June 27, 2025 • 41 mins
What happens when an internationally renowned mental health nursing expert shares stories of being mentored by the legendary Hildegard Peplau? Pure gold for psychiatric nurses and mental health professionals.
Dr. Cheryl Forchuk takes us on a fascinating journey through her remarkable career, beginning with her discovery that psychiatric nursing provided the perfect home for her talents. Unlike other healthcare specialties with clear diagnostic pathways, she was drawn to mental health precisely because "there's no clear right answer," creating space for creativity, flexibility, and truly patient-centered care.
The heart of this episode reveals Dr. Forchuk's unexpected mentoring relationship with Hildegard Peplau herself - complete with Christmas cards demanding "You didn't write me" and blunt directives like "Stop making excuses" when Forchuk hesitated to pursue her PhD. These personal anecdotes illuminate how powerful mentorship shapes careers and ultimately transforms patient care across generations.
From her groundbreaking work addressing homelessness through nursing principles to developing technology that enhances rather than replaces therapeutic relationships, Dr. Forchuk demonstrates how Peplau's concept of "constructive community living" remains revolutionary today. She shares insights about nurses as political advocates who have shaped healthcare policy, revealing how a coordinated campaign of telegrams from nurses across Canada helped close loopholes in healthcare access.
Whether you're a psychiatric nurse, mental health professional, or simply interested in how therapeutic relationships drive healing, this conversation offers wisdom that bridges theory and practice. Subscribe now to hear more conversations with leaders who are shaping the future of mental health care.
Let’s Connect
Dr Dan Wesemann
Email: daniel-wesemann@uiowa.edu
Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner
LinkedIn: www.linkedin.com/in/daniel-wesemann
Dr Kate Melino
Email: Katerina.Melino@ucsf.edu
Dr Sean Convoy
Email: sc585@duke.edu
Dr Kendra Delany
Email: Kendra@empowered-heart.com
Dr Melissa Chapman
Email: mchapman@pdastats.com
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Yeah, just my take on things.
My answer to number twodecrease until they cease.
Let's talk about a discovery,identify and challenge, and
release.
Speaker 2 (00:27):
Welcome back everyone to Pep Lau's Ghost another
exciting episode.
I am so thrilled here at PepLau's Ghost we are going
international today.
We're thrilled to welcome DrCheryl Forchuk, who is
internationally known as a worldleader in mental health,
psychiatric nursing and actuallywas mentored under Dr Hildegard
(00:50):
Peplau.
So, looking forward to herexperiences and, you know,
working with Dr Peplau and justeverything she kind of has to
share with us.
So thank you again, dr Forchuk,for joining us, also joined
with Dr Kate Molino from theUniversity of California, san
Francisco, and, as always, drMelissa Chapman-Hayes, who is
(01:11):
here as well.
So I did have, you know, kind ofa quick bio.
But again, it's just, you knowthere's so much to say about Dr
Forchuk and so I'm just going tokind of get into our
conversation and just let herexperience kind of show itself.
So you know, in this podcast wereally kind of focus a lot on
the idea of psych mental healthnurses, especially in advanced
(01:34):
practice doing psychotherapy and, you know, obviously being
mentored by Hildegard Peplauherself.
You know, when did you firstget interested in psychotherapy,
either in doing psychotherapyor it's kind of it's as an
intervention within psych mentalhealth nursing?
Speaker 3 (01:51):
Well, it's when I first went to nursing school.
I remember I actually thought Iwould like to work in
pediatrics when I started.
Started because I had done alot of work previously in terms
of summer jobs at camps and thatsort of thing and and honestly
(02:11):
I did not like it when I did itas a nurse because I hated
hurting kids in the experience.
But when I hit the psych mentalhealth placement in my
undergrad I knew that that wasfor me.
And the other thing at ourprogram at the University of
Windsor in Ontario, canada, wehad the option to do.
(02:32):
I did a joint psychology andnursing degree when I started
and honestly I was thinking ofswitching to psychology but when
I hit mental health nursing itjust really felt like that was
home.
So I when I graduated I did noteven get a uniform because I
(02:55):
would never wear a uniform.
I'd work community health and Iwould work mental health and
with mental illness.
But uh, and my first job was in, um, in the addiction field and
working in alcoholism.
So I had the opportunity, uh,to do both individual and group
psychotherapy, was it was simplypart of the role.
(03:17):
Uh, at that time, and I willsay too, um, when I was working
in the summers and was workingwith youth, I in Canada we had a
provincial not probably afederal thing where we could
start our own businesses and geta grant as a summer job, and so
(03:40):
I had actually set up a programfor vulnerable youth that were
dealing with sexuality issuesand addiction issues.
So, even as a nursing student,we had that project.
I was working with other peopleand then it sort of led,
(04:00):
naturally, to working in thatfield, but I liked, I enjoyed
doing that.
When I went back for my master's, though, I decided I in some
ways overly focused in in theaddiction area and so I wanted
to have a broader experience.
Um, but but basically I wouldsay I started doing it very
(04:22):
early on in my career, like I, Isay even in nursing school,
just knew that this is where Ibelong.
This is where I feelcomfortable.
I love the fact, compared toother areas of nursing, that
there's no clear, right answer.
Right, we don't know so oftenwhat's going on, and so it
(04:42):
really calls for creativity andflexibility.
And we talk about patientcentered care in almost every
area, but it's I think it'struest in this area and I really
appreciated those aspects.
Sorry, that's no, no, that'sgreat.
Speaker 2 (05:01):
You know and I just was having this conversation the
other day, I think you know,either people get it or they
don't.
In psychiatry, and there's kindof no in between.
I mean, I, I, people, eitherlike the gray, you know, because
, you're right, there's no lab,there's no scan that we can kind
of just hold our hats on andkind of say, you know, you have
(05:25):
this, you have that, or you know, and this is going to work,
it's, it's a lot of,unfortunately, trial and error
and it's a lot of that sort ofthing, and so so, yeah, no, I
appreciate that kind of you know, just finding it and falling in
love right away, it's, it's oneof those things.
Speaker 3 (05:34):
Great Right.
I remember I was working withcolleagues in the UK.
We were, we were looking atthis proposal.
Unfortunately didn't get funded.
We were trying to have a jointprogram and we were looking at
the issue of depression and wefound and there's research
evidence of about 200 differentcauses of depression and so we
(05:58):
were thinking it would be areally good course, just because
you could look at things at themolecular level you know the
neurotransmitter.
just because you could look atthings at the molecular level,
you know the neurotransmitter,the, you know the hormonal, the
intrapersonal, the interpersonal, the community.
It doesn't matter what levelyou look at, you could find
causations.
But I think it's just abeautiful example of the
(06:20):
complexity of the field we workwith.
At the complexity of the fieldwe work with and yeah.
So if you're not comfortablewith complexity and you want
clear cut answers and knowingexactly what you're doing at 10
am, on whatever shift, you knowlike I agree.
It's like if you either reallylike that ambiguity which leads
(06:42):
to creativity, right Like youhave to be flexible, you have to
be flexible, you have to becreative, or you hate it.
You want a recipe book.
Speaker 4 (06:54):
Absolutely, and I just want to say, dr Portek,
it's such an honor to meet you.
I know I shared with you overemail before we recorded, but
you know I'm a fellow Canadian,I'm now a dual citizen and I did
my Bachelor of Science inNursing at the University of
Toronto and your work, you knowvery much, was the foundation
for our mental health nursingclass, in particular your work
(07:15):
around.
You know applying Peplau'stheory and the nurse-patient
relationship, and I understandthat you know Hildegard Peplau
was actually your mentor, so Iwould love to hear a little bit
about you know how working withher informs, or has informed,
the way that you see things.
Speaker 3 (07:31):
Well, it was interesting because I learned
about her in my undergrad.
I never thought I would meether.
After I graduated with mymaster's, I went and worked at a
psych hospital.
As I said, I wanted to have abroader background and go beyond
addiction, even though I loveworking in the addiction field,
and I still today I'm working onbringing harm reduction
(07:52):
practices into our hospitals inLondon, ontario, where I'm
situated now.
But I was the first full-timeclinical nurse specialist.
