Mental health nursing
Psychiatric nursing or mental health nursing is the appointed position of a
Mental health nurses receive specific training in psychological therapies, building a therapeutic alliance, dealing with challenging behaviour, and the administration of psychiatric medication.
In most countries, after the 1990s, a psychiatric nurse would have to attain a bachelor's degree in nursing to become a Registered Nurse (RN), and specialise in mental health. Degrees vary in different countries, and are governed by country-specific regulations. In the United States one can become a RN, and a psychiatric nurse, by completing either a diploma program, an associate (ASN) degree, or a bachelor's (BSN) degree.
Mental health nurses can work in a variety of services, including: Child and Adolescent Mental Health Services (CAMHS), Acute Medical Units (AMUs), Psychiatric Intensive Care Units (PICUs), and Community Mental Health Services (CMHS).
History
![Civilian Public Service -93, Harrisburg, Pennsylvania, psychiatric nursing class (8389167373)](http://upload.wikimedia.org/wikipedia/commons/thumb/7/7c/Civilian_Public_Service_-93%2C_Harrisburg%2C_Pennsylvania%2C_psychiatric_nursing_class_%288389167373%29.jpg/220px-Civilian_Public_Service_-93%2C_Harrisburg%2C_Pennsylvania%2C_psychiatric_nursing_class_%288389167373%29.jpg)
The history of
In 13th century medieval Europe, psychiatric hospitals were built to house the mentally ill, but there were not any nurses to care for them and treatment was rarely provided. These facilities functioned more as a housing unit for the insane.[2] Throughout the high point of Christianity in Europe, hospitals for the mentally ill believed in using religious intervention. The insane were partnered with "soul friends" to help them reconnect with society. Their primary concern was befriending the melancholy and disturbed, forming intimate spiritual relationships. Today, these soul friends are seen as the first modern psychiatric nurses.[3]
In the colonial era of the United States, some settlers adapted community health nursing practices. Individuals with mental defects that were deemed as dangerous were incarcerated or kept in cages, maintained and paid fully by community attendants. Wealthier colonists kept their insane relatives either in their attics or cellars and hired attendants, or nurses, to care for them. In other communities, the mentally ill were sold at auctions as slave labor. Others were forced to leave town.[4] As the population in the colonies expanded, informal care for the community failed and small institutions were established. In 1752 the first "lunatics ward" was opened at the Pennsylvania Hospital which attempted to treat the mentally ill. Attendants used the most modern treatments of the time: purging, bleeding, blistering, and shock techniques. Overall, the attendants caring for the patients believed in treating the institutionalized with respect. They believed if the patients were treated as reasonable people, then they would act as such; if they gave them confidence, then patients would rarely abuse it.[4]
The 1790s saw the beginnings of moral treatment being introduced for people with mental distress.[5] The concept of a safe asylum, proposed by Philippe Pinel and William Tuke, offered protection and care at institutions for patients who had been previously abused or enslaved.[5] In the United States, Dorothea Dix was instrumental in opening 32 state asylums to provide quality care for the ill. Dix also was in charge of the Union Army Nurses during the American Civil War, caring for both Union and Confederate soldiers. Although it was a promising movement, attendants and nurses were often accused of abusing or neglecting the residents and isolating them from their families.[5]
The formal recognition of psychiatry as a modern and legitimate profession occurred in 1808.[2] In Europe, one of the major advocates for mental health nursing to help psychiatrists was Dr. William Ellis. He proposed giving the "keepers of the insane" better pay and training so more respectable, intelligent people would be attracted to the profession. In his 1836 publication of Treatise on Insanity, he openly stated that an established nursing practice calmed depressed patients and gave hope to the hopeless.[3] However, psychiatric nursing was not formalized in the United States until 1882 when Linda Richards opened Boston City College. This was the first school specifically designed to train nurses in psychiatric care.[6]
The discrepancy between the founding of psychiatry and the recognition of trained nurses in the field is largely attributed to the attitudes in the 19th century which opposed training women to work in the medical field.[1]
In 1913
In 1963, President John F. Kennedy accelerated the trend towards deinstitutionalization with the Community Mental Health Act. In 1964, the Civil Rights Act was passed, which made it illegal for an organization to discriminate if federally funded. Despite this ruling, certain states such as Mississippi and Alabama fought these laws in court, promoting segregation within healthcare.[7][8] Moreover, since psychiatric drugs were becoming more available allowing patients to live on their own and the asylums were too expensive, institutions began shutting down.[3] Nursing care thus became more intimate and holistic. Expanded roles were also developed in the 1960s allowing nurses to provide outpatient services such as counseling, psychotherapy, consultations, prescribing medications, along with the diagnosis and treatment of mental illnesses.[6]
The first developed standard of care was created by the psychiatric division of the American Nurses Association (ANA) in 1973. This standard outlined the responsibilities and expected quality of care of nurses.[5]
In 1975, the government published a document called "Better Services for the Mentally Ill" which reviewed the current standards of psychiatric nursing worldwide and laid out better plans for the future of mental health nursing.[9]
