Psychiatric Nursing
Psychiatric Nursing is the practice of caring for people whose mental condition has been affected, and training involves understanding the structure and function of human mentality. Students study the retention and improvement of mental health, prevention of mental health disorders and nursing activities for people with mental disorders in their acute period, rehabilitation and adaptation to community life through one-to-one contact, group dynamics and community mental health activities.
Psychiatric nursing is a specialized field of nursing practice is to apply the theory of human behavior as their knowledge and use of therapeutic self as tricks. Mental nursing practice occurs in a social context and environment. Nursing the soul is one of the five core mental health disciplines. Nurses use knowledge from the soul sciences psychosocial, biophysical, self useness theories of human behavior to derive a theoretical framework which underlies nursing practice. We have developed the profession of nursing as a treatment as a core element of all nursing practice.
Psychiatric nursing is a professional nursing service based on behavioral science, nursing in the human spirit throughout the life cycle in response to psycho-social maladaptive disruption caused by the bio-psycho-social, by using self and soul of nursing therapy (therapeutic communication and therapeutic modalities of mental health nursing) through the nursing process approach to improve, prevent, and maintain and restore clients' mental health problems (individuals, groups, families, and communities). Psychiatric nursing is the interpersonal process of trying to improve and maintain the behavior so that the client can function fully as a human being.
In practical training, students study the necessity of cooperation with the community, including care for mentally ill patients and rehabilitation facilities. Psychiatric aides communicate with the patients as friends and supervise them in enlightening and recreational activities; they also help them with grooming, personal hygiene, and eating. Patients like activities such as playing cards, watching television, sport-related events, or fieldtrips. Psychiatric aides monitor and report to the staff any significant changes in the patients' physical or behavioral health. When patients go to get treatment or exams, the aides will escort them. Psychiatric aides spend so much time with patients that they can actually be influential on the success of a patient's treatment and attitude.
A psychiatric nurse works on different settings such as community mental health programs, psychiatric hospitals and facilities, the academe and even in the criminal justice system. There are only two levels of psychiatric nursing: the basic and the advanced. Both of which have various responsibilities.
For the basic level, the psychiatric nurse will carry out the physician's orders. These are registered nurses who are equipped with the knowledge on developing, implementing and assessing nursing care plans; they also administer medications and provide direct nursing care. They are usually found in family-based settings, assisting the family members in dealing with a member's mental disorder. However, they may also be found in education settings where their primary role is to teach the public or other mental health care providers about mental health and psychological disorders. They may also assist with counseling and intervention.
These are the basic roles of psychiatric nurses. But due to the development of further needs in the management of psychiatric disorders, the roles were expanded to meet the demands.
Another change in the roles of psychiatric nurses is the extension of psychiatric services to prisons. This pose the challenge to psychiatric nurses to give the same mental health care services to inmates regardless of the boundaries set by the lack of facilities and trained people to do the work.
Lastly, the need to advance psychiatric custody to disordered individuals who are under the criminal justice system. As we may know, not all correctional institutions have dedicated units for inmates with psychiatric disorders. But in the past years, psychiatric facilities are being integrated into the criminal justice system. Because of the formation of the mental health courts, newer responsibilities were added to psychiatric nursing.
Mental health nursing, like many other professions, have met fundamental changes in the past recent years. This may be largely attributed to the improvements of newer facilities therefore newer needs for professionals which are mirrored in nursing professions. In many areas of psychiatric though, there is no doubt that there are fewer changes. However, as seen in the mental healthcare, these changes have prepared the way towards better systems and better people working in the field.
The traditional order of life in nursing facilities include psychiatry, community mental health center's psychiatric units in general hospitals, facilities and residential private practice. Initiated by new forms of health services, arises an alternative structure throughout the range of nursing care of the soul. These include service order in the house, partial hospitalization programs, day care centers, orphanages or group homes, hospice, visiting nurse association, emergency units, the main service clinics, schools, prisons, industry, facilities maintenance management and health maintenance organizations. Nursing principles based soul can be seen from the four components of the human, environmental, health, and nursing.
History
The history psychiatric of and psychiatric nursing, although disjointed, can be traced back to ancient philosophical thinkers. Marcus Tullius Cicero in particular, was the first known person to create a questionnaire for the mentally ill using biographical information to determine the best course of psychological treatment and care.
Some of the first known psychiatric care centers were constructed in the Middle East during the 8th century. The medieval Muslim physicians and their attendants relied on clinical observations for diagnosis and treatment.
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. Throughout the highpoint 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.
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. 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.
The 1790’s in Europe is considered a time of enlightenment for the moral treatment of the mentally ill. The concept of a safe asylum, proposed by Phillipe Pinel and William Tukes, offered protection and care at institutions for patients who had been previously abused or enslaved. 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 theAmerican 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.
The formal recognition of psychiatry as a modern and legitimate profession occurred in 1808. 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. However, psychiatric nursing was not formalized in the United States until 1882 when Linda Richard opened Boston City College. This was the first school specifically designed to train nurses in psychiatric care. 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.
