method distilled for the bedside nurse.

First A is ask.

You have to identify a problem.

You can't just be a robot operating on autopilot.

You have to ask a question like why is this patient not getting better or is there a more effective way to manage this aggressive behavior?

You frame a clear clinical question.

Second A is acquire.

Once you have the question, you have to go get the answer.

You search the literature.

You look at the medical databases.

You find the actual studies that address your specific question.

Third A is appraise.

This is the critical thinking step.

You can't just blindly believe everything you read online.

You have to evaluate the literature you acquired.

Is the study valid?

Is it relevant to your population?

Is it scientifically sound?

Fourth A is apply.

You take that appraised evidence and you apply it to your patient's care plan.

But here's the callback to the three prongs.

You do it in combination with your clinical expertise and the patient's preferences.

And the final A, the fifth one, is assess.

Did the intervention actually work?

You evaluate the outcomes if you don't look back to see if what you did was effective.

You aren't doing science.

You're just guessing and hoping for the best.

I want to circle back to that appraised step for a second.

The text includes a really detailed diagram, figure 1 .1, called the hierarchy of evidence.

It essentially ranks different types of scientific studies.

This is a crucial concept for nursing students.

Not all science is created equal.

You have to think of it as a ladder of trustworthiness.

At the very top of that ladder, we have level I.

Level I is the absolute gold standard.

It is a systematic review or meta -analysis of randomized controlled trials or RCTs.

Let's unpack that jargon for the listener.

What exactly is an RCT?

An RCT is an experiment where you take a group of people and you randomly assign half of them to get the new treatment and half of them to get a placebo or the standard care.

The randomization eliminates bias.

A systematic review takes all the RCTs ever done on that specific topic, which could be dozens of studies and thousands of patients, and it combines them into one massive statistically powerful conclusion.

It averages out all the flukes.

That's the strongest evidence you can possibly get.

What's level II?

Level II is a single well -designed RCT.

It's still very strong evidence, but it's just one isolated study, not a combination of many.

Then we step down to level III, level IV.

Right, here we get into controlled trials without randomization, which are called quasi -experimental, or single non -experimental studies like case control or correlational studies.

These are definitely useful, but they have a lot more room for human error and bias.

And then at the very bottom of the hierarchy, we hit level VII.

Level VII is opinions of authorities or reports of expert committees.

Wait, so expert opinion is literally the lowest form of evidence on the chart.

In the strict hierarchy of evidence -based science, yes, it is.

Just because a famous doctor or a well -known committee thinks something is true doesn't automatically make it true.

Hard data beats opinion every time.

However, the text adds a very important nuance here that students need to grasp.

What's that nuance?

While these levels are strictly ranked, all types of evidence have value in clinical decision -making.

Sometimes you simply don't have a level I meta -analysis to rely on.

Maybe you are dealing with a very rare psychiatric condition or a brand new social phenomenon where the big studies just haven't been conducted yet.

In that case, an expert opinion or a descriptive study from level VI might literally be the best data you have.

You have to use the best available evidence, even if it's not at the very top of the pyramid.

That makes a lot of sense.

You can't just stand there doing nothing for your patient because you don't have a perfect RCT.

Exactly.

You act on the best knowledge you have at the time.

OK, so we know what the evidence is and how to rank it, but where do nurses actually find it?

The text discusses resources and implementation next, and it mentions a landmark historical document, the 1999 Surgeon General's Report on Mental Health.

Why is this specific report highlighted in Chapter 1?

It was a massive turning point for the field.

It was the first time a Surgeon General's report focused entirely on mental health.

It reviewed a staggering amount of scientific literature, and it came to a very optimistic conclusion.

Effective treatments exist.

We actually have the medications.

We have the therapies.

They work.

But it also identified a glaring problem.

The problem being?

The gap in practice.

The report challenged the field by asking, are nurses actually using these effective treatments?

Are they aware of the efficacy?

And are the patient outcomes being properly documented?

It basically highlighted that we have the tools in our toolbox, but we aren't always taking them out to use them.

To help nurses actually use those tools, the text lists four specific resources.

Number one is internet resources.

With a very big warning attached.

Using CDIHL, PubMed, Cochrane Reviews, these are all fantastic databases.

But the text warns students to focus exclusively on professional reputable sites.

Professional societies, university libraries, government health sites, not just random blogs or unverified articles.