Global health care underwent huge expansions in the 1980s; this was due to the government's reaction from the fast increasing demand on health care services. The expansion was continued until the economic crisis of the 1970s.[9]
In 1982, the Area Health Authorities was terminated.[9]
In 1983, better structure of hospitals was implemented. General managers were introduced to make decisions, thus creating a better system of operation. The year 1983 also saw a lot of staff cuts which were heavily felt by all the mental health nurses. However, a new training syllabus was introduced in 1982, which offered suitable knowledgeable nurses.[9]
The 2000s have seen major educational upgrades for nurses to specialize in mental health as well as various financial opportunities.[9]
Interventions
Nursing interventions may be divided into the following categories:[6]
Physical and biological interventions
Psychiatric medication
Electroconvulsive therapy
Psychiatric mental health nurses are also involved in the administration of the treatment of electroconvulsive therapy and assist with the preparation and recovery from the treatment, which involves anesthesia. This treatment is only used in a tiny proportion of cases and only after all other possible treatments have been exhausted. Nurses may also be involved in gaining consent for this procedure.[11] However, consent arrangements vary depending on the jurisdiction in which the treatment takes place.
Physical care
Along with other nurses, psychiatric mental health nurses will intervene in areas of physical need to ensure that people have good levels of personal hygiene, nutrition, sleep, etc., as well as tending to any concomitant physical ailments. In mental health patients, obesity is not rare because some medications can have a side effect of gaining weight which can cause the patient to have low confidence and lead to other health issues.[12] To fix this problem, mental health nurses are urged to encourage patients to get more exercise to enhance their physical health, along with their mental health by improving the patients confidence and lowering stress levels, improving their mental health which has been a focus for mental health nurses because many patients do not get enough exercise.[12] Nurses may also need to help the patients with alcohol or drug abuse because mental health patients are at a higher risk for this behavior.[12] Mental health nurses need to be able to communicate to patients about this. The alcohol and drug abuse could cause the patient to also have a higher risk of sexually transmitted diseases because alcohol and drugs can lead to more sexual behavior.[12]
Psychosocial interventions
Psychosocial interventions are increasingly delivered by nurses in mental health settings. These include
Spiritual interventions
The basis of this approach is to look at mental illness or distress from the perspective of a
Therapeutic relationship
As with other areas of
Therapeutic relationship aspects of psychiatric nursing
![](http://upload.wikimedia.org/wikipedia/commons/thumb/1/13/Navy_nurse_corps_1908.jpg/220px-Navy_nurse_corps_1908.jpg)
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.[16]
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.[17] The expression of thoughts and feelings should be encouraged without blaming, judging, or belittling.[18] 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.[19] 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.[16] 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.[20] 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.[21] 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.[22]
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.[19] Minor activities, such as shopping, reading the newspaper together, or taking lunch or dinner breaks with patients can improve the quality of support provided.[23] Physical support may also be used and is manifested through the use of touch.[23] Patients described feelings of connection when nurses hugged them or put a hand on their shoulder.[19] Psychiatric nurses in Berg and Hallberg's study described an element of a working relationship as comforting through holding a patient's hand.[16] Patients with depression described relief when the nurse embraced them.[17] 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.[21] The outcome results in nurses making every effort to attain a non-biased point of view.[21] 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.[24] In his article about pivotal moments in therapeutic relationships, Welch found that nurses must be in accordance with their values and beliefs.[25] Along with the previous concept, O'Brien [26] concluded that being consistent and reliable in both punctuality and character makes for genuinity. Schafer and Peternelj-Taylor [20] believe that a nurses 'genuineness' is determined through the level of consistency displayed between their verbal and non-verbal behaviour. Similarly, Scanlon[27] found that genuineness was expressed by fulfilling intended tasks. Self-disclosure proves to be the key to being open and honest.[28] 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.[28] 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.[19] The friendship of a therapeutic relationship is different from a sociable friendship because the therapeutic relationship friendship is asymmetrical in nature.[19] 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.[29] Psychiatric nurses convey themselves as team members or facilitators of the relationship, rather than the leaders.[19] By empowering the patient with a sense of control and involvement, nurses encourage the patient's independence.[19] 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.[30]
Demonstrating respect
To develop a quality therapeutic relationship, nurses need to make patients feel respected and important.[21] Accepting patient faults and problems is vital to convey respect—helping the patient see themselves as worthy and worthwhile.[18]
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,[31] and instills the patient with feelings of safety and containment.[23] Limit setting also protects the nurse from "burnout",[23] preserving personal stability—thus promoting a quality relationship.