This is quite a while ago we'retalking about early 80s here
and the hospital I worked atactually was for
psych-and-mental health nurses.
(08:12):
You should all know about thishospital.
It was really foundational inmany ways.
It was actually the firsthospital in the world that was
established and this is back inthe 1860s with a policy of no
restraint.
So there are other hospitals,like in France most famously,
where they got rid of therestraint.
This hospital never had them.
(08:34):
So we have people come fromaround the world to the hospital
and they were really well knownfor being innovative.
It was originally called theOntario Hospital, hamilton
Hamilton, because we hadprovincial hospitals in
different areas.
When I was there it was calledHamilton Psych.
It's now part of St Joe's inHamilton.
(08:56):
But one of the other things thatthey did prior to my arrival
they were also so I say alwaysvery innovative.
They had a working farm, theyuh, instead of restraints, they
like.
Even back in the mid 1800s, uh,they, they were working with
patients rather than uh like itwas very much um a collegial
(09:18):
kind of the whole way it was setup, right, uh, it was uh about
having that kind of supportiveenvironment.
Uh, so this hospital, um, priorto my my joining there, which I
joined in 1980, uh, they werethe first uh hospital in canada
that actually required nursingtheory based practice, uh, for
(09:40):
all nurses.
Uh, now, that was originallydone with itagino orlando.
It was the first one there, butwe had moved to the idea of
theoretical pluralism that thenurse could use whatever theory
was important and worked for theparticular patient, but they
had to actually document itwhich theory they were using,
and it was part of theevaluation when you had your
(10:02):
annual evaluation, it was.
You had to be very clear whichtheories you were able to use,
and so, as a consultant, aclinical nurse specialist, when
I would get a request to youknow, usually in the sticky
situations where usual careisn't working, I had to do that
consultation based on the theorythat the nurse was using.
(10:24):
So it was quite interesting andwhat I found, despite the fact
we'd had IDG in Orlando therefirst, the PEPLOS theory was the
most common theory.
So I was using that theoryquite a lot and we did try to
get in various guest speakersfrom around the world to come in
, various guest speakers fromaround the world to come in.
(10:46):
So I wrote her out of the blueand just said would you mind
coming to our hospital?
And I described the hospitallike this would be really good.
And we had some of the otherprovincial psych hospitals were
going to do it to, you know, sothat she could go to some of the
other areas, and we were goingto sort of televise out some of
(11:07):
the events.
And she was going to come forthree days.
Is what we were proposing.
So when I sent that request shewas 78 years old, um, and she
did not have an opening for ayear, for a year.
And then, uh, she was so booked, uh, and, and then she was so
booked and then she was saying,now that I'm getting older, I'm
(11:28):
trying to put a day of travel inbetween my speaking engagements
rather than doing them insequential days.
But as a result, I'm having tobook them so much further out
than I used to, which I kind ofthought was hilarious, and I
have to, which I kind of thoughtwas hilarious, and I have to
say too, so I'd.
(11:48):
When this happened, I'd returnedfrom maternity leave with my
first son and I was planning onhaving the next baby two years
later, so I literally delayedthe birth of that child.
I delayed getting pregnant sothat I would be there 18 months,
so I had to delay by threemonths to make sure I wouldn't
(12:12):
miss this event when she came.
And so anyway, she visited forthree days.
We had some presentations wehad.
I had had different nurses withtough clinical situations that
we had had on various units, andit was marvelous.
(12:32):
You could just see her clinicalexcellence, like it was just
absolutely amazing.
But I was seven months pregnant, keep in mind too, which does
does relate to the rest of thestory.
So anyway, it went really welland at the end of the visit she
(12:55):
said to me write me, you know,gave me her address.
She says I want to, I want, Iwant to, and she said that she
was so impressed that, so, like,she was one of these funny way
Sometimes, the way she saythings that she's she can't
remember having been in ahospital where so many nurses
were approaching competence.
(13:16):
Yes, yes, like, like, anyway, II found that that funny.
Speaker 2 (13:27):
Um, I think I laughed when she said it that's, that's
, um, that's funny and sad allat the same time, right?
I mean, it's one of thosethings like it's sad that she's
just seeing that now, but uh, oh, it's amazing.
Speaker 3 (13:42):
Yeah, yeah.
So anyway, um, the next month Iwent off on maternity leave and
in canada, keep in mind, wehave long maternity leaves and
we have parental leave, so, uh,husbands as well as wives can
get paid maternity leave.
So it meant I was going to belike kind of out of commission
in that way for a year.
Um, and uh, anyway, christmascame, uh, so my son was born in
(14:08):
may.
She was there in april.
My son was born in may, uh, andat christmas I got a call from
the, from the hospital, say wegot a christmas card from you
here, from hildegard peplau,we're going.
Oh, that's weird, and and so Ilive out of town.
So somebody came, dropped itoff and it was Merry Christmas.
You didn't write me.
Speaker 2 (14:33):
She's holding you to the fire.
That's great, that's awesome.
Speaker 3 (14:37):
And you know it was a little bit intimidating.
Oh, you know, the mother ofmodern psychiatric nursing and
plus, like I'm kind of, I hadthese two youngsters I was
dealing with and I didn't do it,honestly, I was a bit
intimidated.
So I wrote her back and I saidwell, you know, I apologize.
(14:58):
I said I'm still on maternityleave but got the letter and,
you know, wrote her a nice noteback.
And then she writes me backagain in the first and she says
so, when are you going to doyour PhD in nursing?
And so I wrote her back and Isaid oh well, I am planning on
doing that.
(15:18):
However, at this point in time,because we're again, my son was
born in 1984.
We don't have doctoral programsin nursing in Canada.
At that point we were just atthe point of planning them and I
have two kids under three agethree.
So I thought those were reallygood reasons, right?
(15:38):
Uh, so she writes me back andsays stop making excuses.
Speaker 4 (15:43):
oh, my goodness, back and says stop making excuses.
Oh, my goodness.
Speaker 2 (15:50):
That's great.
Wow, there's.
There's no excuse he's going totake that's great.
Speaker 3 (15:58):
How are you supposed to get doctoral programs in
nursing in Canada?
Some of you don't leave thecountry to do it and kids under
three are so much more portablethan as they get older.
This is the ideal time.
If you because I said I'm goingto wait until they're both in
school she says you wait untilthen they're in sports teams.
Their schedule is going todictate.
Speaker 2 (16:21):
If you go before that , you can just carry them around
anywhere, so was she offeringyou a slot in her?
Speaker 3 (16:27):
program.
Is that what she was doing?
Theoretically retired right.
Speaker 2 (16:30):
Oh, that's right, that's right yeah.
Speaker 3 (16:32):
I say she was 70.
And so by this time, like,she's like 79 or something.
So anyway, we, I ended up, Idid go back with them quite yet
I went to Wayne State but wemaintained a correspondence,
like every week we maintained acorrespondence.
(16:52):
My doctoral thesis was ontesting her theory and she was
very involved.
Like, for example, we didn'thave, she didn't have a picture
model for her theory, which issomething that normally theories
have, Like they're written in acertain style, but because she
had actually written it in thelate 1940s, it took her a few
(17:15):
years to get it published,because she refused to get a
physician co-author and justabout everything at that point,
for a nursing program required aphysician co-author, and she
said this is supposed to be atheory for nursing I'm program
required a physician co-author,and she said this is supposed to
be a theory for nursing I'm notgetting a physician co-author,
and so it delayed the actualpublication by a few years.
Um, anyway, so, um, so we worked, I worked back and forth with
(17:38):
her on a picture model of thetheory which, and then we
decided what were the mostimportant things in order to
test the model.
Um, and, as I say, uh, we wereable to get together in person a
few times particularly.
Uh, we'd plan it like atconferences, that that sort of
thing.
Like she, if she was asked tospeak, um, she was very generous
(18:00):
and sometimes suggesting Ishould also come and talk about
the practical implementation andthen that would be an
opportunity uh to to gettogether.
So, um, anyway, so wemaintained a weekly course.
I I have binders like thisthick of the that I've kept in
terms of well, I'm sorry youcan't see that uh say several
(18:22):
inches, I don't know.
