ROLES OF THE PSYCHIATRIC-MENTAL | HEALTH NURSE IN . CONTEMPORARY MENTAL HEALTH CAREINTRODUCTION... * Trends & issues in the health care system affect the roles of the psychiatric — mental health nurse. Psychiatric nurses have traditionally worked on inpatient psychiatric units, they have continued to expand their role into the community. There are two levels of psychiatric-mental health nurses: The generalist (registered psychiatric nurse) & the specialist (CNS). * The scope & roles of both are guided by nurse practice acts & by standards of care.Role of the Generalist... The psychiatric mental health generalist nurse is a licensed registered nurse for delivering primary mental health care. It incorporates both physical & mental health care. Generalist exercise a holistic approach to practice & performs psychiatric nursing in prevention programs, community & day treatment centers, psychiatric rehabilitation facilities, homeless, shelters & many other settings.Role of the specialist... * Psychiatric Clinical Nurse Specialist (CNS) holds a masters degree in psychiatric mental health nursing. * CNS is an advanced practice nurse who is usually a primary health care provider, functions autonomously, often works in a semi-isolated situation, has medications prescription privileges (depending upon individual state laws), manages the overall care of people with emotional & psychiatric problem , & usually has a consultative arrangement with a psychiatrist. * For example, a advanced practice nurse in Minnesota are psychotherapists, consultants, milieu specialists, role models, teachers, administrators, crisis intervention specialists co-ordinators.Community Mental Health Nurse (CMHN)... * Community mental health*nursing is the application of knowledge of psychiatric nursing in preventing mental illness, promoting & maintaining mental health of the people. * It includes early diagnosis, appropriate referrals, care & rehabilitation of mentally ill people.Psychiatric Home Care Nurse... * Home health care is one aspect of community health nursing. Psychiatric home care nurses provide holistic psychiatric nursing care on a visiting basis to people needing assistance. *, These nurse provide comprehensive care, including psychiatric & physical assessment, direct nursing care, behavioral management, crisis intervention, psychoeducation, in-home detoxification, medication management, case management & consultation with colleagues.Forensic Psychiatric Nurse... Forensic nursing is a growing specialty in other countries around the globe, especially in the UK, Australia, Germany, Japan & Canada, & it is an expanded scope of practice. The forensic psychiatric nurse works with individuals who have mental health needs & who have entered the legal system. Nurses in this role perform physical & psychiatric assessment & develop plans of care for the patients entrusted to their care.Psychiatric Consultation — Liaison Nurse (PCLN).. . PCLN has arisen in response to the increased recognition of the importance of psycho-physiological inter-relationships & their impact on physical illness, recovery & wellness. It is an advanced practice nurse who practices psychiatric & mental health nursing in medical setting/non-psychiatric setting providing consultation & education to patients, families, & health care team & the community. PCLN may provide assessment, recommendations & supportive therapy to patients who are anxious, depressed or experiencing other psychological problems or emotional distress.Case Manager... Nurse case managers act as advocates for patients & their families by coordinating care & linking the patient with the physician, other members of the health-care-team, resources & payers. In the community, the case manager works with patients on a broad range of issues from accessing needed medical & psychiatric services to carrying out tasks of daily living such as using public transportation, managing money & buying groceries.f & t ~ Count... ‘ \ Ele oanien patient & family NURSE CASE MANAGER: Assesses, plans, implements, coordinates, monitor, & evaluates PedennsTae teak einy ei Peseta oe slelan communication & promotes high quality, cost-effective outcomes & (lSer EEK) etele ls fragmentation of care Rolie i etes3 Onset ofiillness Ceesefrollsr i ciara dle