Nursing Roles to Psychiatric Nursing.Sartika

Roles of Psychiatric Nurses

The function of nursing or caring for the sick has existed since beginning of civilization. Before 1860 the emphasis in psychiatric institution was on custodial care, and attendants were prepared to maintain control of the patients. Frequently these attendants were little more than jailers or cellkeepers with very little training, and psychiatric care was poor. Nursing, as a profession, began to emerge in the late nineteenth century, and by the twentieth century it had evolved into a specialty with unique roles and function.

HISTORICAL PERSPECTIVES

In 1873 Linda Richard graduated from the New England Hospital for Women and Children in Boston. She developed better nursing care in psychiatric hospitals and organized nursing services and educational programs in state mental hospitals in Illinois. For these activities she is called the first American psychiatric nurse. Basic to Richard’s theory of care was her premise: “ It stand to reason that the mentally sick should be at least as wel cared for as the physically sick.”

The first school to prepare nurses to care for the mentally ill opened at McLean Hospital in Waverly, Massachussetts, in 1882. It was a 2 year program, but few psychological skills were addressed; the care was mainly custodial. Nurses took care of the patient’s physical, such as medications, nutrition, hygiene, and activities. Until the end of the nineteenth century changed in the role psychiatric nurses. They had special training in psychiatric, and they primarily the principles of medical surgical nursing to psychiatric setting. At that time psychological care consisted of kindness and tolerance toward the patients. One of Linda Richards more important contributions her emphasis on assessing both to physical and emotional needs of the patients. In this early period of nursing history, nursing education separated these two ; nurses were taught either in the general hospital or in the psychiatric hospital. In 1913 John Hopkins name the first school of nursing to include a fully course for psychiatric nursing in the curriculum. Her school soon began to do likewise. It was not late 1930s that nursing education recognized the importance of psychiatric knowledge in general nursing for all illness.

An important factor in the development of psychiatric nursing was the emergence of various somatic therapy, including insulin shock therapy (1935), psychosurgery (1936), and electroconvulsive therapy (1937). These techniques all required the medical surgical skills of nurses. Although these therapies did not foster the patient insight, they did control behavior therapy. Somatic therapies also increase the demand for improved the psychological treatment for patients who did not respond.

As nurses become more involved with somatic therapies, they began the struggle to began the role as psychiatric nurses. An editorial in the American journal of nursing in 1940 describe the conflict between nurses and physicians as nurses tried to implement what they saw as appropriate care for psychiatric patients. This conflict continues to demand attention in current nursing practice.

The period after the world war II was one of major growth and change in psychiatric nursing. Because of the large number of service related psychiatric problems and the increase the treatment programs offered by the Veterans Administration, psychiatric nurses with advance preparation were demand. The content of psychiatric nursing had now become an integral part of the generic nursing curriculum; its principles were applied to other areas of nursing practice, including general medical, pediatric, and public health nursing. By 1947 eight graduate programs in psychiatric nursing has been started.

ROLE EMERGENCE

The role of the psychiatric nursing began to emerge during this developmental period in the early 1950s. In 1947 Weiss published an article in the American journal of Nursing that reemphasized the shortage of psychiatric nurses and outline the differences between psychiatric and general duty nurses. She described “attitude therapy” as the nurses direct use of attitude that contribute to the patient recovery. In the implementing this therapy the nurse observe the patient for small and fleeting changes, demonstrates acceptance, respect, and the understanding of the patient, and promote the patients interest and participation in reality. More independent functions were described by Santos and Stainbrook in 1949. They believed that nurse should perform “psychotherapeutic task” and should understand concept to therapy, such as transference.

An article by Bennett and Eaton in The American Journal of Psychiatric in 1951 identified the following three problems affecting psychiatric nurses:

These psychiatrists believed that the psychiatric nurse should join mental health societies, consult with welfare agencies, work in outpatient clinics, practice preventive psychiatry, engange the research, and help educate the public. They supported the nurses participation in individual and group psychotherapy and stated. “ despite the fact that most psychiatrists seem to ignore the role of psychiatric nurse in psychotherapy, all nurses in psychiatric wards do psychotherapy of one kind or another by their contacts with patients.

