FUNCTIONS OF MENTAL HEALTH NURSE IN VARIOUS SETTINGS
Practice Setting for Psychiatric Nurses
For many years, the majority of mental health care was provided in the hospital setting. Since the 1970s, the trend has changed to treat patients in less restrictive or community based settings.
While traditional practice settings for psychiatric nurses are psychiatric hospitals, community mental health centers, psychiatric units in the general hospitals, residential treatment facilities and private clinics, more recently alternative treatment settings have emerged. These are partial hospitalization settings, day care centers, home care, outpatient departments or ambulatory care centers. Community based treatment settings have expanded to group homes, hospice, care centers, crisis intervention centers, schools and universities, hospitals for the criminally insane, jails and prisons.
FUNCTIONS OF PSYCHIATRIC NURSE IN VARIOUS SETTINGS
Inpatient Psychiatric Ward
- Provide for environmental safety including protecting the patient and others from injury.
- Perform psychosocial, high-risk and physical assessment.
- Promotion of self-care activities.
- Medication management
- Assisting for somatic therapies
- Accurately observing and documenting the patient’s behavior.
- Providing opportunities for the patient to make his own decisions and to assume responsibility for his life.
- Providing feedback to the patient based on observations of his behavior
- Participation in various therapies, (psychotherapy, behavior therapy, group therapy, play therapy, family therapy, etc.) individual interactions, formal and informal group situations, role play, advocating on behalf of the patient and so forth.
- Delivering psychoeducation
- Counseling the patient and family members
- Cooperating with other professionals in various aspects of the patient care thereby facilitating an interdisciplinary approach to care
- Teaching social skills and stress management strategies
- Discharge planning and community referral and follow-up care
- Supervise the work of subordinated
- Maintain ward cleanliness
Psychiatric Outpatient Department
- Performing clinical assessment
- Assisting for psychometric assessment
- Assisting or providing psychotherapy or behavior therapy
- Counseling the patient and family members
- Conducting group therapy
- Delivering psychoeducation
ECT Treatment Setting
- Teaching the patient prior to ECT treatment
- Preparing the patient for ECT
- Providing care during the procedure
- Assisting with post-treatment
- Providing reassurance to reduce anxiety
- Delivering psychoeducation regarding ECT.
Psychotherapy Unit
Nurses who possess a masters degree in psychiatric nursing and are certified clinical nurse specialists may conduct individual or group psychotherapy.
- Establishing a therapeutic relationship with the patient
- Providing an opportunity for the patient to release tension as problems are discussed
- Assisting the patient in gaining insight about the problem
- Providing opportunity to practice new skills
- Reinforcing appropriate behavior as it occurs
- Providing consistent emotional support
Day Care Centers or Day Hospitals
In day treatment programs patients return home at night.
- Performing clinical assessment
- Accurately observing and documenting the patient’s behavior
- Medication management
- Teaching social skills
- Counseling patient and family members
- Delivering psychoeducation
- Providing occupational or recreational therapy and vocational assistance
Family Therapy Units
Psychiatric nurses’ work with families at all levels of functioning
- Assessing individual and family needs and resources
- Facilitation of a family’s use of positive coping strategies
- Promote adaptive family functioning by teaching communication skills and problem solving skills
- Delivering psychoeducation
Child Psychiatric Ward
- Assessing for biological and psychological need of the child
- Determine the child’s strengths and abilities and develop a care plan to maintain and enhance capabilities
- Monitor the child’s developmental levels and initiate supportive interventions, such as speech, language or occupational skills as needed
- Provide a safe therapeutic environment, including protecting the child and others from injury
- Cooperate with other professionals in an interdisciplinary approach to care
- Provide adequate environment stimulation
- Teach the child adaptive skills, such as eating, dressing, grooming and toileting
- Demonstrate and help the child to practice self care skills
- Provide genetic counseling if necessary
- Deliver psychoeducation
- Medication management
- Provide emotional support to the parents
- Participate in various therapies (behavior therapy, play therapy, expressive therapies, bibliotherapy, etc.)
Home Setting
- Assessment of symptoms
- Teaching the patient and family regarding nutrition, exercise, hygiene and the relationship between physical and emotional health.
- Stress management
- Daily living skills (basic money management, for example, bank accounts, rent, utility bills, use of the telephone, grocery shopping etc.,)
- Medication management – monitoring blood levels, signs and symptoms of overdose or toxicity, teaching on dosage, side effects and purposes.
- Administration of parenteral injections
- Venipuncture for laboratory analysis
- Act as a case manager and coordinate an array of services that include physical therapy, occupational therapy, social work and community services
- Appropriate referrals to community agencies
- Provide supportive counseling and brief psychotherapy
- Promotion of mental health and prevention of mental illnesses.
Community Mental Health Centers
- Identification of patients in the community
- Refer the patients to appropriate hospitals
- Home visiting and providing direct care to the patients in the community
- Follow up care with special emphasis on medication regimen, improvement made and side effects, patient’s occupational function
- Conducting public awareness programs to remove misconceptions regarding mental disorders
- Training of paraprofessional, community leaders, school teachers and other care giving professionals in the community
- Management of resources planning and coordination
- Direct services, like care of families at risk for violence, abuse and dysfunction, care of homeless mentally ill patients, etc.,
Various Roles of Community Psychiatric Nurse
- Addiction counselor
- Counselor
- Crisis worker
- Advocate
- Case manager
- Educator
- Researcher
- Community developer and consultant
Hospice Care Centers
- Helping cancer patients or terminally ill individuals through the grieving process
- Provide supportive psychotherapy
- Provide support groups for families of terminally ill patients.
Emergency Departments
- Crisis intervention during natural disasters, accidents, unexpected illnesses causing increased anxiety, stress or immobilization
- Obstetric nursing centers
- Helping the mother in labor and support person to cope with anxiety/stress during labor
- Providing support to bereaved parents in the event of fetal demise, abortion, birth of an infant with congenital abnormalities
Medical Inpatient Wards
Psychosocial intervention for chronic illnesses with major psychological effects, e.g. Alzheimer’s disease, multiple sclerosis, hemophilia, colostomy, amputation, etc.
Industrial Medical Centers
- Implementing or participating in industrial substance abuse programs for employees
- Providing crisis intervention during accidents or the acute onset of a physical or mental illness (for example, heart attack)
- Teaching stress management
Hospitals for Criminal Insane, Jails and Prisons
- Forensic psychiatric nurses assist patients with self-care, administration of medications and monitor the effectiveness of the treatment
- Promote coping skills
- Advanced nurses are able to diagnose and treat individuals with psychiatric disorders and are allowed to prescribe medications
- Provide psychotherapy and act as consultants
- Forensic evaluation for legal sanity
- Assessment of potential for violence
- Parole/probation considerations
- Assessments of racial/cultural factors during crime
- Sexual predator screening and assessment
- Competency therapy
- Formal written reports to court
- Review of police reports
- On scene consultation to law enforcement.