In 1913 John Hopkins University was the first college of nursing in the United States to offer psychiatric nursing as part of its general curriculum. The first psychiatric nursing textbook, Nursing Mental Diseases by Harriet Bailey, was not published until 1920. It was not until 1950 when the National League for Nursing required all nursing schools to include a clinical experience in psychiatry to receive national accreditation.
The first psychiatric nurses faced difficult working conditions. Overcrowding, under-staffing and poor resources required the continuance of custodial care. They were pressured by an increasing patient population that rose dramatically by the end of the 19th century. As a result, labor organizations formed to fight for better pay and fewer hours. Additionally, large asylums were founded to hold the large number of mentally ill, including the famous Kings Park Psychiatric Center in Long Island, New York. At its peak in the 1950’s, the center housed more than 33,000 patients and required its own power plant. Nurses were often referred to as “attendants” to imply a more humanitarian approach to care. During this time, attendants primarily kept the facilities clean and maintained ordered among the patients. They also carried out orders from the physicians.
In 1963, President John F. Kennedy accelerated the trend towards deinstitutionalization with the Community Mental Health Act. Also, since psychiatric drugs were becoming more available allowing patients to live on their own and the asylums were too expensive, institutions began shutting down. Nursing care thus became more intimate and holistic in nature. Expanded roles were also developed in the 1960’s allowing nurses to provide outpatient services such as counseling, psychotherapy, consultations, prescribing medications, along with the diagnosis and treatment of mental illnesses.
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.
The current challenge facing mental health nurses in the new millennia are the psychiatric illnesses corresponding with the social problems of the time. Specifically, Posttraumatic Stress Disorder has been of particular importance reflecting the trauma endured since the September, 11 2001 attacks and an increased awareness of domestic violence.
Hildegard Peplau, was a nursing theorist whose seminal work Interpersonal Relations in Nursing was published in 1952. Dr. Peplau emphasized the nurse-client relationship as the foundation of nursing practice. At the time, her research and emphasis on the give-and-take of nurse-client relationships was seen by many as revolutionary. Peplau went on to form an interpersonal model emphasizing the need for a partnership between nurse and client as opposed to the client passively receiving treatment (and the nurse passively acting out doctor's orders). The essence of Peplau's theories is the creation of a shared experience. Nurses, she thought, could facilitate this through observation, description, formulation, interpretation, validation, and intervention. For example, as the nurse listens to her client she or he develops a general impression of the client's situation. The nurse then validates his or her inferences by checking with the client for accuracy. The result may be experiential learning, improved coping strategies, and personal growth for both parties. Peplau died in 1999, aged 89.
- Peplau's model
Peplau's model has proved of great use to later nurse theorists and clinicians in developing more sophisticated and therapeutic nursing interventions.
- Peplau's Six Nursing Roles
Peplau's Six Nursing Roles illustrate the dynamic character roles typical to clinical nursing.
1. Stranger role: Receives the client the same way one meets a stranger in other life situations; provides an accepting climate that builds trust.
2. Resource role: Answers questions, interprets clinical treatment data, gives information.
3. Teaching role: Gives instructions and provides training; involves analysis and synthesis of the learner's experience.
4. Counseling role: Helps client understand and integrate the meaning of current life circumstances; provides guidance and encouragement to make changes.
5. Surrogate role: Helps client clarify domains of dependence, interdependence, and independence and acts on clients behalf as advocate.
6. Active leadership: Helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way.
7. Technical expert role: Provides physical care by displaying clinical skills; Operates equipments
- Peplau's Developmental Stages of the Nurse-Client Relationship
1. Orientation Phase
2. Working Phase
-Identification
-Exploitation
3. Termination / Resolution Phase
The principles of Psychiatric Nursing and it contains of four elements
Ø Humans
- Function as being a holistic person to act, interact, and react with the environment as a whole
- Each individual has the same basic needs and essential
- Each individual has self-respect and dignity
- individual goal is to grow, healthy, independent, and achieve self-actualization
- Each individual has the ability to change and berkeingianan to pursue personal goals
- Each individual has the capacity varying köping
- Each individual has the right to participate in decision-making
- All significant individual behavior, where behavior include perceptions, thoughts, feelings and actions
Ø Environment
As a holistic human beings affected by the environment from within himself and the environment from the outside, both families, groups, communities. In dealing with the environment, humans must develop effective strategies to köping can adapt. Interpersonal relationships developed can result in a change from the individual.
Ø Health
- Health is a basic human need which shows one aspect of the quality of human life, therefore every individual has the right to obtain the same health through adequate treatment.
- mental health conditions that facilitate an optimal and in harmony with others, thus achieved the ability to adjust to yourself, others, society and environment; harmony soul function, which is able to face common problems and feel happy. Intact healthy aspects include physical, mental, social, and pribadiyang can be explained as follows:
- physical health, namely physical and physiological functions, kepadanan and efficiency. Indicator of physical health is not the least there dysfunction, with other indicators (eg blood pressure, cholesterol, pulse and heart, and carbon monoxide levels) are commonly used to assess health status.
