Roles of Psychiatric Nurses in Mental Health Nursing - Essay Example

Roles of Psychiatric Nurses in Mental Health Nursing Part A Drawing on current literature, explain the impact of beliefs and values about mental illness on the delivery of mental health care. Explain recommendations to reduce the occurrence of stigma in psychiatric settings. Introduction: It is a well known fact that all cultural groups have sets of values, beliefs, and patterns of accepted behavior. People across different varied cultures, therefore, may have difficulty understanding the cultural parameters of another. This is specifically true in regard to mental illness. In some cultures, the prevalent beliefs and values view it as a condition for which the ill person must be punished and debarred from the society. At the same time, some contemporary cultures are more tolerant, and their beliefs suggest that family and community members are keys to the care and treatment of the mentally ill. The impact of longstanding beliefs and values on care provision: Mental health nurses are from the population, and before being mental health nurses, they were lay people. Therefore, it is very likely that the beliefs and values about mental health deeply ingrained in societies would be carried forward in the nurses, unless they acquire mental health literacy. It is ironical that while amongst the nurses, the importance of health literacy in terms of physical health is well recognised, even among them, the area of mental health literacy is comparatively ignored. Prejudice, stereotyping, and stigma of the healthcare professionals in the psychological health field has influenced care traditionally, mainly because of the fact that those are difficult to change, and if this occurs in the mental health nurses, would influence the care outcome. When nurses understand different cultures as they relate to individual feelings and motivations, they will be better equipped to adapt mental health care to the backgrounds and lifestyles of their clients. It is a matter of growing concern and an important issue in delivery of mental health care in the Australian Healthcare System. According to the DHS (1998) one of the roles of the psychiatric nurse is to have an awareness of stigma and the ability to challenge their beliefs, thoughts, attitudes, and bias about mental disorder. It is required by the standards of practice to implement this changing "attitude" of the nurses into practice to eliminate discrimination in practice, and therefore, "Reflecting on practice, feelings and beliefs and the consequences of these for individuals/groups is an important professional benchmark" (ANMC, 2006). Nursing care of people with psychiatric illnesses and emotional problems very frequently are more complex because of cultural differences between the nurses' and patients' backgrounds and cultural heritages. It is important for nurses to understand clearly the thinking and perspectives of other cultures and groups, especially to which their clients belong. Because treating mental disorders is intertwined with peoples' attitudes about themselves, their beliefs, values, and ways of interacting with their families and communities, it is crucial that psychiatric nurses be culturally competent in their practice. The awareness about these factors leads to knowledge and alteration of beliefs about mental disorders in nurses, and this alteration would aid the recognition, better management, and efficient prevention of these disorders. This awareness has several components including the ability to recognise specific disorders or different types of psychological distress, knowledge and beliefs about risk factors and causes, knowledge and beliefs about interventions, and attitudes that facilitate recognition and offer help. Poor knowledge about mental illness and negative attitude towards patients suffering from mental illness is widespread among the mental health workers including nurses. Educational interventions can reduce stigma, and as noted earlier, stigmatizing opinions are not related to knowledge. Mental health literacy that is defined as knowledge and beliefs about mental illnesses is reportedly adequate in mental health nurses by dint of their specialized training, unfortunately, it has been observed that negative attitudes of mental health nurses toward these patients are not quite uncommon, and this has been a controversial issue across healthcare systems including Australia. It is for this reason cultural competence has been a standard of practice to be attained by mental health nurses, and this indicates the continuous striving by the nurses to achieve the ability and availability to work effectively within the cultural context of the client indicated by family, individual or community. This can be developed through cultural awareness, acquisition of cultural knowledge, development of cultural skills, and engagement in numerous cultural encounters (Mendyka, B., 2000). Practice recommendations that reduce stigma relational to beliefs and values: Culture is a broad term referring to a set of shared beliefs, values, behavioral norms, and practices that are common to a group of people sharing a common identity and language. Australia has diverse cultural groups, whose members have thousands of beliefs and practices related to appropriate behavior. Much of an individual's behavior and way of thinking is automatic and originates from childhood learning. Learning about acceptable and expected behavior in one's culture occurs from earliest childhood through socialization. The family has most profound influence on the development of traditional values and practices. However, the community, school, church, government, and media also play significant roles. Introspection and self-analysis regarding one's own cultural background and membership in particular subcultures