a positive and collaborative way that will empower the patient to draw on his or her inner resources in addition to any other treatment they may be receiving. therapeutic relationship aspects of psychiatric nursing in 1913, johns hopkins university was the first college of nursing in the united states to offer psychiatric nursing as part of its general curriculum. the most important duty of a psychiatric nurse is to maintain a positive therapeutic relationship with patients in a clinical setting. the fundamental elements of mental health care revolve around the interpersonal relations and interactions established between professionals and clients. caring for people with mental illnesses demands an intensified presence and a strong desire to be supportive. understanding and empathy understanding and empathy from psychiatric nurses reinforces a positive psychological balance for patients. conveying an understanding is important because it provides patients with a sense of importance. the expression of thoughts and feelings should be encouraged without blaming, judging, or belittling. feeling important is significant to the lives of people who live in a structured society, who often stigmatise the mentally ill because of their disorder. empowering patients with feelings of importance will bring them closer to the normality they had before the onset of their disorder. when subjected to fierce personal attacks, the psychiatric nurse retained the desire and ability to understand the patient. the ability to quickly empathise with unfortunate situations proves essential. involvedness is also required when patients expect nursing staff to understand even when they are unable to express their needs verbally. when a psychiatric nurse gains understanding of the patient, the chances of improving overall treatment greatly increases. individuality individualised care becomes important when nurses need to get to know the patient. to lives this knowledge the psychiatric nurse must see patients as individual people with lives beyond their mental illness. seeing people as individuals with lives beyond their mental illness is imperative in making patients feel valued and respected. in order to accept the patient as an individual, the psychiatric nurse must not be controlled by his or her own values, or by ideas, and pre-understanding of mental health patients. individual needs of patients are met by bending the rules of standard interventions and assessment. psychiatric nurses spoke of the potential to 'bend the rules', which required an interpretation of the unit rules, and the ability to evaluate the risks associated with bending them. providing support successful therapeutic relationships between nurses and patients need to have positive support. different methods of providing patients with support include many active responses. minor activities, such as shopping, reading the newspaper together, or taking lunch or dinner breaks with patients can improve the quality of support provided. physical support may also be used and is manifested through the use of touch. patients described feelings of connection when nurses hugged them or put a hand on their shoulder. psychiatric nurses in berg and hallberg's study described an element of a working relationship as comforting through holding a patient's hand. patients with depression described relief when the nurse embraced them. physical touch is intended to comfort and console patients who are willing to embrace these sensations and share mutual feelings with nurses. being there and being available in order to make patients feel more comfortable, the patient care providers make themselves more approachable, therefore more readily open to multiple levels of personal connections. such personal connections have the ability to uplift patients' spirits and secure confidentiality. utilisation of the quality of time spent with the patient proves to be beneficial. by being available for a proper amount of time, patients open up and disclose personal stories, which enable nurses to understand the meaning behind each story. the outcome results in nurses making every effort to attain a non-biased point of view. a combination of being there and being available allows empirical connections to quell any negative feelings within patients. being genuine the act of being genuine must come from within and be expressed by nurses without reluctance. genuineness requires the nurse to be natural or authentic in their interactions with the patient. in his article about pivotal moments in therapeutic relationships, welch found that nurses must be in accordance with their values and beliefs. along with the previous concept, o'brien concluded that being consistent and reliable in both punctuality and character makes for genuinity. schafer and peternelj-taylor believe that a nurses 'genuineness' is determined through the level of consistency displayed between their verbal and non-verbal behaviour. similarly, scanlon found that genuineness was expressed by fulfilling intended tasks. self-disclosure proves to be the key to being open and honest. it involves the nurse sharing life experiences and is essential to the development of the therapeutic relationship, because as the relationship grows patients are reluctant to give any more information if they feel the relationship is too one sided. multiple authors found genuine emotion, such as tearfulness, blunt feedback, and straight talk facilitated the therapeutic relationship in the pursuit of being open and honest. the friendship of a therapeutic relationship is different from a sociable friendship because the therapeutic relationship friendship is asymmetrical in nature. the basic concept of genuineness is centered on being true to one's word. patients would not trust nurses who fail in complying with what they say or promise. promoting equality for a successful therapeutic relationship to form, a beneficial co-dependency between the nurse and patient must be established. a derogatory view of the patient's role in the clinical setting dilapidates a therapeutic alliance. while patients need nurses to support their recovery, psychiatric nurses need patients to develop skills and experience. psychiatric nurses convey themselves as team members or facilitators of the relationship, rather than the leaders. by empowering the patient with a sense of control and involvement, nurses encourage the patient's independence. sole control of certain situations should not be embedded in the nurse. equal interactions are established when nurses talk to patients one-on-one. participating in activities that do not make one person more dominant over the other, such as talking about a mutual interest or getting lunch together strengthen the levels of equality shared between professionals and patients. this can also create the "illusion of choice"; giving the patient options, even if limited or confined within structure. demonstrating respect to develop a quality therapeutic relationship, nurses need to make patients feel respected and important. accepting patient faults and problems is vital to convey respect—helping the patient see themselves as worthy and worthwhile. demonstrating clear boundaries boundaries are essential for protecting both the patient and the nurse, and maintaining a functional therapeutic relationship. limit setting helps to shield the patient from embarrassing behaviour, and instills the patient with feelings of safety and containment. limit setting also protects the nurse from "burnout", preserving personal stability—thus promoting a quality relationship. demonstrating self-awareness psychiatric nurses recognise personal vulnerability in order to develop professionally. humanistic insight, basic human values, and self-knowledge improves the depth of understanding the self. different personalities affect the way psychiatric nurses respond to their patients. the more self-aware, the more knowledge on how to approach interactions with patients nurses have. interpersonal skills needed to form relationships with patients were acquired through learning about oneself. clinical supervision was found to provide the opportunity for nurses to reflect on patient relationships, to improve clinical skills, and to help repair difficult relationships. the reflections articulated by nurses through clinical supervision help foster self-awareness. pediatric mental health nursing nurses are vital to the evaluation and treatment of children with mental illness. pediatric mental health nursing is the treatment/nursing of mental illness in pediatric patients. family nurse practitioners (fnps) are typically expected to evaluate and treat pediatric patients struggling with their mental health. one out of five children experience a mental disorder in a given year, but only 20% receive treatment of said disorder. education the institute of pediatric nursing (ipn) began working, in 2011, to reinstate the pediatric nursing curriculum in undergraduate nursing programs (bsn). pediatric mental health nurses must first become an rn and then pass their certified pediatric nurse exam after gaining experience in a pediatric facility. pediatric nurses may then choose to specialize in mental health or return to school for their masters as a mental health nurse practitioner. profession status