nursing role to psychiatric nursing

ROLES OF PSYCHIATRIC NURSING


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.”

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.



Role Emergency


The role of psychiatric nursing began to emerge during this developmental period in the early 1950s. In 1947 publised an article in the American Journal of Nursing that reemphasized the shortage of psychiatric and general duty nurses. She described “attitude therapy” as the nurse’s directed use of attitudes that contribute to the patient’s recovery. In implementing this therapy the nurse observes the patient for small and fleeting changes, demonstrates acceptance, respect, and understanding of the patient, and promotes the patient’s interest and participation in reality. More independent functions were described by Santos and Stainbrool in 1949. They believed that nurses should perfom “psychotherapeutic tasks” and should understand concepts related to therapy, such as transfereance.

An article by Bennett and Eaton in the American Journal of Psychiatry in 1951 identified the following threee problems affecting psychiatric nurses:

The scarcity of qualified psychiatric nurses

The underutilization of their abilities

The fact that “very little real psychiatric nursing is carried out in otherwise good psychiatric hospitals and units”

At this same time, nursing, as a profession, was defening caring as a core element og all nursing practice, and the contributions of psychiatric nurses were embraced by nurses of all specialty groups. Partly as a result of this broader definition of psychiatric nursing practice and the perceived skills and competencies of psychiatric nurses, nursing education reorganized its approach to psychiatric nursing curriculum and began to integrate psychiatric nursing content into nonpsychiatric courses. This blending of content was evedent in the second change in the name of the field in the 1970s from “psychiatric and mental health” nursing to “psychosicial” nursing. The integration of psychiatric nursing content into basic courses became so complete that faculty no longer viewed these areas as psychiatric nursing but saw them as an expanded, more holistic approach to nursing care. Ate the same time, clinical rotations focusing on the psychiatric illnesses of patients in psychiatric settings were often replaced by clinical rotations integrating psychosocial aspects of the care of physically ill patients on general medical-surgical units. Unfortunately, this trend often did not.



Role of Psychiatric Nursing


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.

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 an cera provided by others. The Care Manager also manages patient needs and resources episodeically and is skilled in managing psychiatric rehabilitation as well 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 wich they review aspects of the patient's care and influences 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

Nurse 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 this roles, they interface with consumers, employers, providers and regulators adn 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 and Clinical/Medical Affairs.



Psychiatric nurses became the pacesetters in specialty nursing practice. They were the fist to:

- Develop a structure within the American Nurse’ Association to focus on specialty practice

- Develop statements on scope of practice

- Establih generalist and specialist certication


The specialty was defined within a nursing framework of practice, and psychiatric nursing textbooks shifted away from the medical model and were organized around the nursing process, nursing diagnoses, and standards of psychiatric nursing practice.


Evolving Functions

In 1958 the following functions of psychiatric nurses were described

Dealing with patients’ problems of attitude, mood, and interpretation of reality

Exploring disturbing and conflicting thoughts and feelings

Using the patient’s positive feelings toward the therapist ti bring about psychophysiological homeostasis

Counseling patitients in emergencies, including panic and fear

Strengthening the well part of patients


The nurse-patient relationship was referred to by a variety of terms, including “therapeutic nurse-patient relationship,” “psychiatric nursing therapy,” “Supportive psychotherapy,” “rehabilitation therapies,” and “nondi-rective counseling.” The distinction between these terms and the exact nature of the nurse’s role remained hazy.




reference :


American Psychiatric Nursing Association. Roles of Psychiatric-Mental Health Nurses in Managed Care. http://www.apna.org/i4a/pages/index.cfm?pageid=3344

http://www.ehow.com/about_5147673_role-psychiatric-nursing.html


Stuart & Sundeen. 1995. Principles & Practice Of Psychiatric Nursing Fifth Edition. St. Louis Missouri: Mosby

Yosep, Iyus. 2007. Keperawatan Jiwa. Bandung : Refika Aditama


bismillah

This blog can finally completed, this blog in the finish to meet the soul of nursing duties and to bring the author became increasingly interested in the world of writing ..
thanks to allah swt .. thanks to parents who are always supportive in many ways, thanks also to my friends who always supported me and my friends who are willing to always be with me.

regard's
Previarsi R