Speaker 2 (18:25):
That's great yeah.
Speaker 3 (18:27):
Yeah, so, anyway, that, yeah, so she and the other
thing she did.
That was really important andvery consistent with her theory,
because it's all aboutrelationships, right, she also
connected with me, with otherpeople and, uh, in in many
different ways.
Like she would say, oh, so, andyou know, like, uh, you know
(18:48):
phil barker and scotland isdoing something similar.
You should connect with them.
You should connect with billreynolds is doing work on
empathy.
That's related, um, grace sills, uh, you know, has done this
review.
You need to, you know you needto connect with her.
So, um, uh, so, so she wasreally and she would, and
sometimes I would just getletters from people saying
(19:10):
hildegard peplau said I have tocontact you, uh, and ask you
about this, or that I wonder ifthey got the nasty letters too,
like why haven't you reached outto cheryl yet?
yeah, like I, like I would saynasty, so much as firm, which I
and I remember saying to her.
I says well, your, your theoryis very much about being patient
(19:34):
centered and going, going withthe flow, like the nerve sets,
the sets, the process, but but,but it's very patient centered,
that I said.
But so so how come, you know,like a sort of joke, but yet
you're kind of bossy, which kindof goes in a different
direction, right?
Speaker 2 (19:54):
yeah, and thank you for correcting me.
I, I think you know, I thinkthis is, uh, what very driven
people are.
They just kind of, they have apassion and and it's like
nothing gets in the way.
They're just like that.
That's, they're gonna get itdone and and and either you get
on that bus or you don't.
And if you don't, you she mightkind of drag you along for a
while and until you get the ideathat you need to be on that bus
(20:14):
.
Speaker 3 (20:14):
So that's awesome yeah, but yeah yeah.
But I yeah, anyways, it, it, it.
It was great to to have thatopportunity and it is like she
she was very supportive in somany ways, like the different
connections with other people,et cetera was really
(20:36):
foundational allowed us toreally create a community of
people working on similar areasand a lot of those people I'm
still in touch with, the onesthat are still alive.
Speaker 5 (20:50):
This is so fascinating.
Thank you, and given you knowyour experience and these
experiences, I'd love to hearmore about how you see nursing
being a leader in performingpsychotherapies.
Speaker 3 (21:03):
Oh, absolutely, because I think we have, because
, like her form of psychotherapy, as you know, it's not as
purely insight driven as manyforms are.
(21:26):
It's really very much aboutcompetency development.
You know, this idea of creative, constructive community living
is the goal and the person whodoes the work, of course, is the
person who gains through thework, and that they're
identifying're identifying um,what, what to work on, uh.
(21:49):
But in some ways it's likeinsight is more the side effect
of that growth versus being kindof flipped around in another
way.
In many models, I think theidea is the focus is on insight
and then the insight will createthe, the growth, um, but but
(22:10):
it's about this learning andproblem solving and and helping
them develop these confidence,these competencies of
constructive community living,um, I, I think it, um.
It like, when you look at a lotof her work I think a lot of
people have done similar things,like even her issues around use
(22:31):
of language is very similar to,say, aaron Beck's work that
came after Right, that you'relooking for patterns in the
language and reflecting,reflecting back on the, on the
use of language, but, but as alearn, like, as a learning tool.
But I say like, I think it's.
(22:54):
It's very flexible in that waybecause I've worked with people
with a wide range, like in someof the programs I would work
with, I'd be working with peoplewith developmental handicap,
but yet we could still work withwhere they were at and and look
at learning and look atconstructive community living,
(23:15):
or or be working with people whoalso had a PhD and and had and
were at a very different.
So I think it's very flexible,uh, in that way.
But also this idea of it beingvery much about growth I think
that's so much about nursing isthis idea of growth,
interpersonal growth, um, andand this development of
(23:39):
competencies, uh, as I say,that's why it was funny given
that being a main part of hertheory when, when she was
talking about that, after shemet the staff and I think we
actually did have very excellentstaff at that hospital Of all
the provincial hospitals, we hadthe shortest length of stay,
which in Canada is a good thing,and you know, most of our work
(24:06):
was actually in the community,um, like we have so many more
community community patientsthan inpatients, we we had the
the fewest per capita uh numberthat were actually hospitalized,
because our, our goal wasaround constructive community
living Um so, so like, as I say,it was just all in all a really
(24:26):
good fit.
So I don't know, did that answeryour question, melissa?
Speaker 5 (24:34):
Yeah, thank you.
I've just had as the non-nurseconstructive community living.
I've heard you say a number oflike that phrase I haven't heard
before.
Speaker 3 (24:42):
Yeah, yeah, it's in her 1952 book, thanks, yeah,
when she talk about the purposeof nursing.
Speaker 2 (24:51):
Yeah, thank you.
I know it was one of the thingsthat's, you know, coming to
fruition too, because I was kindof looking kind of with your
past work and one of the videosI ran across was the doc talks
from St John's and your talkabout homelessness and I think
that constructive community typeof involvement with PEPLAO, you
know, just really kind ofconnects that and I wondered if
(25:14):
you could kind of again for ouraudience just kind of share that
connection with PEPLAO and howthat really does address
homelessness.
Speaker 3 (25:22):
Yeah, and on different levels.
Again, because one of thethings that peplab talks about,
uh, and again this is importantin psychotherapy generally it's
about self-reflection as well,it's about understanding there's
more than one party, uh.
So one of the things peplabalways said was that if you are
assessing the patient without orclient, depending on the
(25:45):
context without equal assessmentof yourself, at least you're
not using her theory.
So the person providing thecare and the person receiving
the care both need assessment.
So what I've done with myresearch from a research methods
, I always include the peopleproviding direct care as well as
the patient experience, and Ido a lot of systems-related work
(26:10):
.
And certainly I have been doingsome other work around the
transitional discharge model,which is very consistent with
Pat Klaus model, which was givenby the World Health
Organization as an example of amodel that respects patient
(26:32):
rights, because it very much wasco-designed with patients and
frontline staff.
But also my work onhomelessness is very much the
same and I was seeing anover-representation of people
with mental illness, includingaddiction, in that population
and again, exactly as you'resaying, because that runs
(26:56):
contrary to this idea ofconstructive and productive
community living.
So we've done a number ofprojects to look at specific
subgroups to end it, but all ofthose include people with a
lived experience and frontlinestaff to co-create what the
solutions are.
(27:16):
So it's very similar to what wedo on a one-to-one basis in
therapy, but doing it more on alarger group basis, but it's the
exact same process.
It's the exact kind of dualinvolvement with the same kind
of goal of this living and thesame thing.
(27:37):
I have a process in place, butthe actual ideas and the design
and what is required actually toset that agenda comes from the
people with the lived experience.
So we've come up with modelslike for youth homelessness,
people with chronic addiction,family homelessness.
I'm right now working onprojects related to women
(28:02):
veterans who've experiencedhomelessness.
But I always use that sameapproach.
And I was talking about youknow, the study in terms of
addiction, what I've beenworking on in the London Ontario
hospitals around bringing inharm reduction strategies, but
again the same thing.
There we talked, we werefocusing on methamphetamine
(28:22):
because there's not a clearsubstitute and hospitals are
often the hole in the middle ofthe donut when it comes to harm
reduction.
I don't know what it's like inthe States, but it's very well
accepted in the communitysettings and then you go to
hospital.
It's no, by the way, don't usewhile you're here, you might get
kicked out, which goes contrary.
So we were trying to addresssome of those issues.
(28:44):
So we talked to people with alived experience.
What would you want in place?
Talk to the staff, what do yousee as the issues, and then kind
of plan together how we canmake the things that happen that
are based on what peopleactually want no-transcript
(29:36):
underestimate the advocacy roleof nurses and we do that on
multiple systems levels.
And again, when we're thinkingof that constructive community
living, again we have to right.
We have to do that.
We have to speak with ourpatients and support them to
also speak out so that we're nottaking their voice from them
(30:00):
but amplifying it with them.
Right, but like Canada as well,I would say, like our nurses
are incredibly politicallyinvolved.
It's something that we do areally good job of.
Um so have have a huge influenceon health care policy.
