Ten years ago I practiced as a registered nurse in the field of in-patient and outpatient mental health. The settings were both adult psychiatric units that dealt with a host of issues, including depression, anxiety, bipolar disorder, substance abuse, obsessive-compulsive disorder, panic and phobia disorders, post-traumatic stress, schizophrenia, ADD, eating disorder, delirium, suicide attempts, etc. It was truly a field of its own. Mental health nursing can be in a hospital setting, such as I was, mental health centers, jails, home health agencies, the military, addiction facilities, community mental health programs, health maintenance organizations and clinics.
A psychiatric-mental health nurse must possess the following knowledge: Biologic and psychological theories of mental health and mental illness, psychotherapeutic modalities, substance abuse and dual diagnosis, care of populations at risk, community milieu as a therapeutic modality, cultural and spiritual implications of nursing care, family dynamics in mental health and illness, psychopharmacology, legal and technical factors, including documentation specific to the care of those with a mental illness.
A psychiatric-mental health nurse must possess the following skills: Comprehensive biopsychosocial assessment, interdisciplinary collaboration, identification and coordination of relevant resources for clients and families, use of psychiatric diagnostic classification systems, therapeutic communication, therapeutic use of self, psychoeducation with clients and families, and administering and monitoring psychopharmacologic agents.
Mental health registered nurses work with individuals, families, groups, and communities to assess mental health needs, develop diagnoses, and plan, implement and evaluate nursing care. The nursing practice is characterized by interventions that promote and foster health, assess dysfunction, assist clients to regain or improve their coping abilities and prevent further disability. These interventions focus on psychiatric-mental health clients and include health promotion, preventive management of a therapeutic environment, assisting client with self-care activities, administering and monitoring psychobiological treatment regimens, health teaching (including psychoeducation; crisis intervention, counseling and case management).
The psychiatric nurse is usually one of the first people a patient will encounter when he/she is admitted to a mental facility. The nurse will be monitoring the patient’s plan of care and implementing the doctors’ orders. The plan of care is tailored for each patient individually. It is used to help form a well-rounded nursing relationship with the patient and addresses every specific problem. As with any field of nursing, these plans need to be updated and progress reporting to the doctor and other nursing staff is necessary. It is especially important for psychiatric nurses to be aware of his/her demeanor. This provides confidence in a caregiver as well as trust. Excellent communication skills and listening skills through maintaining eye contact are two key elements for the patient to know that the nurse is approachable. Additionally, the mental health nurse needs to be ready to deal with conflict; he/she can still be assertive without being threatening.
It is very important to educate both the patients and their families. This education can extend from the very basic care to teaching the individual about the medications they are taking and their condition. Psychiatric nurses might also teach groups about certain techniques or subjects within mental health. Further, it is the nurse’s job to stand up for her patients’ rights as individuals. If someone has taken advantage of the patient or even abused the patient in some way, this needs to be reported. If the nurse notices a mistake in the treatment plan, that needs to be reported. Many mistakes have been corrected because of an observant nurse. Bottom line, the nurse needs to step up and take that advocate role, making sure her patients get the best possible care.
In mental health nursing it is also important to note that some patients may have what is referred to as ‘dual-diagnosis’. When done properly, dual diagnosis can treat both disorders and help the patient lead a normal life. In these particular situations, the patient will have a psychiatric or emotional problem in addition to a substance abuse problem.
Mental health nursing is, indeed, a field of its own. It is difficult, yet rewarding, particularly when you have a breakthrough with a patient. Both the patient and the family are extremely appreciative when the psychiatric nurse helps to achieve a better quality of life. It is a specialized area of nursing practice – one that is based on theories of human behavior as its science and the ‘therapeutic use of self’ as its art. The elements of the nurse-patient relationship have evolved into a nurse-patient partnership, which includes the elements of clinical competence, patient-family advocacy, fiscal responsibility, interdisciplinary collaboration, social accountability and legal-ethical parameters.