Number two on the list, clinical practice guidelines.

These are basically summaries of the best evidence that are used to standardize care across the board.

For example, the American Psychiatric Association publishes highly detailed guidelines for treating schizophrenia.

This saves the bedside nurse from having to go read 500 individual research studies.

The experts have already done the appraised step of the five A's for you.

Number three, clinical algorithms.

I really want to spend a minute here because the text walks us through a specific one, figure 1 .2, which is the suicide risk algorithm.

This is a remarkably powerful tool.

It takes a very complex, highly emotional clinical decision and turns it into a clear logical flow chart.

Describe what it looks like for the listener.

Well, it starts with an immediate action step.

Attempt to reduce suffering and initiate close observation.

That's about immediate physical safety.

Then the flow chart moves down to check risk factors.

And the text lists these factors out clearly.

Social isolation, mate gender, chronic illness, substance abuse, and having a formulated suicide plan.

Right.

And then based on those factors, you hit a critical decision point.

It's a logic gate.

The chart says if the patient has one or fewer positive factors, it is considered a clinical suspicion.

You watch them closely.

You continue to assess.

But if they have two or more positive factors, media psychiatric consultation.

Exactly.

It takes the guesswork out of the nurse's hands.

It ensures that if a patient hits a certain mathematical threshold of risk, the response is automatic and it is immediately escalated.

It prevents the clinician from underreacting in a life or death scenario.

And then the fourth resource mentioned is clinical or critical pathways.

These are institution specific maps.

They detail the exact treatment plan over a specific time frame.

Like day one, admit the patient and start medication.

Day two, attend group therapy.

Day three, have a family meeting.

It keeps the entire interdisciplinary care team on the exact same track.

All of these tools, the guidelines, the algorithms, the pathways, they're all trying to solve one big systemic problem that the text identifies.

The research practice gap.

Yes.

The text cites the Institute of Medicine, the IOM findings here.

There is a shockingly wide gap between what clinical research shows actually works and what happens every day at the patient's bedside.

Some studies mentioned in the field suggest it takes an average of 17 years for a new medical discovery to become standard clinical practice.

Seventeen years.

That's an entire generation of patients.

It is completely unacceptable.

And that is exactly why we talk so much about translational research.

That is the science of actually applying the evidence to real world practice.

We desperately need to shrink that 17 year gap.

To illustrate how nurses can help close that gap, the chapter provides a really great case study.

It's in the applying evidence based practice box.

Let's walk through this scenario because I think it really grounds all this dense theory we've been talking about.

The scenario is very realistic.

It involves a 63 year old homeless female.

She was discharged from a psychiatric hospital.

She did provide contact information upon discharge, but because she is homeless, the information was essentially invalid.

So she just fell right through the cracks of the system.

Exactly.

A week later, her psychiatric medications were stolen on the street.

She became suicidal and highly confused, and she managed to call the crisis line.

This is a classic system failure.

So how did the nurse in this scenario use the EBP approach to actually fix this?

Let's look at the three prongs of EBP again.

First, experience.

The nurse knows from her own clinical experience that homeless patients very often have invalid contact info.

Second, the literature.

The research shows that missed clinic appointments are very often due to logistical barriers like illness or lack of transportation, not just intentional noncompliance.

And third, patient preference.

The patient actually wanted help.

We know this because she called the crisis line herself.

So what was the plan that came up with?

The immediate plan was, of course, safety.

The crisis team helped her get her replacement meds and find immediate shelter.

But the systemic plan, the translational research part that was the real game changer.

The nurse practitioner in the clinic developed a brand new demographic page in their electronic health record, the EHR.

What did the new page do?

Instead of just asking for a static home address, which is useless for a homeless patient, it specifically tracked where the patients sleep or eat on specific days of the week.

Like, where are you usually on Tuesdays at noon?

Which soup kitchen?

That is absolutely brilliant.

It adapts the rigid medical system to the patient's actual reality.

And the text notes that this perfectly touches on the QSEN standards, specifically safety and informatics.

They use the computer system, the informatics, to solve a real human safety problem.

That is evidence based practice in action.

That leads us perfectly into section five of the chapter, modern frameworks of care.

The text highlights a few different models that are currently shaping the nursing profession.

The first one it details is the recovery model.

This represents a major, major paradigm shift in mental health.

To truly understand it, you have to understand what replaced, which is the traditional medical model.

