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 effects 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.
Electroconvulsive therapy
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.[citation needed]
Physical care
Along with other nurses, psychiatric mental health nurses will intervene in areas of physical need to ensure that people have good 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 a 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 qualitative 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.
Organization of mental health care
Psychiatric mental health nurses work in a variety of hospital and community settings.
People generally require an admission to hospital, voluntarily or involuntarily if they are experiencing a crisis- that means they are dangerous to themselves or others in some immediate way. However, people may gain admission for a concentrated period of therapy or for respite. Despite changes in mental health policy in many countries that have closed psychiatric hospitals, many nurses continue work in hospitals though patient length of stay has decreased significantly.
Community Nurses who specialize in mental health work with people in their own homes (case management) and will often emphasize work on mental health promotion. Psychiatric mental health nurses also work in rehabilitation settings where people are recovering from a crisis episode and the where the aim is social inclusion and a return to living independently in society. These nurses are sometimes referred to as community psychiatric nurses (the term psychiatric has been retained, but is being gradually replaced with the title "Community Mental Health Nurse" or CMHN)).
Psychiatric mental health nurses also work in forensic psychiatry with people who have mental health problems and have committed crimes. Forensic mental health nurses work in adult prisons, young offenders' institutions, medium secure hospitals and high secure hospitals. In addition forensic mental health nurses work with people in the community who have been released from prison or hospital and require on-going mental health service support.
People in the older age groups who are more prone to dementia tend to be cared for apart from younger adults. Admiral Nurses are specialist dementia nurses, working in the community, with families, carers and supporters of people with dementia. The Admiral Nurse model was established as a direct result of the experiences of family carers. The Admiral nurse role is to work with family carers as their prime focus, provide practical advice, emotional support, information and skills, deliver education and training in dementia care, provide consultancy to professionals working with people with dementia and promote best practice in person- centred dementia care.
Psychiatric mental health nurses may also specialize in areas such as drug and alcohol rehabilitation, or child and adolescent mental health.
UK, Ireland, US, and Canada
also: Psychiatric and mental health nurse practitioner and Registered psychiatric nurse
Canada
The registered psychiatric nurse is a distinct nursing profession in all of the four western provinces. Such nurses carry the designation "RPN". In Eastern Canada, an Americanized system of psychiatric nursing is followed.
Ireland
In Ireland, mental health nurses undergo a 4 year honors degree training programme. Nurses that trained under the diploma course in Ireland can do a post graduation course to bring their status from diploma to degree.
UK
In the UK and Ireland the term psychiatric nurse has now largely been replaced with mental health nurse. Mental health nurses undergo a 3-4 year training programme at either diploma or degree level, in common with other nurses. However, most of their training is specific to caring for clients with mental health issues.
US
In North America, there are three levels of psychiatric nursing.
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 effects 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.
Electroconvulsive therapy
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.[citation needed]
Physical care
Along with other nurses, psychiatric mental health nurses will intervene in areas of physical need to ensure that people have good 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 a 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 qualitative 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.
Organization of mental health care
Psychiatric mental health nurses work in a variety of hospital and community settings.
People generally require an admission to hospital, voluntarily or involuntarily if they are experiencing a crisis- that means they are dangerous to themselves or others in some immediate way. However, people may gain admission for a concentrated period of therapy or for respite. Despite changes in mental health policy in many countries that have closed psychiatric hospitals, many nurses continue work in hospitals though patient length of stay has decreased significantly.
Community Nurses who specialize in mental health work with people in their own homes (case management) and will often emphasize work on mental health promotion. Psychiatric mental health nurses also work in rehabilitation settings where people are recovering from a crisis episode and the where the aim is social inclusion and a return to living independently in society. These nurses are sometimes referred to as community psychiatric nurses (the term psychiatric has been retained, but is being gradually replaced with the title "Community Mental Health Nurse" or CMHN)).
Psychiatric mental health nurses also work in forensic psychiatry with people who have mental health problems and have committed crimes. Forensic mental health nurses work in adult prisons, young offenders' institutions, medium secure hospitals and high secure hospitals. In addition forensic mental health nurses work with people in the community who have been released from prison or hospital and require on-going mental health service support.
People in the older age groups who are more prone to dementia tend to be cared for apart from younger adults. Admiral Nurses are specialist dementia nurses, working in the community, with families, carers and supporters of people with dementia. The Admiral Nurse model was established as a direct result of the experiences of family carers. The Admiral nurse role is to work with family carers as their prime focus, provide practical advice, emotional support, information and skills, deliver education and training in dementia care, provide consultancy to professionals working with people with dementia and promote best practice in person- centred dementia care.
Psychiatric mental health nurses may also specialize in areas such as drug and alcohol rehabilitation, or child and adolescent mental health.
UK, Ireland, US, and Canada
also: Psychiatric and mental health nurse practitioner and Registered psychiatric nurse
Canada
The registered psychiatric nurse is a distinct nursing profession in all of the four western provinces. Such nurses carry the designation "RPN". In Eastern Canada, an Americanized system of psychiatric nursing is followed.
Ireland
In Ireland, mental health nurses undergo a 4 year honors degree training programme. Nurses that trained under the diploma course in Ireland can do a post graduation course to bring their status from diploma to degree.
UK
In the UK and Ireland the term psychiatric nurse has now largely been replaced with mental health nurse. Mental health nurses undergo a 3-4 year training programme at either diploma or degree level, in common with other nurses. However, most of their training is specific to caring for clients with mental health issues.
US
In North America, there are three levels of psychiatric nursing.
- The licensed vocational nurse (licensed practical nurse in some states) and the licensed psychiatric technician may dispense medication and assist with data collection regarding psychiatric and mental health clients.
- The registered nurse or registered psychiatric nurse has the additional scope of performing assessments and may provide other therapies such as counseling and milieu therapy.
- The advanced practice registered nurse (APRN) either practices as a clinical nurse specialist or a nurse practitioner after obtaining a Master’s degree in psychiatric-mental health nursing. Psychiatric-mental health nursing (PMHN) is a nursing specialty. The course work in a Master’s degree program includes specialty practice. APRN’s assess, diagnose, and treat individuals or families with psychiatric problems/disorders or the potential for such disorders, as well as performing the functions associated with the basic level. They provide a full range of primary mental health care services to individuals, families, groups and communities, function as psychotherapists, educators, consultants, advanced case managers, and administrators. In many states, APRN’s have the authority to prescribe medications. Qualified to practice independently, psychiatric-mental health APRN’s offer direct care services in a variety of settings: mental health centers, community mental health programs, homes, offices, HMOs, etc.