The psychiatric nurse is usually one of the first people a patient will see when he is admitted to a mental hospital. He or she will be monitoring most of the patient's plan of care and implementing doctors' orders. The other roles, there are :


1.Medical Duties

A nurse in a psychiatric setting helps to implement the plan of care, as set forth by the doctor and follows his treatment orders. She'll be helping the patient with everyday care. She will administer medications to the patient as ordered, as needed. As she takes care of the patient, she should be careful to chart every detail of her interactions with and observations of patients, as well as vital medical information, so that the doctor and other staff can make objective decisions concerning that patient's care, having been educated as to his progress, or lack thereof. She will most likely be reporting, in person, on the patient's care to both doctors and other nursing staff, as needed, for the best care possible.

2.Nursing Care Plan

As the nurse cares for each of her patients, she will examine him and institute a plan of care, coming up with certain nursing diagnoses and care plans for each diagnosis. This helps to form a well-rounded nursing relationship with each patient as she seeks the best for each one. These plans depend on each patient's specific problem and is tailored to each patient's special needs.

3.Demeanor

It is important for the psychiatric nurse to be aware of her demeanor, or the way she portrays herself. It is important for her to help patients to feel confident in her as their caregiver. She should actively listen to her patients and show that she is listening through maintaining eye contact; this helps with trust. She should also let the patient know that she is approachable. She needs to watch expressions on her face and body language when communicating with patients. On the other hand, it is still important for the nurse to be confident and decisive when it comes to her job in caring for these patients. She needs to be ready to deal with conflict; she can still be assertive without being threatening. There will be times where she will have to bravely stand her ground; however, there will also be times when she can be less serious with the patient and maybe even jovial.

4.Patient Educator

Of course, as a nurse, she should not only fulfill the medical side of the care plan, but she also needs to educate her patients and their families. This education can extend from the most basic care to teaching the patient about the medications they are taking and their condition. They will ask questions and she should make sure she has researched and studied and listened, so that she can give them the correct information. She might even teach a group of patients about certain techniques or subjects within mental health. It all depends on where she works and her job responsibilities.

5.Patient Advocate

It is also the nurse's job to stand up for her patients' rights as individuals. If she notices a mistake or something that just doesn't seem right in the patient's treatment plan, she should first study it and then approach the doctor. Many mistakes have been corrected because of an observant nurse. If someone has taken advantage of the patient or even abused the patient in some way, this too needs to be reported. If the patient has any kind of problems, it's the nurse's job to report these to the doctors in charge. The nurse is the one who will see the patient the most often and who will get to know the patient on a daily basis, and she needs to step up and take that advocate role, making sure her patients get the best care possible.

6. Care Manager

Nurses in this role assess patients and develop treatment plans, coordinate resources and care provided by others. The Care Manager also manages patient needs and resources episodically and is skilled in managing psychiatric rehabilitation as well as relapse prevention.

7. Assessment. Evaluation. Triage and Referral Nurse

In this role, the nurse evaluates patients in direct encounters or by telephone in order to triage the patient to the most appropriate level of care, including referrals to credentialed providers, contracted facilities and community resources.

8. Utilization Review Nurse

Many managed care companies employ psychiatric nurses to function as utilization reviewers in which they review aspects of the patient’s care and influence decisions about treatment assignment. In this role they serve as "gatekeepers" to mental health services.

9.Risk Manager

Nurses who work as risk managers are charged with the task of decreasing the probability of adverse outcomes related to patient care. They engage in identifying risk factors, individual and system-wide problems, corrective actions and the implementation of strategies to reduce risk and prevent loss.

10 Chief Quality Officer

Nurses have assumed primary responsibility for formulating and implementing comprehensive quality management and improvement programs for managed care companies. They engage in training other staff on-site and synthesize data related to performance improvement, outcomes management and other health services research activities.

11.Marketing and Development Specialist

Some psychiatric nurses work in the managed care growth areas of sales (proposal writing), marketing and program development. In these roles, they interface with consumers, employers, providers and regulators and they make recommendations for furthering the mission and goals of the managed care organization.

12.Corporate Managers and Executives

Psychiatric nurses are also present in middle management positions, as well as senior management positions where they participate in the development of corporate policy and strategic planning. Nurses hold positions in various departments including: Provider Relations, Quality Management, Care Management/Clinical Operations, Service Operations and Clinical/Medical Affairs.