Psychiatric mental health nursing

Centre for Psychiatric Nursing
Psychiatric Mental HealthPsychiatric Mental Health
NursingNursing

Overview ofOverview of
Psychiatric/Mental HealthPsychiatric/Mental Health
NursingNursing
Outline
 Similarities & differences between
psychiatric nursing and other fields of
nursing
 Skills & knowledge of the psychiatric nurse

Overview ofOverview of
Psychiatric/mental HealthPsychiatric/mental Health
NursingNursing
 The importance of psychiatric nursing skills
in all clinical settings
 Career opportunities
 Postgraduate study & endorsement
 Professional affiliation

The Psychiatric/mental HealthThe Psychiatric/mental Health
NurseNurse
“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)

The Essence ofThe Essence of
Psychiatric/mental HealthPsychiatric/mental Health
NursingNursing
 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)

Similarities & DifferencesSimilarities & 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

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

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)

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

Philosophy of the ProfessionPhilosophy 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

Philosophy of the professionPhilosophy 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…

Philosophy of the professionPhilosophy 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)

The Knowledge, Skills &The Knowledge, Skills &
Attitudes of theAttitudes of the
Psychiatric/mental Health NursePsychiatric/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)

 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

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)

The Knowledge, Skills & AttitudesThe Knowledge, Skills & Attitudes
of the Psychiatric/mental Healthof the Psychiatric/mental Health
NurseNurse
 Milieu management
 Assessing, planning, implementing & evaluating
care
 Pharmacological interventions
 Documentation/Administration
 Legal requirements
 Educating/supervision
 Coordination/Multidisciplinary team member

The Importance ofThe Importance of
Psychiatric/mental Health NursingPsychiatric/mental Health Nursing
Knowledge, Skills & AttitudesKnowledge, 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)

 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

 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

Career OpportunitiesCareer Opportunities
Diversity within the profession
Attractive transferable skills
Consultation
Management
Education
Independent Practitioner

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

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.

 Career structure
 Professional development
 Clinical supervision
 Scholarships
 Graduate nurse Programs
 Postgraduate Study
 Paid study leave

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

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

ReflectionReflection
“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)

ReferencesReferences
 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

ReferencesReferences
 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

Psychiatric mental health nursing

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