(30:21):
As, as a result of that wasquite a few years ago around
that way, back when I was doingmy phd we were revising the
canada health act, um, and atthat point, one of the things
like because there was thepossibility at that time of
physicians extra billing overand above um the the free health
(30:45):
care that everybody's entitledto, paid through taxes I mean,
it's not free-free and thenurses wanted to close that gap
and say no, no one should beable to jump the queue.
And of course, all thephysicians wanted the ability to
earn extra money and theprovinces thought that would be
(31:06):
okay.
But the nurses lobbied verystrong In fact, during the one
meeting we had strategicallyacross the whole country where
every five minutes we senttelegrams, that everybody was
receiving these telegrams fromdifferent nursing groups across
and all day, all day.
So at the end of the day thatwas essentially made illegal,
(31:30):
that the if, if a physician,let's say, charges you an extra
hundred dollars to get someproceed medically necessary
procedure earlier than someoneelse, someone else, um, that
means the province, for thefederal funds to go from the
(31:51):
federal government to theprovince, gets a hundred dollars
less.
And they know who it is.
That did it.
Uh, so, uh, you know so, sothey're in trouble.
So, so like it.
So it really, um, it reallyclosed that.
It really closed that gap.
It really closed that gap.
But it was nurses that did that.
And you know, some people say,and we, when we were making
(32:14):
those changes, we had littlebuttons made up saying nurses,
nurses, no, nurses care, nursesvote, because in Canada nurses
are one of the groups that havethe highest voting rates of
almost any other profession.
And then we would say about youknow for each province how many
voters are nurses.
(32:35):
So it makes a very clearmessage you better pay attention
to the, to the nurses.
Speaker 4 (32:43):
I love this piece about.
You know how important theadvocacy is, and nurses as a
formidable political voice.
I think that's so important,yeah, and so, dr Porchak, I'd
like to ask you, which I thinkis maybe our final question,
which is you know, giveneverything that you, you know,
have learned, that you know,that you've shared with us, how
(33:04):
do you see sort of the future of, you know, mental health,
nursing, psychotherapy,unfolding, given all of the
challenges that we have intoday's world, some of which
you've talked about already?
Speaker 3 (33:19):
Yeah, I.
Well, some of the challengesthat I've worked on as well is
the issues related.
I would say, well, there's twoissues.
One of them relates to shortlength of stay because, like,
our length of stay is not basedon an insurance program but it's
(33:39):
still, it's more similar to anHMO.
So you get up, the hospitalshave a blanket amount for the
area they serve.
So if you have a fast admission, then it's, it's, it's better
for them.
And so sometimes you'll hearpeople say well, you know, if
they're in on a short admission,it's difficult to form
relationships, but but you know.
(34:00):
So that's some of the some ofwhat I find when I'm talking to
staff now that we have to reallylook at, and sometimes it's
about setting the person in aposition.
Maybe that long-termrelationship is going to be with
the community nurse, maybe itmay not be with the hospital
nurse, but you can still setthem up in a position where they
trust nurses because of whatyou started with them, so that
(34:23):
they can transition thatrelationship to the community.
The other thing is aroundtechnology, uh, and so I've been
very involved, some of ourprojects looking at how do we
have technology, uh, forsolutions that support the
therapeutic relationship ratherthan get in the way, uh, and so
(34:43):
we've been looking at and, and Ithink that's really, really
important and if we do not, ifwe're not involved with that,
then these tools will bedeveloped that that do not
support the relationship.
Um, you know, for example, uh,you know we were uh.
One of the things we had doneis we'd worked on a phone app
(35:06):
and and, like we, I remember wewere looking at like mood
monitors.
There was like over 200 uh, uhout there at the time.
I'm sure there's many more now,but only six had ever even been
tested.
But most of them focus onintrospection, like you're doing
this in isolation.
You're focusing on the scale,and we know that introspection
and depression without aconnection with another person
(35:28):
is not really a good thing, butthat's not how they're being
evaluated.
So what we've done is look atthings where the client can be
empowered by seeing all theirown data, by seeing all their
(35:51):
own data, but it connects withthat healthcare provider with
the nurse most often, but alsocould be a social worker or
someone else so that it supportsthe relationship.
And so, for example, if they'redoing a self-assessment for
depression, for example, thatit's negotiated between them.
At what point should the careprovider get an alert right?
So you know, some people aredepressed all the time and maybe
(36:15):
it's when it starts going upthat you need the alert right.
So it's a negotiated thing andthere would be these alerts, but
it would be completelytransparent.
So it's a negotiated thing andthere would be these alerts, but
it would be completelytransparent and it gave them
things such as it was updatedtwice a day, so if they had a
(36:38):
medication change at 11, theycould see that on their phone at
noon.
It was noon and midnight thatit would get updated.
So they had complete control.
They had their crisis plan wason their phone, their
medications, their varioustreatment objectives, and they
could create their own scales ofwhat they were monitoring.
But it would be all incommunication with their care
provider rather than purely themfocusing on their own.
And this was people with seriousmental and schizophrenia and
(37:00):
major mood disorders, right.
So you don't you want it to bethis, you know?
So I think that's an example.
I think, with the technology,um, my fear is that that if we
aren't involved with that, uh,and do it in these very
therapeutic, supporting oftherapeutic relationship ways,
we're going to end up with thesethings that are going to going
(37:22):
to interfere with thoserelationships.
So that, and I say the shortlength of stay and those
transitions between services, Ithink we have to pay attention
to as well.
Speaker 2 (37:37):
Yeah, I love that.
You know that technology kindof adds to the relationship.
You know there's a way of kindof doing that without just kind
of making it.
You just kind of making it.
You know for for lack of abetter term kind of just more
medical model, where we're justkind of checking boxes, we're
looking at symptoms and andmaking diagnoses and such so.
So yeah, thank you yeah, sorry.
Speaker 3 (37:57):
Yeah, yeah, no, no.
I say like we, we have a.
A lot of people would say therewhen they would have the
therapeutic meetings.
It was more focused becauseinstead of saying, well, how's
it been going, they had thatinformation and the patients
were able to look at patternsthemselves.
Like, hey, you know what Inoticed?
I'm most depressed on the daysI'm not doing activities, or the
(38:17):
day I talked to my mother orwhatever, and I remember a
couple of them said, becausethey were also looking at things
like blood, every time my bloodglucose goes down I'm depressed
.
And then realizing that that'sin fact what they had to deal
with.
So they could have like thislittle experiment of one,
because they could plot thosetwo things together and say, oh,
(38:38):
my goodness, there's my bloodglucose level and there's my
depression level.
And then when they come in itwas very focused saying you know
what?
I've totally been missing this.
Speaker 2 (38:48):
Yeah, yeah, something you know, they they feel seen,
they feel heard, they feel asense of control.
There's something I can do toameliorate these symptoms and
that's, and that can be a realsense of power for a patient.
Speaker 3 (38:59):
So yeah, and very focused discussions when they
would get together there.
You know they both have thesame information and they're
saying oh, I want to talk aboutthis.
Speaker 2 (39:09):
Yeah, yeah, excellent .
Well, I love that future.
That's awesome.
Thank you, dr Forchuk.
Thank you so much and thank youfor those listening.
I hope everybody's learned alittle bit.
Something had some fun.
I, you know I definitely youknow for me kind of going back
and what we talked about alittle bit today.
You know, I definitely you knowfor me kind of going back and
what we talked about a littlebit today.
You know I, um, you mentioned,dr Forchuk, about the idea of
(39:30):
these open units and that'ssomething that I actually
experienced, uh, in Iowa cityhere.
You know we have, we had, Ishould say, unfortunately the
hospital shut it down, but itwas this open, uh, open
psychiatric unit which was justkind of mind blowing at the time
that you would actually have apsychiatric unit that wasn't
locked and so didn't userestraints.
Yeah, so very, very novel and Ihadn't seen or heard of
(39:52):
anything else, at least in theUnited States.
So I'm interested that they'vehad that in other places and
around the world.
1860s, yeah, right, I know, yeah, it's a blast from the past at
the very least.
So, but that's great.
And thank you again for sharingyour stories about Dr Hildegard
Peplau.