- Mental health/psychological/mental, that is primarily about the feelings of subjective well-being, a self-assessment of one's feelings; covers areas such as self-concept about one's ability, fitness and energy, feelings of well-being, and Traffic's internal controls; indicator of mental health conditions/psychological/soul that is at least not feel depressed/depression.
- Social Health, which is a social activity. Person's ability to complete the task, role, and learn various skills for adaptive functioning in society. Indicator on the status of the minimum social health is the ability to perform basic tasks and skills appropriate to the role of a person.
- Personal Health is a state that goes beyond functioning effectively and adequate of the three aspects mentioned above; emphasizes the possibility of capacity, resources and talents and the talents of a person's internal, that might not be/will be displayed in an atmosphere of daily life as usual.
Ø Nursing
In the spirit of nursing, nurses in a holistic look at human beings and the use of therapeutic self. Methodology in the soul of nursing is to use self terapeutik dan interpersonal interactions with self aware, the environment, and interaction with the environment. This awareness is the basis for change. Clients grow aware of themselves and situasiny, thus more accurately identify needs and problems choosing a healthy way to cope. Nurse member of constructive stimulus to clients and help clients respond constructively so that clients learn how to handling problems that are the basic capital in the face of various problems of life.
· Assessing Mental Health
The term mental health encompasses a great deal about a single person, including how we feel, how we behave, and how well we function. This single aspect of our person cannot be measured or easily reported but it is possible to obtain a global picture by collecting subjective and objective information in order to delve into a person’s true mental health and well being. When identifying mental health wellness and planning interventions, here are a few things to keep in mind when completing a thorough mental health assessment in the nursing profession:
- Is the patient sleeping adequate hours on a regular sleeping cycle?
- Does the patient have a lack of interest in communication with other individuals?
- Is the patient eating and maintaining an adequate nutritional status?
- Is the ability to perform activities of daily living present (bathing, dressing, toileting one self)?
- Can the patient contribute to society and maintain employment?
- Is the ability to reason present?
- Is safety a recurring issue?
- Does the patient frequently make decisions without regards to their own safety or the safety of others?
- Does the patient exhibit a difficulty with memory or recognizance?
· Therapeutic relationship
As with other areas of nursing practice, psychiatric mental health nursing works within nursing care model, utilizing nursing care plans, and seeks to care for the whole person. However, the emphasis of mental health nursing is on the development of a therapeutic relationship or alliance. In practice, this means that the nurse should seek to engage with the person in care in a positive and collaborative manner that empowers them to draw on their inner resources in addition to any other treatment they may be receiving.
· Interventions
- Nursing interventions may be divided into the following categories:
- Physical and biological interventions
· Psychiatric medication
Psychiatric medication is a commonly used intervention and many psychiatric mental health nurses are involved in the administration of medicines, both in oral (e.g tablet or liquid) form or by intramuscular injection. Nurses will monitor for side effect and response to these medical treatments by using assessments. Nurses will also offer information on medication so that, where possible, the person in care can make an informed choice, using the best evidence available.
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 an anesthesia. This treatment is only used in a tiny proportion of cases and only after all other possible treatments have been exhausted. Approximately 85% of clients receiving ECT have major depression as the indication for use, with the remainder having another mental disease such as schizoaffective disorder, mania or schizophrenia.
· Physical care
Along with other nurses, psychiatric mental health nurses will intervene in areas of physical need to ensure that people have acceptable levels of personal hygiene, nutrition, sleep etc as well as tending to any concomitant physical ailments.
· Psychosocial interventions
Psychosocial interventions are increasingly delivered by nurses in mental health settings and include psychotherapy interventions such as cognitive behavioural therapy, family therapy and less commonly other interventions such as milieu therapy or psychodynamic approaches. These interventions can be applied to broad range of problems including psychosis, depression and anxiety. Nurses will work with people over a period of time and use psychological methods to teach the person psychological techniques that they can then use to aid recovery and help manage any future crisis in their mental health. In practice, these interventions will be used often, in conjunction with psychiatric medications. Psychosocial interventions are based on evidence based practice and therefore the techniques tend to follow set guidelines based upon what has been demonstrated to be effective by nursing research. There has been some criticism that evidence based practice is focused primarily on quantitative research and should reflect also a more quantitative research approach that seeks to understand the meaning of people's experience.
· Spiritual interventions
The basis of this approach is to look at mental illness or distress from the perspective of a spiritual crisis. Spiritual interventions focus on developing a sense of meaning, purpose and hope for the person in their current life experience. Spiritual interventions involve listening to the person's story and facilitating the person to connect to God, a greater power or greater whole, perhaps by using meditation or prayer. This may be a religious or non-religious experience depending on the individual's own spirituality. Spiritual interventions, along with psychosocial interventions, emphasize the importance of engagement, however, spiritual interventions focus more on caring and 'being with' the person during their time of crisis, rather than intervening and trying and 'fix' the problem. Spiritual interventions tend to be based on qualitative research and share some similarities with the humanistic approach to psychotherapy.
