Psychiatric Mental Health Nursing

1. Psychiatric Mental Health Nursing

2. Overview of Psychiatric/Mental Health Nursing Outline • Similarities & differences between psychiatric nursing and other fields of nursing • Skills & knowledge of the psychiatric nurse

3. Overview of Psychiatric/mental Health Nursing • The importance of psychiatric nursing skills in all clinical settings • Career opportunities • Postgraduate study & endorsement • Professional affiliation

4. The Psychiatric/mental Health Nurse • “Mental Health Nursing is a specialised field of nursing which focuses on meeting the mental health needs of the consumer, in partnership with family, significant others and the community in any setting. It is a specialised interpersonal process embodying a concept of caring….” (p. 3) ANZCMHN (1995)

5. The Essence of Psychiatric/mental Health Nursing • Lies not in tasks performed or with the presenting illness but in the relationship that develops with clients and families and their responses to the illness, including the impact that the illness has on their lives. • The essence is in establishing a ‘therapeutic partnership’, a connectedness, between the nurse and client which is based on empathy and trust. Elsom (2001)

6. Similarities & Differences SIMILARITIES • Work in close contact with people from a wide variety of backgrounds • Provide CARE for people with a wide variety of illnesses • Involved in health promotion and illness prevention • Nursing philosophy of benevolence

7. Similarities & Differences SIMILARITIES • Education: must meet required level of knowledge and skills to attain registration/endorsement • Governed by the Nurses Codes – Professional Conduct & Ethics • Structure of work hours, salary, benefits

8. Similarities & Differences DIFFERENCES Core focus of Psychiatric Mental Health Nursing • Therapeutic relationship • Use of self as a therapeutic tool • People-centred approach, engaging clients in discourse, promoting change • Less task orientated • Less technical environment • Professional autonomy Moir & Abraham (1996)

9. Similarities & Differences DIFFERENCES • Clinical competence based on interpersonal techniques Stuart & Laraia (2001) • Less repetition in process & procedures due to client individuality Moir & Abraham (1996)

10. Philosophy of the Profession Each individual: • Has intrinsic worth and dignity and each person is worthy of respect. • Has the potential to change. • Has common, basic human needs… • Varies in their coping capacities

11. Philosophy of the profession Each individual(s): • Behaviour is meaningful… • Has a right to equal opportunity for adequate health care. • Has the right to participate in decision making regarding their care. • Has the right to self-determination…

12. Philosophy of the profession The fundamental premise is: The goal of nursing care is to promote wellness, maximise integrated functioning….nursing care is based on mutually determined needs and expected treatment outcomes.. An interpersonal relationship can produce change and growth within the individual…. Stuart & Laraia (2001, p. 7)

13. The Knowledge, Skills & Attitudes of the Psychiatric/mental Health Nurse The knowledge base of the psychiatric/mental health nurse is grounded in the integration of the biological, psychological, spiritual, social and environmental realms of the human experience. Stuart & Laraia (2001)

14. The Knowledge, Skills & Attitudes of the Psychiatric/mental Health Nurse • Broad context of care • Requires purposeful use of self as a therapeutic tool • “Knowing you, Knowing me” (Awareness of self) Barker, Jackson & Stevenson (1999) • Requires great sensitivity to the social environment & advocacy needs of clients/families • Requires careful consideration of legal & ethical issues

15. The Knowledge, Skills & Attitudes of the Psychiatric/mental Health Nurse THERAPEUTIC NURSE-CLIENT RELATIONSHIP • Physical dimension • Safety dimension • Social dimension • Spiritual dimension • Provision of treatment modalities • Encouraging self-determination • Provision of information Cowman, Farrelly & Gilheany (2001)

16. The Knowledge, Skills & Attitudes of the Psychiatric/mental Health Nurse • Milieu management • Assessing, planning, implementing & evaluating care • Pharmacological interventions • Documentation/Administration • Legal requirements • Educating/supervision • Coordination/Multidisciplinary team member

17. The Importance of Psychiatric/mental Health Nursing Knowledge, Skills & Attitudes In Australia, one in five persons will at some stage in their lives, experience a major mental illness. Commonwealth Department of Health and Aged Care Services (1997)

18. The Importance of Psychiatric/mental Health Nursing Knowledge, Skills & Attitudes • Exposure to clients with mental health problems or illness in any area of practice • Skills will assist the nurse to provide comfort to clients who may be experiencing a myriad of emotions. I.e. grief, anxiety, anger, cognitive deficits and subsequent behaviour, and diagnosed mental illness

19. The Importance of Psychiatric/mental Health Nursing Knowledge, Skills & Attitudes • Mental state assessment skills • Early intervention - reduced stays, improved recovery rates. Improved client outcomes • Nurse more comfortable, confident in working with clients with mental illness

20. Career Opportunities • Diversity within the profession • Attractive transferable skills • Consultation • Management • Education • Independent Practitioner

21. Career Opportunities DIVERSITY • Public & Private Mental Health Services • In-Patient Facilities • Out-patient or Day-patient Programs • Crisis Assessment & Treatment Teams • Community Teams • Consultation-Liaison Mental Health Nurse

22. Career Opportunities DIVERSITY • Adult Acute • Community • Adult Rehabilitation • Child & Adolescent • Aged Mental Health • Forensic • Specialty Programs: I.e. Eating Disorders, Substance Abuse Treatment, Cognitive Behavioural Programs, Parent-Infant.

23. Career Opportunities • Career structure • Professional development • Clinical supervision • Scholarships • Graduate nurse Programs • Postgraduate Study • Paid study leave

24. Postgraduate Study & Endorsement • Postgraduate studies in Psychiatric/Mental Health Nursing • Graduate Diploma • Graduate Certificate • Endorsement by the NBV (Where relevant) • Highly attractive to prospective employers

25. Professional Affiliation • Australian Collage of Mental Health Nurses ACMHN. Standards of Practice • Centre for Psychiatric Nursing (CPN)

26. Reflection “Nurses are ‘traveling companions’ with patients, not ‘travel agents’… the heart (of nursing) is the skills and values needed by nurses to establish and maintain human contact with patients.” Peck & Norman (1999)

27. References • Australian and New Zealand Collage of Mental Health Nurses Inc. (ANZCMHN) (1995). Standards of Practice for Mental Health Nursing in Australia Adelaide: ANZCMHN Inc. • Barker, P., Jackson, S. & Stevenson, C. (1999). What are psychiatric nurses needed for? Developing a theory of essential nursing practice Journal of Psychiatric and Mental Health Nursing 6, 273-282. • Commonwealth Department of Health and Aged Care Services. (1997). National Mental Health Report 1996: Fourth Annual Report, Changes in Australia’s Mental Health Services under the National Mental Health Strategy 1995-6. Canberra: Australian Government Printing Services

28. References • Cowman, S., Farrelly, M. & Gilheany, P. (2001). An examination of the role and function of psychiatric nurses in clinical practice in Ireland Journal of Advanced Nursing 34(6), 745-753. • Elsom, S. (2001). The active participants in Mental Health Services. In Meadows, G. & Singh, B. (Ed.), Mental Health in Australia, Collaborative Community Practice (pp. 136-162). Melbourne: Oxford University Press. • Grigg, M. (2001) The role of the psychiatric nurse. Australasian Psychiatry 9(2), 143-145. • Peck, E. & Norman, I. (1999). Working together in adult community mental health services: exploring inter-professional role relations. Journal of Mental Health 8, 231-242