You know I love the idea thatwe, you know, family planning,
(40:13):
got involved with your firstmeeting with her and how you,
you know, just kind of keptconnecting with her, and so I'm
hoping that that's what thispodcast does for people is
continue to connect.
You know, like-minded peoplethat we, you know, can all kind
of stay connected.
So my last plug will be tosubscribe like comment.
(40:35):
Please put comments and let usknow who you want to hear from
next, or if you want to hearfrom Dr Forchuk again, maybe
kind of make that plea and seeif she's available again.
So thank you so much and lookforward to another episode
coming soon on Pep Lau's Ghost.
Take care.
Speaker 1 (41:01):
Bye leaving so you can be.
You Got a discovery Identifyingchallenging your beliefs,
reframing your mind Negativethoughts.
Release these cognitivedistortions, decrease until they
cease.
Yeah, got a discoveryIdentifying challenging your
beliefs, reframing your mindNegative thoughts.
Release these cognitivedistortions, decrease until they
(41:24):
cease.
Yeah, just my take on things.
My answer to number twodecrease until they cease.
Let's talk about a discovery,identify and challenge, and
release.
Speaker 2 (00:27):
Welcome back everyone to Pep Lau's Ghost another
exciting episode.
I am so thrilled here at PepLau's Ghost we are going
international today.
We're thrilled to welcome DrCheryl Forchuk, who is
internationally known as a worldleader in mental health,
psychiatric nursing and actuallywas mentored under Dr Hildegard
(00:50):
Peplau.
So, looking forward to herexperiences and, you know,
working with Dr Peplau and justeverything she kind of has to
share with us.
So thank you again, dr Forchuk,for joining us, also joined
with Dr Kate Molino from theUniversity of California, san
Francisco, and, as always, drMelissa Chapman-Hayes, who is
(01:11):
here as well.
So I did have, you know, kind ofa quick bio.
But again, it's just, you knowthere's so much to say about Dr
Forchuk and so I'm just going tokind of get into our
conversation and just let herexperience kind of show itself.
So you know, in this podcast wereally kind of focus a lot on
the idea of psych mental healthnurses, especially in advanced
(01:34):
practice doing psychotherapy and, you know, obviously being
mentored by Hildegard Peplauherself.
You know, when did you firstget interested in psychotherapy,
either in doing psychotherapyor it's kind of it's as an
intervention within psych mentalhealth nursing?
Speaker 3 (01:51):
Well, it's when I first went to nursing school.
I remember I actually thought Iwould like to work in
pediatrics when I started.
Started because I had done alot of work previously in terms
of summer jobs at camps and thatsort of thing and and honestly
(02:11):
I did not like it when I did itas a nurse because I hated
hurting kids in the experience.
But when I hit the psych mentalhealth placement in my
undergrad I knew that that wasfor me.
And the other thing at ourprogram at the University of
Windsor in Ontario, canada, wehad the option to do.
(02:32):
I did a joint psychology andnursing degree when I started
and honestly I was thinking ofswitching to psychology but when
I hit mental health nursing itjust really felt like that was
home.
So I when I graduated I did noteven get a uniform because I
(02:55):
would never wear a uniform.
I'd work community health and Iwould work mental health and
with mental illness.
But uh, and my first job was in, um, in the addiction field and
working in alcoholism.
So I had the opportunity, uh,to do both individual and group
psychotherapy, was it was simplypart of the role.
(03:17):
Uh, at that time, and I willsay too, um, when I was working
in the summers and was workingwith youth, I in Canada we had a
provincial not probably afederal thing where we could
start our own businesses and geta grant as a summer job, and so
(03:40):
I had actually set up a programfor vulnerable youth that were
dealing with sexuality issuesand addiction issues.
So, even as a nursing student,we had that project.
I was working with other peopleand then it sort of led,
(04:00):
naturally, to working in thatfield, but I liked, I enjoyed
doing that.
When I went back for my master's, though, I decided I in some
ways overly focused in in theaddiction area and so I wanted
to have a broader experience.
Um, but but basically I wouldsay I started doing it very
(04:22):
early on in my career, like I, Isay even in nursing school,
just knew that this is where Ibelong.
This is where I feelcomfortable.
I love the fact, compared toother areas of nursing, that
there's no clear, right answer.
Right, we don't know so oftenwhat's going on, and so it
(04:42):
really calls for creativity andflexibility.
And we talk about patientcentered care in almost every
area, but it's I think it'struest in this area and I really
appreciated those aspects.
Sorry, that's no, no, that'sgreat.
Speaker 2 (05:01):
You know and I just was having this conversation the
other day, I think you know,either people get it or they
don't.
In psychiatry, and there's kindof no in between.
I mean, I, I, people, eitherlike the gray, you know, because
, you're right, there's no lab,there's no scan that we can kind
of just hold our hats on andkind of say, you know, you have
(05:25):
this, you have that, or you know, and this is going to work,
it's, it's a lot of,unfortunately, trial and error
and it's a lot of that sort ofthing, and so so, yeah, no, I
appreciate that kind of you know, just finding it and falling in
love right away, it's, it's oneof those things.
Speaker 3 (05:34):
Great Right.
I remember I was working withcolleagues in the UK.
We were, we were looking atthis proposal.
Unfortunately didn't get funded.
We were trying to have a jointprogram and we were looking at
the issue of depression and wefound and there's research
evidence of about 200 differentcauses of depression and so we
(05:58):
were thinking it would be areally good course, just because
you could look at things at themolecular level you know the
neurotransmitter.
just because you could look atthings at the molecular level,
you know the neurotransmitter,the, you know the hormonal, the
intrapersonal, the interpersonal, the community.
It doesn't matter what levelyou look at, you could find
causations.
But I think it's just abeautiful example of the
(06:20):
complexity of the field we workwith.
At the complexity of the fieldwe work with and yeah.
So if you're not comfortablewith complexity and you want
clear cut answers and knowingexactly what you're doing at 10
am, on whatever shift, you knowlike I agree.
It's like if you either reallylike that ambiguity which leads
(06:42):
to creativity, right Like youhave to be flexible, you have to
be flexible, you have to becreative, or you hate it.
You want a recipe book.
Speaker 4 (06:54):
Absolutely, and I just want to say, dr Portek,
it's such an honor to meet you.
I know I shared with you overemail before we recorded, but
you know I'm a fellow Canadian,I'm now a dual citizen and I did
my Bachelor of Science inNursing at the University of
Toronto and your work, you knowvery much, was the foundation
for our mental health nursingclass, in particular your work
(07:15):
around.
You know applying Peplau'stheory and the nurse-patient
relationship, and I understandthat you know Hildegard Peplau
was actually your mentor, so Iwould love to hear a little bit
about you know how working withher informs, or has informed,
the way that you see things.
Speaker 3 (07:31):
Well, it was interesting because I learned
about her in my undergrad.
I never thought I would meether.
After I graduated with mymaster's, I went and worked at a
psych hospital.
As I said, I wanted to have abroader background and go beyond
addiction, even though I loveworking in the addiction field,
and I still today I'm working onbringing harm reduction
(07:52):
practices into our hospitals inLondon, ontario, where I'm
situated now.
But I was the first full-timeclinical nurse specialist.
This is quite a while ago we'retalking about early 80s here
and the hospital I worked atactually was for
psych-and-mental health nurses.
(08:12):
You should all know about thishospital.
It was really foundational inmany ways.
It was actually the firsthospital in the world that was
established and this is back inthe 1860s with a policy of no
restraint.
So there are other hospitals,like in France most famously,
where they got rid of therestraint.
This hospital never had them.
(08:34):
So we have people come fromaround the world to the hospital
and they were really well knownfor being innovative.
It was originally called theOntario Hospital, hamilton
Hamilton, because we hadprovincial hospitals in
different areas.
When I was there it was calledHamilton Psych.
It's now part of St Joe's inHamilton.
(08:56):
But one of the other things thatthey did prior to my arrival
they were also so I say alwaysvery innovative.
They had a working farm, theyuh, instead of restraints, they
like.
Even back in the mid 1800s, uh,they, they were working with
patients rather than uh like itwas very much um a collegial
(09:18):
kind of the whole way it was setup, right, uh, it was uh about
having that kind of supportiveenvironment.
