SCOPE OF MENTAL HEALTH NURSING
Psychiatric mental health nursing is a specialized area of nursing practice which uses nursing, neurobiological and psychosocial theories and research evidence as its science and purposeful use of self as its art, to promote mental health through the assessments, diagnosis and treatment of human responses to mental health problems and psychiatric disorders.
Psychiatric nurses provide patient centered comprehensive pyschiatric care in a variety of settings across the entire continuum of care. The continuum of care levels span from illness to wellness states. The primary goal of a continuum of care is to provide treatment that allows the patient to achieve the highest level of functioning in the least restrictive environment.
The essential components of psychiatric nursing practice include promotion of mental health, prevention of mental health problems, care and treatment of persons with psychiatric disorders and rehabilitation of mentally ill individuals.
The areas of concern for a psychiatric nurse include a wide range of actual or potential mental health problems, such as:
- Promotion of well-being, mental and physical health.
- Prevention of mental illnesses.
- Emotional stress or crises related to illness, pain, disability and loss
- Impaired ability to function related to mental health problems
- Alteration in thinking, perceiving and communicating due to mental health problems.
- Behavioral and mental states that indicate potential danger to self or others
- Self-concept and body image changes, developmental issues, life process changes, physical symptoms that occur due to psychological changes.
- Psychological symptoms that occur along with altered physiological status
- Side effects or complications associated with psychopharmacological interventions and other treatment modalities
- Alcohol and substance abuse and dependence problems
- Interpersonal, organizational or other environmental circumstances and their effects on mental well-being of the individual, family and community.
Today, the scope of mental health nursing is not restricted within the confines of the bedside nursing care. A mental health nurse needs to be skilled and clinically competent, sensitive to the social environment, the advocacy needs of the patients and their families as well as be aware of the legal and ethical dilemmas.
Roles of the Psychiatric-Mental Health Nurse in Contemporary Mental Health Care
Trends and issues in the health care system affect the roles of the psychiatric-mental health nurse. Although psychiatric nurses have traditionally worked on impatient psychiatric units, they have continued to expand their role into the community.
There are two levels of psychiatric-mental health nurses: The generalist (registers psychiatric nurse) and the specialist (CNS). The scope and roles of both are guided by nurse practice acts and by standards of care.
Role of the Generalist
The psychiatric mental health generalist nurse is a licensed registered nurse for delivering primary mental health care. It incorporated both physical and mental health care. Generalist exercises a holistic approach to practice and performs psychiatric nursing in prevention programs, community and day treatment centers, psychiatric rehabilitation facilities, homeless shelters and may other settings.
Role of the Specialist
Psychiatric clinical Nurse Specialist (CNS) holds a masters degree in psychiatric mental health nursing. CNS is an advanced practice nurse who is usually a primary health care provider, functions autonomously, often works in a semi-isolated situation, has medication prescription privileges (depending on individual state laws), manages the overall care of people with emotional and psychiatric problems, and usually has a consultative arrangements with a psychiatrist. For example, the advanced practice nurses in Minnesota are psychotherapists, consultants, milieu specialists, role models, teachers, administrators, crisis intervention specialists and co-coordinators.
Community Mental Health Nurse
Community mental health nursing (CMHN) is the application of knowledge of psychiatric nursing in preventing mental illness, promoting and maintaining mental health of the people. It includes early diagnosis, appropriate referrals, care and rehabilitation of mentally ill people.
Psychiatric Home Care Nurse
Home health care is one aspect of community health nursing. Psychiatric home care nurses provide holistic psychiatric nursing care in a visiting basis to people needing assistance. These nurses provide comprehensive care, including psychiatric and physical assessment, direct nursing care, behavioral management crisis intervention, psycho education, in-home detoxification, medication management, case management and consultation with colleagues.
Forensic Psychiatric Nurse
Forensic nursing is a growing specialty in other countries around the globe, especially in the UK, Australia, Germany, Japan and Canada and it is an expanded scope of practice. The forensic psychiatric nurse works with individuals who have mental health needs and who have entered the legal system.
Nurses in this role perform physical and psychiatric assessment and develop plans of care for the patients entrusted to their care.
Psychiatric Consultation-Liaison Nurse
Psychiatric consultation-liaison nurse (PCLN) has arisen in response to the increased recognition of the importance of psychophysiological inter-relationships and their impact on physical illness, recovery and wellness. It is an advanced practice nurse who practices psychiatric and mental health nursing in a medical setting/non-psychiatric setting providing consultation and education to patients, families, and health care team and the community. PCLN may provide assessment, recommendations and supportive therapy to patients who are anxious, depressed or experiencing other psychological problems or emotional distress.
Nurse case managers act as advocates for patients and their families by coordinating care and linking the patient with the physician, other members of the healthcare team, resources and the payers.
Factors that indicate the need for a nurse case manager include:
- A complex treatment plan that requires coordination
- An injury or illness that may permanently prevent the patient form returning to a previous level of health
- Pre-existing medical condition that may complicate or prolong recovery
- A need for assistance in accessing healthcare resources
- Environmental stressors that may interfere with recovery
In the community, the case manager works with patients on a broad range of issues from accessing needed medical and psychiatric services to carrying out tasks of daily living such as using public transportation, managing money and buying groceries.
