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Psychiatric nursing is an interpersonal process that promotes and maintains behavior that contributas to integrated functioning. The patient may be an individual, family, group, organization, or community. Psychiatric nurses deliver primary mental health care, which includes the continuous and comprehensive services necessary for the promotion of optimal mental health, prevention of mental illness, health maintenance, management of and referral of mental and physical health problems, the diagnosis and treatment of mental disorders and their sequelae, and rehabilitation. The Center for Mental Health Services officially recognizes psychiatric nursing as one of the five core mental health disciplines. The other four disciplines are marriage and family therapy, psychiatry, psychology, and social work.

The current practice of psychiatric nursing is based on a number of underlying premises or beliefs. The psychiatric nurse uses knowledge from the psychosocial and biophysical sciences and theories of personality and human behavior. From these sources the nurse derives a theoretical framework on which to base nursing practice. The choice of a conceptual model or theoretical framework is an individual one.

Finally, the contemporary practice of psychiatric nursing occurs within a social and environmental context. The professional psychiatric nursing role has grown in complexity from its original historical elements. It now includes the parameters of clinical competence, patient advocacy, fiscal responsibility, professional collaboration, social accountability, and legal and ethical obligations. These factors influence the education research, and clinical components of contemporary psychiatric nursing practice.

Elements of the professional psychiatric nursing role

Competent Caring

There are three domains of contemporary psychiatric nursing practice; direct care, communication, and management activities. Within these overlapping domains of practice, the teaching, coordinating, delegating, and colaborating functions of the role are expressed. Often the communication and management domains of practice are overlooked when discussing the psychiatric nursing role. However, these integrating activities are critically important and very time-consuming aspects of a nurse’s role. They are also likely to become more important in a reformed health-care system that places emphasis on efficient patient triage and management. Thus they should not be minimized or discounted when describing the contemporary psychiatric nursing role.

• Make biopsychosocial health assessments that are culturally sensitive.

• Design and implement treatment plans for patients and families with complex health problems and comorbid conditions.

• Engage in case management activities, such as organizing, accessing, negotiating, coordinating, and integrating services and benefits for individuals and families.

• Provide a “health-care map” for individuals, families, and groups to guide them to community resources for mental health-including the most appropriate providers, agencies, technologies, and social systems.

• Promote and maintain mental health and manage the effects of mental illness through teaching and counseling.

• Provide care for the physically ill with psychological problems and the psychiatrically ill with physical problems.

• Manage and coordinate systems of care integrating the needs of patients, families, staff, and regulators

The Role of Psychiatric Nurse Today

Psychiatric nurses are vital members of the mental health team. They actively direct and evaluate client responses to stress across the life span. Their continuous monitoring of clients experiencing crises further employs the nurse’s input to intervene and create environments that minimize maladaptive responses and promote mental health. The impact of these interventions on client outcomes is often minimized by psychiatric nurses and other mental health professionals.

Psychiatric nurses need to appreciate their role in various mental health settings. This process can initially be accomplished by recognizing the importance of daily interventions and client responses. The agitated client who calms down after the nurse establishes trust and explains that the oral lorazepam (Ativan) will reduce irritability is an example of a frequently used psychiatric nursing intervention. Understanding the effects of benzodiazepines on the nervous system helps nurses recognize the impact of medication on client behavior.

The role of psychiatric nursing stems from its responsibility in promoting and restoring mental health. Primary prevention can be used to identify high-risk groups and provide health education. The nurse can intervene at this stage by using secondary preventionto restore health and to halt the disease process or deterioration.

Secondary prevention can be initiated during an acute phase on inpatient, emergency departments, or homeless shelters. As clients respond to interventions and health is restored, the psychiatric nurse is concerned with preventing deleterious effects of mental illness. This stage is referred to as tertiary prevention.

The role of the nurse in tertiary prevention is to prevent disability and promote rehabilitation and health maintenance. Aftercare programs such as Alcoholics Anonymous, Narcotics Anonymous, and Cocaine Anonymous are examples of tertiary programs. Nurses may also be invloved in education programs for the mentally ill and focus on medication compliance, dual diagnoses, stress managemant, and coping skills. Prescription authority enables advanced-practice registered nurses to collaborate with the physician and support clients on maintenance medications and to evaluate their response over time through direct observation and drug levels.


References:
American Nurses Association. 1967. Steatment on Psychiatric and Health Nursing Practice. Kansas: MO. 

Videbeck, Sheila L. 2008. Psychiatric Mental Health Nursing. Edisi bahasa Indonesia. Jakarta : EGC.