Uh, so this hospital, um, priorto my my joining there, which I
joined in 1980, uh, they werethe first uh hospital in canada
that actually required nursingtheory based practice, uh, for
(09:40):
all nurses.
Uh, now, that was originallydone with itagino orlando.
It was the first one there, butwe had moved to the idea of
theoretical pluralism that thenurse could use whatever theory
was important and worked for theparticular patient, but they
had to actually document itwhich theory they were using,
and it was part of theevaluation when you had your
(10:02):
annual evaluation, it was.
You had to be very clear whichtheories you were able to use,
and so, as a consultant, aclinical nurse specialist, when
I would get a request to youknow, usually in the sticky
situations where usual careisn't working, I had to do that
consultation based on the theorythat the nurse was using.
(10:24):
So it was quite interesting andwhat I found, despite the fact
we'd had IDG in Orlando therefirst, the PEPLOS theory was the
most common theory.
So I was using that theoryquite a lot and we did try to
get in various guest speakersfrom around the world to come in
, various guest speakers fromaround the world to come in.
(10:46):
So I wrote her out of the blueand just said would you mind
coming to our hospital?
And I described the hospitallike this would be really good.
And we had some of the otherprovincial psych hospitals were
going to do it to, you know, sothat she could go to some of the
other areas, and we were goingto sort of televise out some of
(11:07):
the events.
And she was going to come forthree days.
Is what we were proposing.
So when I sent that request shewas 78 years old, um, and she
did not have an opening for ayear, for a year.
And then, uh, she was so booked, uh, and, and then she was so
booked and then she was saying,now that I'm getting older, I'm
(11:28):
trying to put a day of travel inbetween my speaking engagements
rather than doing them insequential days.
But as a result, I'm having tobook them so much further out
than I used to, which I kind ofthought was hilarious, and I
have to, which I kind of thoughtwas hilarious, and I have to
say too, so I'd.
(11:48):
When this happened, I'd returnedfrom maternity leave with my
first son and I was planning onhaving the next baby two years
later, so I literally delayedthe birth of that child.
I delayed getting pregnant sothat I would be there 18 months,
so I had to delay by threemonths to make sure I wouldn't
(12:12):
miss this event when she came.
And so anyway, she visited forthree days.
We had some presentations wehad.
I had had different nurses withtough clinical situations that
we had had on various units, andit was marvelous.
(12:32):
You could just see her clinicalexcellence, like it was just
absolutely amazing.
But I was seven months pregnant, keep in mind too, which does
does relate to the rest of thestory.
So anyway, it went really welland at the end of the visit she
(12:55):
said to me write me, you know,gave me her address.
She says I want to, I want, Iwant to, and she said that she
was so impressed that, so, like,she was one of these funny way
Sometimes, the way she saythings that she's she can't
remember having been in ahospital where so many nurses
were approaching competence.
(13:16):
Yes, yes, like, like, anyway, II found that that funny.
Speaker 2 (13:27):
Um, I think I laughed when she said it that's, that's
, um, that's funny and sad allat the same time, right?
I mean, it's one of thosethings like it's sad that she's
just seeing that now, but uh, oh, it's amazing.
Speaker 3 (13:42):
Yeah, yeah.
So anyway, um, the next month Iwent off on maternity leave and
in canada, keep in mind, wehave long maternity leaves and
we have parental leave, so, uh,husbands as well as wives can
get paid maternity leave.
So it meant I was going to belike kind of out of commission
in that way for a year.
Um, and uh, anyway, christmascame, uh, so my son was born in
(14:08):
may.
She was there in april.
My son was born in may, uh, andat christmas I got a call from
the, from the hospital, say wegot a christmas card from you
here, from hildegard peplau,we're going.
Oh, that's weird, and and so Ilive out of town.
So somebody came, dropped itoff and it was Merry Christmas.
You didn't write me.
Speaker 2 (14:33):
She's holding you to the fire.
That's great, that's awesome.
Speaker 3 (14:37):
And you know it was a little bit intimidating.
Oh, you know, the mother ofmodern psychiatric nursing and
plus, like I'm kind of, I hadthese two youngsters I was
dealing with and I didn't do it,honestly, I was a bit
intimidated.
So I wrote her back and I saidwell, you know, I apologize.
(14:58):
I said I'm still on maternityleave but got the letter and,
you know, wrote her a nice noteback.
And then she writes me backagain in the first and she says
so, when are you going to doyour PhD in nursing?
And so I wrote her back and Isaid oh well, I am planning on
doing that.
(15:18):
However, at this point in time,because we're again, my son was
born in 1984.
We don't have doctoral programsin nursing in Canada.
At that point we were just atthe point of planning them and I
have two kids under three agethree.
So I thought those were reallygood reasons, right?
(15:38):
Uh, so she writes me back andsays stop making excuses.
Speaker 4 (15:43):
oh, my goodness, back and says stop making excuses.
Oh, my goodness.
Speaker 2 (15:50):
That's great.
Wow, there's.
There's no excuse he's going totake that's great.
Speaker 3 (15:58):
How are you supposed to get doctoral programs in
nursing in Canada?
Some of you don't leave thecountry to do it and kids under
three are so much more portablethan as they get older.
This is the ideal time.
If you because I said I'm goingto wait until they're both in
school she says you wait untilthen they're in sports teams.
Their schedule is going todictate.
Speaker 2 (16:21):
If you go before that , you can just carry them around
anywhere, so was she offeringyou a slot in her?
Speaker 3 (16:27):
program.
Is that what she was doing?
Theoretically retired right.
Speaker 2 (16:30):
Oh, that's right, that's right yeah.
Speaker 3 (16:32):
I say she was 70.
And so by this time, like,she's like 79 or something.
So anyway, we, I ended up, Idid go back with them quite yet
I went to Wayne State but wemaintained a correspondence,
like every week we maintained acorrespondence.
(16:52):
My doctoral thesis was ontesting her theory and she was
very involved.
Like, for example, we didn'thave, she didn't have a picture
model for her theory, which issomething that normally theories
have, Like they're written in acertain style, but because she
had actually written it in thelate 1940s, it took her a few
(17:15):
years to get it published,because she refused to get a
physician co-author and justabout everything at that point,
for a nursing program required aphysician co-author, and she
said this is supposed to be atheory for nursing I'm program
required a physician co-author,and she said this is supposed to
be a theory for nursing I'm notgetting a physician co-author,
and so it delayed the actualpublication by a few years.
Um, anyway, so, um, so we worked, I worked back and forth with
(17:38):
her on a picture model of thetheory which, and then we
decided what were the mostimportant things in order to
test the model.
Um, and, as I say, uh, we wereable to get together in person a
few times particularly.
Uh, we'd plan it like atconferences, that that sort of
thing.
Like she, if she was asked tospeak, um, she was very generous
(18:00):
and sometimes suggesting Ishould also come and talk about
the practical implementation andthen that would be an
opportunity uh to to gettogether.
So, um, anyway, so wemaintained a weekly course.
I I have binders like thisthick of the that I've kept in
terms of well, I'm sorry youcan't see that uh say several
(18:22):
inches, I don't know.
Speaker 2 (18:25):
That's great yeah.
Speaker 3 (18:27):
Yeah, so, anyway, that, yeah, so she and the other
thing she did.
That was really important andvery consistent with her theory,
because it's all aboutrelationships, right, she also
connected with me, with otherpeople and, uh, in in many
different ways.
Like she would say, oh, so, andyou know, like, uh, you know
(18:48):
phil barker and scotland isdoing something similar.
You should connect with them.
You should connect with billreynolds is doing work on
empathy.
That's related, um, grace sills, uh, you know, has done this
review.
You need to, you know you needto connect with her.
So, um, uh, so, so she wasreally and she would, and
sometimes I would just getletters from people saying
(19:10):
hildegard peplau said I have tocontact you, uh, and ask you
about this, or that I wonder ifthey got the nasty letters too,
like why haven't you reached outto cheryl yet?
yeah, like I, like I would saynasty, so much as firm, which I
and I remember saying to her.