Case management can be provided by an individual or a team. It may include both face-to-face and telephone contact with the patient as well as contact with other service providers.
One of the most valuable assests case managers possess is their ability to synthesize patient data and act as conduits between patients and the health care system.
Geronursing is expanding the psychiatric nursing practice to aged people who have been affected by emotional and behavioral disorders such as dementia, chronic schizophrenia, delirium, etc.,
Parish nursing is another area of expansion in the role of a psychiatric nurse. Parish nursing is a program that promotes health and wellness of body, mind and spirit. The parish nurse is a pastorally called, spiritually mature, licensed registered nurse, with a desire to serve the members and friends of his or her congregation. In 1998, the American Nursing Association recognized parish nursing as a specialty focusing in disease prevention and health promotion. It is a noninvasive type of nursing in which no hands-on nursing care is provided; rather parish nurses are conduits of health information, support and social services. They evaluate the unique needs of various age groups within the congregation, including children, adults and the elderly. They serve as the community link between health institution and home by providing physical and mental health screenings, outreach education and visits to the home, hospital or long-term care facility.
Nurses engaged in telenursing practice use technologies such as internet, computers, telephones, digital assessment tools and telemonitoring equipments to deliver nursing care. In India, around 10 hospitals are having tele-medicine departments. For example, at Apollo hospitals, Narayana Hrudayalaya and Hosmat hospital at Bengaluru, job opportunities are available for tele-nurses. Chaitanya Medical Foundation, Bengaluru, is providing tele-nursing education. IT companies are recruiting telehealth nurses in Hyderabad, Bengaluru and Chennai. For example: Infosys, Vivus, etc.
Nurse researchers are scientists who seek to find answers to questions through methodical observations and experimentation. They design studies, conduct research and disseminate findings at professional meets and in peer reviewed journals. They are doctorally or postdoctorally prepared persons who initiate or participate in all phases of the research process. They work in a variety of settings.
Psychiatric Nurse Educator
The psychiatric nurse educator works in educational institutions, staff development department of health care agencies and patient education department as well ( teach the mentally ill patients and their families about care to provide at home). Another function of a nurse educator is planning and changing the curriculum according to the needs of the society and learner.
A nurse manager work less directly with patients, but has the responsibility to provide nursing leadership to ensure that an appropriate therapeutic milieu is maintained. Key responsibility is to support and aid development of nurses and represents nursing views to senior managers. Nurse Manager plays an important role in negotiating and allocating nursing resources within clinical directorates. Individuals who assume a nurse executive role typically hole a masters degree. They serve at all management levels in health care organizations and in the community.
Psychiatric Nurse as Collaborative Member of the Interdisciplinary Team
Collaboration implies a commitment to common goals, with shared responsibility for the outcome of care. It also implies helping to facilitate the mental health of the patient, family or community within the context of the treatment team. Nurses bring their own specialized knowledge to the treatment process, thereby, enhancing information about the patients’ assessment, treatment needs and progress. Seven characteristics of effective collaboration include: Trust, respect, commitment, cooperation, coordination, communication and flexibility.
One of the latest roles is that of the nurse psychopharmacologist- the psychiatric clinical nurse specialist with prescriptive authority.
Holistic nursing integrates complementary and alternative modalities such as relaxation, meditation, guided imagery, body mind interventions, bio-feedback, reikhi, etc., along with traditional nursing interventions. A holistic nurse uses theories of wholeness, expertise, caring and intuition. In CAM therapies, patients become therapeutic partners in a mutually evolving process towards healing, balance and wholeness. Holistic nurses conduct holistic assessments, select appropriate interventions and assist the patient in exploring self-awarness, spirituality and personal transformation in healing. The most frequently employed therapies used by the nurses are massage, music, exercise, diet, prayer and counseling.
The new opportunities for psychiatric nursing practice that are emerging throughout the continuum of mental health care are exciting for the specialty. They allow psychiatric nurses to demonstrate their flexibility, accountability, and self-direction as they move forward into these expanding areas of practice. The expansion of mental health treatment settings is providing psychiatric nurses with the opportunity to implement primary, secondary and tertiary prevention functions from a holistic, biopsychosocial perspective, thus expanding their base of practice to better meet the mental health needs of individuals, families, groups and communities.
Focuses Areas of Psychiatric Nursing Practice
Areas of focus within pyschiatric nursing have emerged based on current and anticipated societal needs. These areas of focus include adult, child-adolescent, geriatric, developmental disability, forensic, addiction, community and family psychiatry.
Clinical practice settings for psychiatric nurses include psychiatric emergency services, crisis intervention centers, acute inpatient care, chronic inpatient care, rehabilitation centers, partial hospitalization centers, child-adolescent psychiatry centers, family therapy units, psychotherapy units, home settings, community based centers, tele-nursing, hospice care centers, medical inpatient wards, industrial medical centers, forensic psychiatric wards and private practice.