Home care & rehabilatory Sages Collaborates withiNursing; psychiatrist, psychologists, ‘social worker, occupational Ce TSS Ae Talal Ely cia toast CASEMANAGEMENT MODELCount... ¢ Factors that indicate the need for a nurse case manager include: ¥ Acomplex treatment plan that requires co-ordination ¥ An injury or illness that may permanently prevent the patient from returning to a previous level of health ¥ Pre-existing medical condition that may complicate or prolong recovery Y Aneed for assistance in accessing health-care resources Y Environmental stressors that may interfere with recoveryCount... * Case management can be provided by an individual or a team. * It may include both face-to-face & telephone contact with the patient, as well as contact with other service providers. * One of the most valuable assets case managers possess is their ability to synthesize patient data & act as conduits between patients & the health care system.Geropsychiatric Nurse... * Geronursing is expanding the psychiatric nursing practice to aged people who have been affected by emotional & behavioral disorders such as dementia, chronic schizophrenia, delirium, etc.Parish Nurse... Parish nursing is another area of expansion of psychiatric nurse role. Parish nursing is a program that promotes health & wellness of body, mind & spirit. The parish nurse is a pastorally called, spiritually mature, licensed registered nurse with desire to serve the members & friends of his or her congregation. * In 1998 the APA recognized parish nursing as a specialty focusing on disease prevention & health promotion. * It is a non-invasive type of nursing in which no hands-on nursing care is providedTelehealth / Telenurse... ¢ Nurses engaged in telenursing practice use technologies such as internet, computers, telephones, digital assessment tools & telemonitoring equipment to deliver nursing care. In India around 10 hospitals are having tele- medicine departments. For example, at Apollo hospitals, Narayana Hrudayalaya & Hosmat hospital at Bengaluru.Nurse Researcher... ¢ Nurse researchers are scientists who seek to find answers to questions through methodical observations & experimentation. * The design studies, conduct research & disseminate findings at professional meets & in peer reviewed journals. * They are doctorally or post-doctorally prepared persons who initiate or participate in all phases of the research process. ¢ They work in a variety of setting.Psychiatric Nurse Educator... The psychiatric nurse educators works in educational institutions, staff development department of health care agencies, patient education department (teach the mentally ill patients & their families about care to provide at hone). Another function of nurse educator in planning & changing the curriculum planning according to the needs of the society & learner.Nurse Administrator / Managev... * Anurse manager works less directly with patients, but has the responsibility to provide nursing leadership to ensure that an appropriate therapeutic milieu is maintained. * Akey responsibility is the support & development of nurses, representing nursing views to senior managers. Nurse Manager plays an important role in negotiating & allocating nursing resources within clinical directorates. Individuals, who assume a nurse executive role, typically hold a master’s degree.Psychiatric nurse as collaborative members of the interdisciplinary team... . Collaboration implies a commitment to common goals, with shared responsibility for the outcome of care. It also implies helping to facilitate the mental health of the patient, family or community within the context of the treatment team. Nurses bring their own specialized knowledge to the treatment process. Seven characteristics of effective collaboration includes: trust, respect, commitment, co-operation, co-ordination, communication & flexibility.Nurse Psychopharmacologist... * One of the latest roles is that of the nurse psychopharmacologist — the psychiatric clinical nurse specialist with prescriptive authority. The new opportunities for psychiatric nursing practice that are emerging throughout the continuum of mental health care exciting for the specialty. They allow psychiatric nurses to demonstrate their flexibility, accountability, & self direction as