I says well, your, your theoryis very much about being patient
(19:34):
centered and going, going withthe flow, like the nerve sets,
the sets, the process, but but,but it's very patient centered,
that I said.
But so so how come, you know,like a sort of joke, but yet
you're kind of bossy, which kindof goes in a different
direction, right?
Speaker 2 (19:54):
yeah, and thank you for correcting me.
I, I think you know, I thinkthis is, uh, what very driven
people are.
They just kind of, they have apassion and and it's like
nothing gets in the way.
They're just like that.
That's, they're gonna get itdone and and and either you get
on that bus or you don't.
And if you don't, you she mightkind of drag you along for a
while and until you get the ideathat you need to be on that bus
(20:14):
.
Speaker 3 (20:14):
So that's awesome yeah, but yeah yeah.
But I yeah, anyways, it, it, it.
It was great to to have thatopportunity and it is like she
she was very supportive in somany ways, like the different
connections with other people,et cetera was really
(20:36):
foundational allowed us toreally create a community of
people working on similar areasand a lot of those people I'm
still in touch with, the onesthat are still alive.
Speaker 5 (20:50):
This is so fascinating.
Thank you, and given you knowyour experience and these
experiences, I'd love to hearmore about how you see nursing
being a leader in performingpsychotherapies.
Speaker 3 (21:03):
Oh, absolutely, because I think we have, because
, like her form of psychotherapy, as you know, it's not as
purely insight driven as manyforms are.
(21:26):
It's really very much aboutcompetency development.
You know, this idea of creative, constructive community living
is the goal and the person whodoes the work, of course, is the
person who gains through thework, and that they're
identifying're identifying um,what, what to work on, uh.
(21:49):
But in some ways it's likeinsight is more the side effect
of that growth versus being kindof flipped around in another
way.
In many models, I think theidea is the focus is on insight
and then the insight will createthe, the growth, um, but but
(22:10):
it's about this learning andproblem solving and and helping
them develop these confidence,these competencies of
constructive community living,um, I, I think it, um.
It like, when you look at a lotof her work I think a lot of
people have done similar things,like even her issues around use
(22:31):
of language is very similar to,say, aaron Beck's work that
came after Right, that you'relooking for patterns in the
language and reflecting,reflecting back on the, on the
use of language, but, but as alearn, like, as a learning tool.
But I say like, I think it's.
(22:54):
It's very flexible in that waybecause I've worked with people
with a wide range, like in someof the programs I would work
with, I'd be working with peoplewith developmental handicap,
but yet we could still work withwhere they were at and and look
at learning and look atconstructive community living,
(23:15):
or or be working with people whoalso had a PhD and and had and
were at a very different.
So I think it's very flexible,uh, in that way.
But also this idea of it beingvery much about growth I think
that's so much about nursing isthis idea of growth,
interpersonal growth, um, andand this development of
(23:39):
competencies, uh, as I say,that's why it was funny given
that being a main part of hertheory when, when she was
talking about that, after shemet the staff and I think we
actually did have very excellentstaff at that hospital Of all
the provincial hospitals, we hadthe shortest length of stay,
which in Canada is a good thing,and you know, most of our work
(24:06):
was actually in the community,um, like we have so many more
community community patientsthan inpatients, we we had the
the fewest per capita uh numberthat were actually hospitalized,
because our, our goal wasaround constructive community
living Um so, so like, as I say,it was just all in all a really
(24:26):
good fit.
So I don't know, did that answeryour question, melissa?
Speaker 5 (24:34):
Yeah, thank you.
I've just had as the non-nurseconstructive community living.
I've heard you say a number oflike that phrase I haven't heard
before.
Speaker 3 (24:42):
Yeah, yeah, it's in her 1952 book, thanks, yeah,
when she talk about the purposeof nursing.
Speaker 2 (24:51):
Yeah, thank you.
I know it was one of the thingsthat's, you know, coming to
fruition too, because I was kindof looking kind of with your
past work and one of the videosI ran across was the doc talks
from St John's and your talkabout homelessness and I think
that constructive community typeof involvement with PEPLAO, you
know, just really kind ofconnects that and I wondered if
(25:14):
you could kind of again for ouraudience just kind of share that
connection with PEPLAO and howthat really does address
homelessness.
Speaker 3 (25:22):
Yeah, and on different levels.
Again, because one of thethings that peplab talks about,
uh, and again this is importantin psychotherapy generally it's
about self-reflection as well,it's about understanding there's
more than one party, uh.
So one of the things peplabalways said was that if you are
assessing the patient without orclient, depending on the
(25:45):
context without equal assessmentof yourself, at least you're
not using her theory.
So the person providing thecare and the person receiving
the care both need assessment.
So what I've done with myresearch from a research methods
, I always include the peopleproviding direct care as well as
the patient experience, and Ido a lot of systems-related work
(26:10):
.
And certainly I have been doingsome other work around the
transitional discharge model,which is very consistent with
Pat Klaus model, which was givenby the World Health
Organization as an example of amodel that respects patient
(26:32):
rights, because it very much wasco-designed with patients and
frontline staff.
But also my work onhomelessness is very much the
same and I was seeing anover-representation of people
with mental illness, includingaddiction, in that population
and again, exactly as you'resaying, because that runs
(26:56):
contrary to this idea ofconstructive and productive
community living.
So we've done a number ofprojects to look at specific
subgroups to end it, but all ofthose include people with a
lived experience and frontlinestaff to co-create what the
solutions are.
(27:16):
So it's very similar to what wedo on a one-to-one basis in
therapy, but doing it more on alarger group basis, but it's the
exact same process.
It's the exact kind of dualinvolvement with the same kind
of goal of this living and thesame thing.
(27:37):
I have a process in place, butthe actual ideas and the design
and what is required actually toset that agenda comes from the
people with the lived experience.
So we've come up with modelslike for youth homelessness,
people with chronic addiction,family homelessness.
I'm right now working onprojects related to women
(28:02):
veterans who've experiencedhomelessness.
But I always use that sameapproach.
And I was talking about youknow, the study in terms of
addiction, what I've beenworking on in the London Ontario
hospitals around bringing inharm reduction strategies, but
again the same thing.
There we talked, we werefocusing on methamphetamine
(28:22):
because there's not a clearsubstitute and hospitals are
often the hole in the middle ofthe donut when it comes to harm
reduction.
I don't know what it's like inthe States, but it's very well
accepted in the communitysettings and then you go to
hospital.
It's no, by the way, don't usewhile you're here, you might get
kicked out, which goes contrary.
So we were trying to addresssome of those issues.
(28:44):
So we talked to people with alived experience.
What would you want in place?
Talk to the staff, what do yousee as the issues, and then kind
of plan together how we canmake the things that happen that
are based on what peopleactually want no-transcript
(29:36):
underestimate the advocacy roleof nurses and we do that on
multiple systems levels.
And again, when we're thinkingof that constructive community
living, again we have to right.
We have to do that.
We have to speak with ourpatients and support them to
also speak out so that we're nottaking their voice from them
(30:00):
but amplifying it with them.
Right, but like Canada as well,I would say, like our nurses
are incredibly politicallyinvolved.
It's something that we do areally good job of.
Um so have have a huge influenceon health care policy.
(30:21):
As, as a result of that wasquite a few years ago around
that way, back when I was doingmy phd we were revising the
canada health act, um, and atthat point, one of the things
like because there was thepossibility at that time of
physicians extra billing overand above um the the free health
(30:45):
care that everybody's entitledto, paid through taxes I mean,
it's not free-free and thenurses wanted to close that gap
and say no, no one should beable to jump the queue.
And of course, all thephysicians wanted the ability to
earn extra money and theprovinces thought that would be
(31:06):
okay.
But the nurses lobbied verystrong In fact, during the one
meeting we had strategicallyacross the whole country where
every five minutes we senttelegrams, that everybody was
receiving these telegrams fromdifferent nursing groups across
and all day, all day.
So at the end of the day thatwas essentially made illegal,
(31:30):
that the if, if a physician,let's say, charges you an extra
hundred dollars to get someproceed medically necessary
procedure earlier than someoneelse, someone else, um, that
means the province, for thefederal funds to go from the
(31:51):
federal government to theprovince, gets a hundred dollars
less.