Demonstrating self-awareness
Psychiatric nurses recognise personal vulnerability in order to develop professionally.[24] Humanistic insight, basic human values, and self-knowledge improves the depth of understanding the self.[32] 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.[26] Interpersonal skills needed to form relationships with patients were acquired through learning about oneself.[27] Clinical supervision was found to provide the opportunity for nurses to reflect on patient relationships,[33] to improve clinical skills,[32] and to help repair difficult relationships.[34] The reflections [21] 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.[35]
Profession status
Canada
The registered psychiatric nurse is a distinct nursing profession in all of the four western provinces. Such nurses carry the designation "
Ireland
In Ireland, mental health nurses undergo a 4-year honors degree training programme. Nurses that trained under the diploma course in Ireland can do a post graduation course to bring their status from diploma to degree.[citation needed]
New Zealand
Mental Health Nurses in New Zealand require a diploma or degree in nursing. All nurses are now trained in both general and mental health, as part of their three-year degree training programme. Mental health nurses are often requested to complete a graduate diploma or a post graduate certificate in mental health, if they are employed by a District Health Board. This gives additional training that is specific to working with people with mental health issues.[citation needed]
Sweden
In Sweden, to become a registered psychiatric nurse one must first become a registered nurse which requires a BSc. (Bachelor of Science) in Nursing (three years of full-time study, 180 higher education credits). Then, one must complete one year of graduate studies in psychiatric/mental health nursing (60 higher education credits), which also includes writing a MSc. (Master of Science) thesis.[36] The registered psychiatric nurse is an evolving profession in Sweden. However, unlike in countries such as the US, there is no psychiatric-mental health nurse practitioner, so in Sweden, the profession cannot for example prescribe pharmacological treatment.[37]
United Kingdom
In the
RMNs can continue into further training as Advanced Nurse Practitioners (ANPs): this requires completion of a 9-month Master's programme. The role includes prescribing medications, being on call for hospital wards and delivering psychosocial interventions to clients.
United States
In North America, there are three levels of psychiatric nursing.
- The licensed vocational nurse (licensed practical nurse in some states) and the licensed psychiatric technicianmay dispense medication and assist with data collection regarding psychiatric and mental health clients.
- The registered nurse or registered psychiatric nurse has the additional scope of performing assessments and may provide other therapies such as counseling and milieu therapy.
- The advanced practice registered nurse (APRN) either practices as a clinical nurse specialist or a nurse practitioner after obtaining a master's degree in psychiatric-mental health nursing. Psychiatric-mental health nursing (PMHN) is a nursing specialty. The course work in a master's degree program includes specialty practice. APRNs assess, diagnose, and treat individuals or families with psychiatric problems/disorders or the potential for such disorders, as well as performing the functions associated with the basic level.[38]They provide a full range of primary mental health care services to individuals, families, groups and communities, function as psychotherapists, educators, consultants, advanced case managers, and administrators. In many states, APRNs have the authority to prescribe medications. Qualified to practice independently, psychiatric-mental health APRNs offer direct care services in a variety of settings: mental health centers, community mental health programs, homes, offices, HMOs, etc.