they move forwards into these expanding areas of practice.EXTENDED AND EXPANDED ROLE OF psychiatric NURSEDEFINITION EXTENDED ROLE - “It is the responsibility assumed by a nurse beyond traditional functioning of the nurse and it is the scope of nursing services outside the hospital”.DEFINITION EXPANDED ROLE “Expanded role of nursing means engagement of nurse role within the boundaries of nurse,” it is the responsibility assumed by a nurse within field of practice autonomv”.NEED TO EXTEND AND EXPAND THE ROLE OF A NURSE * Acquire the attitudes, skills. * Build a stronger trust with patients. * Detect,prevent and report medication errors ¢ Explore cultural diversity . __* Manage a heavier caseload .DIFFERENT EXTENDED ROLE OF PSYCHIATRIC NURSE 1.CARE GIVER ¢ Planning. ° Implementat ° Evaluation.2.MANAGER * Co-ordinate with other health team. ¢ Manage their own time and resources. ° Use critical thinking ¢ Make decision and consult to skills. “yo Spe es ~") HX yy Mi a ye eB +S, SVD ae J L we ty vy ¥3. PROTECTOR Maintain a safe Prevent environment Injury ehutte kK Slater etat a —— ; Protect From ad Adverse Effect of treatment www.shutterstock.com - 7050766874. ADVOCATE lh Protect client’s ( tuman & legal Patient advocate protect a patient's rights5) COUNSELOR:- Explore feelings & attitude about wellness Emotional ‘motional, Teach intellectual, desired psychological behavior support Therapeutic Encourage communicatio alternative n skills behavior Recognize choices & sense of control6. EDUCATOR ASSESSMENT, LA ANINTINKGS re 9 = rs r a = ira = a = EVALUATION7. COMMUNICATOR meeting the needs of client, family & community ° Liestning * Verble communication. * Non-verble communication8. COLLABORATOR- A nurse can be a good collaborator when- * Knowledgeable. * good planner ( care). * good communicator ( assessment).g. SCHOOL HEALTH NURSE- SCHOOL NURSES Keeping Students Healthy & Safe 2 ee ee vw10. OCCUPATIONAL HEALTH NURSE 11.PUBLIC HEALTH NURSE- 12, HOSPICS NURSE- 13. REHABILITATION NURSE 14.NURSE EPIDEMIOLOGIST-15.MILITARY NURSE- Also called Army nurse16. AEROSPACE NURSE 17. TELE NURSE 18. DISASTER NURSE 1g. FORENSIC NURSE 20. NURSING IN RED-CROSS = SOCIETY 21. SPORTS NURSING22. PRISON NURSE * Deliver high quality care within custodial settings. ¢ Maintain safe & secure environment. * Improve mental health & behavior of prisoners.diFFERENT EXPANDED ROLE OF PSYCHIATRIC NURSE - ADVANCED PRACTICE NURSING Has a master’s degree in nursing. Certification and expertise in specialized area. Works in primary, acute & restorative care settings.2.CLINICAL NURSE SPECIALIST 3.CERTIFIED NURSE MIDWIFES 4.NURSING GENERALIST 5.NURSE EDUCATOR6. NURSE RESEARCHER 7.NURSING ADMINISTRATION 8.NURSE PRACTITIONERFUNCTIONS OF MENTAL FEALTEH NURSE IN VARIOUS _. | SETTINGINPATIENT PSYCHIATRIC WARD... * Provide for environment safety including protecting the patient & others from injury. * Perform psychosocial, high risk & physical assessment. + Promotion of:selficare activities. *. Medication management. . Assisting for somatic therapies: * Accurately obse fing & documenting the patient’ s ~behavior. |) 5B | i i Poviding opportinities for the patient to make his his gs ciSi sibility for his liCount... * Participation in various therapies, (psychotherapy, behavioral therapy, group therapy, play therapy, family therapy, etc) individual interagtions, formal & informal group situations, role play, advocating on behalf of the patient & so forth. ¢ Delivering psycho-education. * Counseling the patient & family members. * Co-operating with other professionals in various aspects of the patients care; thereby facilitating an interdisciplinary approach — tocar. 4 erp * Teaching social skills. & stress management strategies. *PSYCHIATRIC OUTPATIEBT DEPARTMENT... * Performing’clinical assessment. _ . Assisting for psychometric asseaement . Assisting or providing psychotherapy or behavior therapy. tient & family members. erapy. sho FA dation. 