And they know who it is.
That did it.
Uh, so, uh, you know so, sothey're in trouble.
So, so like it.
So it really, um, it reallyclosed that.
It really closed that gap.
It really closed that gap.
But it was nurses that did that.
And you know, some people say,and we, when we were making
(32:14):
those changes, we had littlebuttons made up saying nurses,
nurses, no, nurses care, nursesvote, because in Canada nurses
are one of the groups that havethe highest voting rates of
almost any other profession.
And then we would say about youknow for each province how many
voters are nurses.
(32:35):
So it makes a very clearmessage you better pay attention
to the, to the nurses.
Speaker 4 (32:43):
I love this piece about.
You know how important theadvocacy is, and nurses as a
formidable political voice.
I think that's so important,yeah, and so, dr Porchak, I'd
like to ask you, which I thinkis maybe our final question,
which is you know, giveneverything that you, you know,
have learned, that you know,that you've shared with us, how
(33:04):
do you see sort of the future of, you know, mental health,
nursing, psychotherapy,unfolding, given all of the
challenges that we have intoday's world, some of which
you've talked about already?
Speaker 3 (33:19):
Yeah, I.
Well, some of the challengesthat I've worked on as well is
the issues related.
I would say, well, there's twoissues.
One of them relates to shortlength of stay because, like,
our length of stay is not basedon an insurance program but it's
(33:39):
still, it's more similar to anHMO.
So you get up, the hospitalshave a blanket amount for the
area they serve.
So if you have a fast admission, then it's, it's, it's better
for them.
And so sometimes you'll hearpeople say well, you know, if
they're in on a short admission,it's difficult to form
relationships, but but you know.
(34:00):
So that's some of the some ofwhat I find when I'm talking to
staff now that we have to reallylook at, and sometimes it's
about setting the person in aposition.
Maybe that long-termrelationship is going to be with
the community nurse, maybe itmay not be with the hospital
nurse, but you can still setthem up in a position where they
trust nurses because of whatyou started with them, so that
(34:23):
they can transition thatrelationship to the community.
The other thing is aroundtechnology, uh, and so I've been
very involved, some of ourprojects looking at how do we
have technology, uh, forsolutions that support the
therapeutic relationship ratherthan get in the way, uh, and so
(34:43):
we've been looking at and, and Ithink that's really, really
important and if we do not, ifwe're not involved with that,
then these tools will bedeveloped that that do not
support the relationship.
Um, you know, for example, uh,you know we were uh.
One of the things we had doneis we'd worked on a phone app
(35:06):
and and, like we, I remember wewere looking at like mood
monitors.
There was like over 200 uh, uhout there at the time.
I'm sure there's many more now,but only six had ever even been
tested.
But most of them focus onintrospection, like you're doing
this in isolation.
You're focusing on the scale,and we know that introspection
and depression without aconnection with another person
(35:28):
is not really a good thing, butthat's not how they're being
evaluated.
So what we've done is look atthings where the client can be
empowered by seeing all theirown data, by seeing all their
(35:51):
own data, but it connects withthat healthcare provider with
the nurse most often, but alsocould be a social worker or
someone else so that it supportsthe relationship.
And so, for example, if they'redoing a self-assessment for
depression, for example, thatit's negotiated between them.
At what point should the careprovider get an alert right?
So you know, some people aredepressed all the time and maybe
(36:15):
it's when it starts going upthat you need the alert right.
So it's a negotiated thing andthere would be these alerts, but
it would be completelytransparent.
So it's a negotiated thing andthere would be these alerts, but
it would be completelytransparent and it gave them
things such as it was updatedtwice a day, so if they had a
(36:38):
medication change at 11, theycould see that on their phone at
noon.
It was noon and midnight thatit would get updated.
So they had complete control.
They had their crisis plan wason their phone, their
medications, their varioustreatment objectives, and they
could create their own scales ofwhat they were monitoring.
But it would be all incommunication with their care
provider rather than purely themfocusing on their own.
And this was people with seriousmental and schizophrenia and
(37:00):
major mood disorders, right.
So you don't you want it to bethis, you know?
So I think that's an example.
I think, with the technology,um, my fear is that that if we
aren't involved with that, uh,and do it in these very
therapeutic, supporting oftherapeutic relationship ways,
we're going to end up with thesethings that are going to going
(37:22):
to interfere with thoserelationships.
So that, and I say the shortlength of stay and those
transitions between services, Ithink we have to pay attention
to as well.
Speaker 2 (37:37):
Yeah, I love that.
You know that technology kindof adds to the relationship.
You know there's a way of kindof doing that without just kind
of making it.
You just kind of making it.
You know for for lack of abetter term kind of just more
medical model, where we're justkind of checking boxes, we're
looking at symptoms and andmaking diagnoses and such so.
So yeah, thank you yeah, sorry.
Speaker 3 (37:57):
Yeah, yeah, no, no.
I say like we, we have a.
A lot of people would say therewhen they would have the
therapeutic meetings.
It was more focused becauseinstead of saying, well, how's
it been going, they had thatinformation and the patients
were able to look at patternsthemselves.
Like, hey, you know what Inoticed?
I'm most depressed on the daysI'm not doing activities, or the
(38:17):
day I talked to my mother orwhatever, and I remember a
couple of them said, becausethey were also looking at things
like blood, every time my bloodglucose goes down I'm depressed
.
And then realizing that that'sin fact what they had to deal
with.
So they could have like thislittle experiment of one,
because they could plot thosetwo things together and say, oh,
(38:38):
my goodness, there's my bloodglucose level and there's my
depression level.
And then when they come in itwas very focused saying you know
what?
I've totally been missing this.
Speaker 2 (38:48):
Yeah, yeah, something you know, they they feel seen,
they feel heard, they feel asense of control.
There's something I can do toameliorate these symptoms and
that's, and that can be a realsense of power for a patient.
Speaker 3 (38:59):
So yeah, and very focused discussions when they
would get together there.
You know they both have thesame information and they're
saying oh, I want to talk aboutthis.
Speaker 2 (39:09):
Yeah, yeah, excellent .
Well, I love that future.
That's awesome.
Thank you, dr Forchuk.
Thank you so much and thank youfor those listening.
I hope everybody's learned alittle bit.
Something had some fun.
I, you know I definitely youknow for me kind of going back
and what we talked about alittle bit today.
You know, I definitely you knowfor me kind of going back and
what we talked about a littlebit today.
You know I, um, you mentioned,dr Forchuk, about the idea of
(39:30):
these open units and that'ssomething that I actually
experienced, uh, in Iowa cityhere.
You know we have, we had, Ishould say, unfortunately the
hospital shut it down, but itwas this open, uh, open
psychiatric unit which was justkind of mind blowing at the time
that you would actually have apsychiatric unit that wasn't
locked and so didn't userestraints.
Yeah, so very, very novel and Ihadn't seen or heard of
(39:52):
anything else, at least in theUnited States.
So I'm interested that they'vehad that in other places and
around the world.
1860s, yeah, right, I know, yeah, it's a blast from the past at
the very least.
So, but that's great.
And thank you again for sharingyour stories about Dr Hildegard
Peplau.
You know I love the idea thatwe, you know, family planning,
(40:13):
got involved with your firstmeeting with her and how you,
you know, just kind of keptconnecting with her, and so I'm
hoping that that's what thispodcast does for people is
continue to connect.
You know, like-minded peoplethat we, you know, can all kind
of stay connected.
So my last plug will be tosubscribe like comment.
(40:35):
Please put comments and let usknow who you want to hear from
next, or if you want to hearfrom Dr Forchuk again, maybe
kind of make that plea and seeif she's available again.
So thank you so much and lookforward to another episode
coming soon on Pep Lau's Ghost.
Take care.
Speaker 1 (41:01):
Bye leaving so you can be.
You Got a discovery Identifyingchallenging your beliefs,
reframing your mind Negativethoughts.
Release these cognitivedistortions, decrease until they
cease.
Yeah, got a discoveryIdentifying challenging your
beliefs, reframing your mindNegative thoughts.
Release these cognitivedistortions, decrease until they
(41:24):
cease.
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