Psychiatric nurses who earn doctoral degrees (PhD, DNSc, EdD) often are found in practice settings, teaching, doing research, or as administrators in hospitals, agencies or schools of nursing.
Australia
In Australia, to be a psychiatric nurse a bachelor's degree of nursing need to be obtained in order to become a registered nurse (RN) and this degree takes three years full-time.[39] Then a diploma in mental health or something similar will need to also be obtained, this is an additional year of study. An Australian psychiatric nurse has duties that may include assessing patients who are mentally ill, observation, helping patients take part in activities, giving medication, observing if the medication is working, assisting in behaviour change programs or visiting patients who are at home. Australian nurses can work in public or private hospitals, institutes, correctional institutes, mental care facilities and homes of the patients.[40]
See also
- List of counseling topics
- Mental health professional
- Psychiatric and mental health nurse practitioner
- Tom Main- author of seminal paper on psychiatric nursing
- Hildegard Peplau - psychiatric nurse theorist
- Tidal Model - model developed for mental health nursing
References
- ^ a b Alfredo, D. (2009). The History of Psychiatric Nursing. [full citation needed]
- ^ a b c Alexander, F.; Selesnick, S. T. (1967). The History of Psychiatry: An Evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present. Michigan: Allen and Unwin.[page needed]
- ^ a b c d e Nolan, P. (1993). A History of Mental Health Nursing. United Kingdom: Stanley Thornes Ltd.[page needed]
- ^ a b Levine, M. (1981). The History and Politics of Community Mental Health. United States: Oxford Press.[page needed]
- ^ ISBN 9780781764254.[page needed]
- ^ ISBN 978-0-397-55178-1.[page needed]
- ^ Smith, Kylie M. (July 6, 2020). "Discrimination and Racism in the History of Mental Health Care". NAMI: National Alliance on Mental Illness. Retrieved 2023-01-27.
- ^ "Discrimination and Racism in the History of Mental Health Care | NAMI: National Alliance on Mental Illness".
- ^ ISBN 9780748737215.[page needed]
- PMID 30764821.
- ISBN 978-0-323-29415-7.
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- ISBN 978-1-85302-804-5.[page needed]
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- ^ "Resources". IPN. Retrieved 2021-09-20.
- ^ "Specialistsjuksköterskeprogrammet med inriktning mot psykiatrisk vård" (In Swedish). University of Gothenburg. Accessed: January 26, 2018. URL: https://utbildning.gu.se/program/program_detalj/?programid=V2PSV
- ^ "Kompetensbeskrivning för legitimerad sjuksköterska med specialistsjuksköterskeexamen, inriktning psykiatrisk vård". (In Swedish). The Swedish Society of Nursing. Accessed: 26 January 2018. URL: https://www.swenurse.se/globalassets/01-svensk-sjukskoterskeforening/publikationer-svensk-sjukskoterskeforening/kompetensbeskrivningar-publikationer/kompetensbeskrivning.sjukskoterska.psykiatri.2014.pdf
- ^ APNA About Psychiatric Mental Health Nurses
- ^ "Mental health nurse workforce". mhsa.aihw.gov.au. Retrieved 2016-05-10.
- ^ "About MH Nursing". www.acmhn.org. Retrieved 2016-05-10.
External links
- "Mental Health Nurse Job Profile".
- "The Nursing and Midwifery Council's Code of Conduct".
- "Creating a Nursing Portfolio". YouTube. Archived from the original on 2021-12-21.
- "A Day in the Life of a Psychiatric Nurse". YouTube. Archived from the original on 2021-12-21.
- "Nursing Careers: A Career in Mental Health Nursing". YouTube. Archived from the original on 2021-12-21.
- Keyes, Corey L. M. (July 2006). "Mental health in adolescence: Is America's youth flourishing?". American Journal of Orthopsychiatry. 76 (3): 395–402. PMID 16981819.
- Galderisi, Silvana; Heinz, Andreas; Kastrup, Marianne; Beezhold, Julian; Sartorius, Norman (2015). "Toward a new definition of mental health". World Psychiatry. 14 (2): 231–233. PMID 26043341.