4 e hd get Counseling thECT TREATMENT SETTING... . Teaching-the patient prior to ECT treatment. . Preparin g the patient for ECT. * Providing care during the procedure. . Assisi ng with Post treatment. _* Providi —* Delivering rs a ECT. reassurance to: teduce anxiety.PSYCHOTHERAPY UNIT... Nurses who possess a masters degree in psychiatric nursing & are,certified clinical nurse specialists may conduct individual or group psychotherapy. . Establishing a a therapeu! cc relationship with the patient. S Providing an Opportunity for the patient to release tension as problem are discussed. © Assisting the | eens g insight about the — problem), — pyicine ( anid Fd practice new skills. & a in p ropriate ior as it / S. . 8 consiste) emo [pport.DAY CARE CENTERS OR DAY HOSPITALS... In day treatien programs patients wo home at night. * Performing clinical assessment. * Accurately observing & documenting the patient’s behavior. . Medication management. ~* Teaching social skills¢CHILD PSYCHIATRIC WARD... ° Assessing < x biclogigal & psychological need of the child. . Determine i child’s strengths & abilities & develdp a-care plan’ to’maintain & enhance capabilities. + Monitor the child’s developmental levels & “initiate supportive itt infterventions such as speech, ~ language or ational puuls as needed. "Provide a saf og eutiCount... * Co-operate with other professionals in an interdisciplinary approach to care. * Provide adequate environmental stimulation. * Teach the child adaptive skills such as eating, dressing, grooming & toileting. * Demonstrate & help thé’ child to practice self care skills. * Provide genetic counseling if necessary. _+ Deliver psychoeducation. . iene + Medication’ gement. ° Provide otional ‘support to the parents. articipatejin various therapies (behavior therapy, é sive oS “— ”HOME SETTING... * Assessment of symptoms. Teaching thetpatient & family regarding nutrition, exercise, hygiene & the relationship between physiéal &. emotionalhealth, + Stress management. + Daily living kills (basic money management, for example, b ccotnts, rent, utility bills, use of ~~ the e telephion enCount... * Medication management — monitoring blood levels, signs & symptoms of overdose or toxicity, teaching on dosage, side effects & purposes. * Acts as a case manager & coordinate an array of - : = . services that include physical therapy, occupational therapy, social work & community services. ~ © Appropriate referrals to community agencies. ~* Provide|supportive counseling & beet th & porCOMMUNITY MENTAL HEALTH CENTERS... * Identification of patient s in the community. * Refer the patients to appropriate hospitals. * Home visiting & providing direct care to the patients in the community. * Follow up care with special emphasis on medication regimen, improvement made & ~ side ie patient’ 's occupational function. ° Condue ting public | Avareness programs to nee isconceptions regardin, g mental &Count... * Training of paraprofessional, community leaders, school teachers & other care giving professionals in the commiunity. te zh: * Management of Fe Tes Boyes & co- oo Lae s Direct s services lk é;4 icareol, amilies at risk for violence, abuse & dysfunc on, care of homeless ed atientsietc.HOSPICE CARE CENTERS... ¢ Helping cancer patients or terminally ill individualsxhrough the grieving process. . Provide supportive sychotherapy. . Provide support groups for families of - ie ill, Patients. — WeEMERGENCY DEPARTMENTS... * Crisis intervention during natural disasters, accidents, unexpected illnesses causing increased anxiety, stress or immobilization. * Obstetric nursing centers. + Helping the mother in labor & support person to cope with anxiety / stress.during labor. __* Providing supporto bereaved patients in the event of fetal demise, abortion, birth of an Bi uf. A a i ith cong abnormalities. & a ‘ |MEDICAL INPATIENT WARDS... . Psychologital intervention for chronic illnesses with major psychological effects for example; Alzheimer’s disease, HIV / AIDS, diabetes mellitus, Parkinson’s disease, multiple sclerosis, hemophilia, colostomy, amputation, etc.HOSPITALS FOR CRIMINAL INSANE, JAILS & PRISONS... * Forensic psythiatric nurses assist patients with self care, administration of medications & monitor the effectivertess of the treatment. * Promote coping skills sgAdvanced nurses are able to diagnose & treat individuals with p psychiatric disorders & are — allowed 0 prescribe medications. beCount... ¢ Assessment of potential for violence. * Parole / prébation considerations. : Assessment of ‘racial / cultural factors during . Sexual predator: screening & assessment. a Competency therapy.