Nursing in different stages of a bipolar manic episode: Coping with dual loyalty and staying connected to outpatients and caregivers is easier when anticipated by having a good connection with both and making relapse prevention plans, a qualitative study.

Abstract

Background: Bipolar disorder follows a pattern of different recurrent mood episodes. Acute mania causes marked impairment in social or occupational functioning and mania can be quite disruptive to families and caregivers. Caregivers often consult nurses because of recognizing prodromes of a manic episode in the patients’ condition. Aim: Nurses can reflect on their own practice when reading this report. Research question: What do nurses experience towards different opinions of caregivers and patients when the patients’ mood is changing towards mania and how do they respond to it? Method: This study follows a qualitative design. Results: Nurses experience dual loyalty. Taking caregivers serious can affect their confidential relationship with patients. In fear the patient steps out of contact nurses strive to stay connected to the patients in an open and transparent manner. Nurses also stay connected to caregivers. When necessary ignoring privacy regulations. The connection with the patient after the manic episode is easily restored. Conclusion: Coping with dual loyalty and staying connected to patients and caregivers, during stages of a manic episode, is easier when anticipated by having a good connection and making relapse prevention plans. Recommendations: Involve caregivers into the treatment. Make and evaluate relapse prevention plans with patients and caregivers.