The medical model focuses heavily on curing the disease, right?

Right.

It focuses on the illness, the pathology, the broken part of the brain.

The mentality is here is a pill to fix the chemical imbalance.

The recovery model, which actually originated from Alcoholics Anonymous and the consumer and survivor movements of the 1980s and 90s, is completely different.

It's a social model of disability.

What does a social model mean in this context?

It means the entire focus of care shifts from cure to living.

The core concept is that people can absolutely recover from severe mental illness to lead full, productive, satisfying lives, even if they still experience symptoms.

The text defines it as a personal journey of healing.

So under this model, you might still hear voices occasionally, but you can still have a job you like, a healthy relationship, and a life you genuinely love.

Exactly.

It mandates that psychiatric care must be consumer and family -driven.

It focuses on building the patient's resilience, not just managing their symptoms with medication.

The next major framework discussed is trauma -informed care.

This is critical for any nurse to understand.

The text discusses the National Center for Trauma -Informed Care, the NCTIC.

The key takeaway here is profoundly changing the fundamental question we ask our patients.

What is the old question?

The old question under the medical model was,

what is wrong with you?

And the new question.

What has happened to you?

That shift in phrasing is just profound.

It changes everything about how you approach a patient.

It recognizes that severe trauma, whether that's physical abuse, sexual abuse, combat war, or natural disaster, is almost universally found in the personal histories of mental health patients.

If you don't know that, and if you don't screen for it, you severely risk re -traumatizing them during their treatment.

How does that happen?

How would a nurse re -traumatize someone?

Well, for example, if a patient is acting out on the unit, and you and the staff physically restrain them to a bed, and that patient happens to be a survivor of a violent sexual assault, that physical restraint can exactly duplicate the terror and trauma of their original assault.

Trauma -Informed Care is entirely about avoiding that scenario.

It emphasizes building open, collaborative relationships,

empowering the patient, and showing deep cultural respect.

Then we move on to QSEN, Quality and Safety Education for Nurses.

This is the overarching educational framework.

Its primary goal is to repair all future nurses with what they call the KSA's knowledge, skills, and attitudes.

The text clearly lists out six core standards.

Let's list those six out for the listener.

Sure.

Number one is patient -centered care.

Number two is teamwork and collaboration.

Number three is evidence -based practice.

Number four is quality improvement.

Number five is safety.

And number six is informatics.

It's basically the ultimate checklist for being a fully competent, modern nurse.

It really is.

It's the standard everything is measured against now.

And just briefly, before we move on, the text mentions concept -based nursing education.

Right.

This just explains why nursing textbooks and curriculums are changing so much right now.

We are moving away from having students memorize endless lists of isolated facts about specific diseases.

Instead, the education focuses on broader concepts like psychosis or anxiety or perfusion that can apply to dozens of different clinical situations.

It encourages much higher -level critical thinking, and it leads to much better retention for the student.

We have covered the science side extensively here.

Now, I really want to pivot to the other half of the chapter's title, the art of nursing.

This is where the magic really happens on the floor.

The text explicitly acknowledges that evidence alone just isn't enough.

You can have the best science, the perfect -level IRCT data, but without the art of nursing, the care is cold and mechanical.

The art includes things like intuition, interpersonal skills, and deep cultural competence.

The text references a researcher named Benner here, noting that these artistic attributes are often totally invisible.

They are.

They are rarely charted in the EHR.

You don't ever see a chart note that says,

nurse used clinical intuition to sense the patient was feeling profoundly lonely today.

But Benner argues that these invisible skills are absolutely essential to healing.

And they all fall under a concept the chapter calls the therapeutic use of self.

Which means using your own unique personality, your verbal and nonverbal communication, and your emotional presence as a deliberate tool to promote healing.

The text makes a really powerful statement here.

It says the strength of the clinician -patient relationship is very often the deciding factor in therapy outcomes, not the drug, the relationship.

The chapter breaks the art down into three main pillars.

We've touched on advocacy already at the very beginning, but let's look at the other two.

Caring and attending.

Caring is a word that sounds very soft, but the text grounds it firmly in nursing theory.

It mentions Schoenhofer's themes of caring, which include empathic understanding, and this idea of giving of self while preserving self.

That preserving self part is so important for preventing nurse burnout.

Absolutely vital.

The section also brings in Jean Watson's caring theory.

She talks about the ten karitas, which are loving principles.

