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Psychiatric and mental health nursing

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For specific information about this topic in the United States, see Psychiatric and mental health
Nurse Practitioner. For Canada, see Registered Psychiatric Nurse.
Psychiatric nursing or mental health nursing is the speciality of nursing that cares for people
of all ages with mental illness or mental distress, such as schizophrenia, bipolar disorder,
psychosis, depression or dementia. Nurses in this area receive additional training in
psychological therapies, building a therapeutic alliance, dealing with challenging behavior, and
the administration of psychiatric medication.

• 1 Therapeutic relationship
• 2 Interventions
○ 2.1 Physical and biological interventions
 2.1.1 Psychiatric medication
 2.1.2 Electroconvulsive therapy
 2.1.3 Physical care
○ 2.2 Psychosocial interventions
○ 2.3 Spiritual interventions
• 3 Organization of mental health care
• 4 UK, Ireland, US, and Canada
○ 4.1 Further levels of practice in US
• 5 References
• 6 See also

[edit] Therapeutic relationship

Main article: Therapeutic relationship
As with other areas of nursing practice, psychiatric mental health nursing works within nursing
models, 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.[1]
[edit] Interventions
Nursing interventions may be divided into the following categories:[2]
[edit] Physical and biological interventions
[edit] 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.
[edit] 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]
[edit] 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.
[edit] 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[3] 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.
[edit] 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.[4] 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.
[edit] 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 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.
• Psychiatric mental health nurses also work in forensic psychiatry with people who are
detained as they have committed a crime or are particularly dangerous.
• People in the older age group who are more prone to dementia tend to be cared for in
separate places than younger adults and there are also specialist services for the care of
adolescents with mental health problems. Occasionally there have been efforts to
integrate psychiatric units across the age spectrum.
[edit] UK, Ireland, US, and Canada
In the UK and Ireland the term psychiatric nurse has now largely been replaced with mental
health nurse.
In the UK, 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. 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.
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. Admiral Nurses are named after Joseph Levy, who had
dementia. He was known by his family as ‘Admiral Joe’ due to his keen interest in sailing. 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. [5]
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
• In 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.
• The advanced practice psychiatric registered nurse is prepared at the masters or doctoral
degree level and functions as a clinical specialist and/or psychiatric nurse practitioner
encompassing all of these and may additionally include prescribing medication and
providing psychiatric diagnosis (under direct supervision by a physician or independently
in most states).
Mental health nurses may work in inpatient settings or in the community as community
psychiatric nurses (the term psychiatric has been retained, but is being gradually replaced with
the title "Community Mental Health Nurse" or CMHN)). They may also specialize in areas such
as drug and alcohol rehabilitation, or child and adolescent mental health.
[edit] Further levels of practice in US
The clinical practice of psychiatric-mental health nursing occurs at two levels: basic and
advanced. At the basic level, registered nurses work with individuals, families, groups and
communities, assessing mental health needs, developing a nursing diagnosis and a plan of
nursing care, implementing the plan and finally evaluating the nursing care. Basic level nursing
practice is characterized by interventions that promote and foster health and mental health, assist
clients to regain or improve their coping skills or abilities, and prevent further disability.
In working with psychiatric clients or patients, basic level nurses assist them with self care,
administer and monitor biopsychosocial treatment regimens, teach about health and mental
health individually or in groups, including psycho-education. Basic level nurses are also prepared
to assist with crisis intervention, counseling and work as case managers.
Advanced practice registered nurses (APRN) have a Master’s degree in psychiatric-mental health
nursing and assume the role of either clinical nurse specialist or nurse practitioner. Psychiatric-
mental health nursing (PMHN) is considered a specialty in nursing. Specialty practice is part of
the course work in a Master’s degree program. In addition to the functions performed at the basic
level, APRN’s assess, diagnose, and treat individuals or families with psychiatric
problems/disorders or the potential for such disorders. 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.
Because of their broad background in both the biological, including pharmacological, sciences as
well as the behavioral sciences, APRNs in PMHN are a rich resource as providers of psychiatric-
mental health services and are advocates of and partners with the consumers of their services.
Psychiatric nurses who earn doctoral degrees (PhD, DNSc, EdD) often are found in practice
settings, teaching, doing research, or as administrators in hospitals, agencies or schools of