title: Nurses' Experience of Maintaining Their Therapeutic Relationship With Outpatients With Bipolar Disorder and Their Caregivers During Different Stages of a Manic Episode: A Qualitative Study.
abstract: OBJECTIVE
  Caregivers often consult community mental health (CMH) nurses when they recognize prodromes of mania in the outpatient. The purpose of this study was to determine nurses' experiences of their therapeutic relationship and nursing interventions to outpatients and caregivers during different stages of mania.
  
  
  METHODS
  A qualitative study was conducted. Nine nurses were interviewed.
  
  
  RESULTS
  CMH nurses experienced dual loyalty when facing conflicting interests. They strived to stay connected to patients and caregivers with an open and nonjudgmental attitude. In euthymic episodes, nurses anticipated by developing good relationships with both and by making relapse prevention plan.
  
  
  CONCLUSIONS
  Early involvement of caregivers in the treatment is recommended.
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands.|Saxion University of Applied Science, Faculty of Health, Deventer, the Netherlands.|Dimence Group Mental Health Care Center, Bipolar Specialists Center, Deventer, the Netherlands.|Nursing Science Program, Clinical Health Sciences, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Titus A A
authors.initials: TA
authors.lastname: Beentjes
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands.|Dimence Mental Health Care Centre, Bipolar Specialists Center, Deventer, the Netherlands.|Ghent University, Department of Nursing Sciences, Ghent, Belgium.|GGZ-VS, Institute for Education of Clinical Nurse Specialist in Mental Health, Utrecht, the Netherlands.
authors.forename: Peter J J
authors.initials: PJ
authors.lastname: Goossens
authors.affiliation: Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.|Clinical Health Sciences Program, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Irene P
authors.initials: IP
authors.lastname: Jongerden
mesh_terms: D001714:Bipolar Disorder / Q000451:nursing* / Q000628:therapy*; D017028:Caregivers / Q000523:psychology*; D003155:Community Mental Health Centers; D006801:Humans; D007407:Interviews as Topic; D009426:Netherlands; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology*; D010045:Outpatients / Q000523:psychology*; D036301:Qualitative Research
keywords: Bipolar disorder; caregiver burden; dual loyalty; manic episode