Her theory includes concepts like altruism, faith, hope, and even maintaining an openness to miracles.

It's a very spiritual, deeply holistic view of nursing.

It involves providing social, emotional, physical, and spiritual support all at once.

Then there is the pillar of attending.

How is that functionally different from caring?

Attending is really about presence.

The text defines it beautifully as an intensity of presence, being fully in tune with the patient.

So it's not just physically being in the same room while you type on the computer?

No, not at all.

It's active listening.

It's your body posture.

It's making meaningful eye contact.

It's appropriate touch.

The ultimate purpose of attending is to reduce the patient's overwhelming sense of isolation.

When you truly attend to someone, you are nonverbally telling them, I am right here with you.

You are not alone in this dark place.

And finally, we revisit advocacy as the third pillar of the art.

Here, the text connects it directly to the ANA code of ethics, specifically provision 3 .5.

It emphasizes that advocacy isn't just a nice thing to do.

It is a strict ethical obligation.

Nurses must remain alert to any incompetent, unethical, or illegal practices happening in their facility.

It gives examples like ensuring true informed consent is obtained and fiercely protecting patient privacy.

And again, it emphasizes that we must respect patient decisions, even those we strongly disagree with clinically.

That is the true art of advocacy, supporting the patient's eponymy, not just forcing them to do what you think is best for them.

To wrap up all these concepts, the text provides some great scenarios for applying critical judgment.

Let's roleplay these a bit to see how the science and art actually come together in practice.

Let's do it.

Okay, scenario A, the veteran friend.

You have a friend who just returned from military service.

He's looking very disheveled.

He's muttering and talking to himself.

And you notice he jumps out of his skin every time a car backfires down the street.

Okay, so applying the text.

First, EBP tells me these are classic symptoms of PTSD, the hyper arousal, the intrusive thoughts.

Next, the recovery model tells me that I need to focus on hope and helping him reintegrate into his community, not just trying to fix or suppress his symptoms.

And finally, trauma -informed care tells me to ask, what happened to you?

And to approach him with a focus on safety and trust, understanding that his jumping at the car backfire is a biological survival reflex, not him just acting crazy.

Perfect.

Scenario B, the controlled drinking claim.

A friend of yours comes up and says they heard about a new practitioner who can teach severe alcoholics how to drink in moderation safely.

And your friend says this practitioner has tons of patient testimonials to prove it works.

I would immediately use the hierarchy of evidence from figure 1 .1 here.

I would explain to my friend that patient stories and testimonials are level 7 evidence, or maybe level 6 if it's a descriptive study.

That is the weakest kind of evidence.

I would point out that the level I and level 2 evidence, the big randomized controlled trials,

generally do not support controlled drinking for people with severe alcohol dependence.

I would use the strong science to refute the dangerous claim.

Excellent.

And scenario C, the new age critique.

You hear a fellow nursing student call all this stuff about the art of nursing weird,

new age, touchy -feely stuff that doesn't belong in a hospital.

I would fiercely defend it using the concept of therapeutic use of self.

I'd explain to that student that it is a highly disciplined professional skill set.

It involves Watson's theories of caring, attending, and ethical advocacy.

It's not just good vibes, it is a vital clinical tool used to build a relationship that very often saves the patient's life.

We have covered so much ground today.

The science side with EBP, the 5 A's, the hierarchy of evidence and the clinical algorithms, and the art side with caring, attending, and advocacy.

It really is a comprehensive map of the entire psychiatric nursing profession, all packed into Chapter 1.

I want to leave the listener with a final provocative thought based on what we've discussed.

We talked a lot about the research practice gap.

Yeah.

That 17 -year gap between what we know from research and what we actually do at the bedside.

We have the science, which is the level I evidence, and we have the art, which is the deep compassion and attending.

But the challenge for you, the listener, the future nurse sitting in class or doing clinicals right now, is that you are the bridge.

You are the sole connection between that textbook evidence and the scared patient in front of you.

If you don't bring both the science and the art to work with you every day, that gap remains and the patient suffers.

You are the bridge.

That is a truly powerful place to end our discussion today.

Thank you so much for breaking this dense chapter down with me.

It was absolutely my pleasure.

And to our listeners, thank you for tuning in to this deep dive.

Keep learning, keep caring, and keep asking the right questions.

From the Last Minute Lecture Team, goodbye.