is important. Cultural sensitivity requires the nurse to develop awareness of his or her attitudes, beliefs, and values. Values and beliefs that are not examined and analyzed can influence the nurse's judgment about clients, thereby affecting the nurse-client relationship. Nursing is no stranger to the issue of cultural diversity. The professed gold standard is to guarantee culturally relevant care in a multicultural society, where cross-cultural communication and cultural sensitivity are the norm and care is provided by culturally competent nurses who were educated in programs with a culturally diverse student body and faculty. Multicultural medical and psychiatric issues are incorporated into the curriculum. If nurses are to deliver culturally-diverse care effectively, they need to reflect upon their values and beliefs, seek direction from their professional organizations, and modify their own behavior. The expression of symptoms of mental illness and how they are perceived varies widely among cultures. Major psychiatric disorders occur in every society and primary symptoms are similar across cultures. However, the secondary features of these disorders can be strongly influenced by culture. In many ethnic groups, there is no distinction among physical, mental, and spiritual illness. Therefore, an individual suffering from severe environmental stressors or emotional distress might express this distress as a physical problem. Complaints such as insomnia, anorexia, and weight loss may be an expression of depressive illness (Andrews, M., & Boyle, J. S., 2002). The nurse needs to be sensitive to issues affecting the psychiatric needs of both the client and the family. During the initial assessment, the nurse needs to encourage the client to identify those people, he considers family members. Family members who accompany the client and expect to be part of the treatment planning are included in any teaching done by the nurse. A psychoeducational approach, in which the nurse educates the family about the illness and offers supportive understanding of the family experience, may help in this situation. People with mental illnesses or emotional problems often are stigmatized by the society in which they live. Stigmatization is the process of assigning negative characteristics and identity to one person or group, causing that person or group to feel unaccepted, devalued, ostracized, and isolated from the larger society. Prejudice, discrimination, and stereotyping foster stigmatization. Although individuals can be victims of stigmatization, even large groups within a society can become victims of stigma, such as those of certain ethnic or cultural groups, those of certain socioeconomic status, and certainly those with a mental handicap or illness. Stigma remains attached to those with mental disorders or those who seek help for mental illness. Many service providers across continents describe the negative attitude that continues to persist in the people and mental health services. Negative labels about the mentally challenged, misconceptions, and stigma regarding mental illness persist in the society for the same reasons that racial and ethnic stigma persists, and the reasons are misunderstanding and fear (Byrne, P., 2001). Roles and responsibilities of the health professional to reduce the occurrence of stigma: Stigmatization is a powerful force in influencing the treatment and rehabilitation of the person with a mental disorder. It is estimated that nearly two thirds of people with mental disorders do not seek treatment. Stigma surrounding mental health treatment is one of many barriers that discourage people from seeking help. Its effects are not easily overcome. When people are subjected to stigmatization over a long time, they usually try to conceal their disorders and worry that others may discover the illness. They become discouraged, hurt, and angry and develop low self-esteem, and all these are known to worsen the prognosis of mental illness. Denial of mental illness is common among family members. The psychiatric nurse needs to be aware of the effects of stigma on patients and families and to support efforts to change the social view of mental disorders. The nurses have important roles to prevent stigma coming in the way of the outcome of nursing care in the clients with mental illness. To be able to do this, a cultural nursing assessment would need to be done that includes a systematic appraisal of the cultural beliefs of the clients. The nursing assessment must include practices to determine nursing needs and intervention practices within the cultural context of the individuals to be included in the plan. Cultural assessment of a mentally ill client can be part of the initial data collection for a nursing history. Additional cultural assessment information includes inquiries related to the composition and frequency of contact with the family or social network. Cultural data needs to be analysed in the appropriate context, and the nursing diagnosis should be designed as appropriate for the client and that must be contingent on the cultural needs assessed from the analysis of the data. The nurse must analyze cultural issues that may present problems in accepting nursing care to plan for negotiation, repatterning, or restructuring. The nurse's attitude of wanting to learn about the client's ethnicity demonstrates respect and acceptance of ethnically diverse clients. Nursing interventions specific to cultural considerations include those that enable the nurse to establish a trusting relationship; to communicate with the ethnically diverse client, including the family or social network in the care plan; and to incorporate the cultural beliefs of the client and family in treatment. The nurse's knowledge about the client's culture is used in selecting culturally congruent actions (Caldwell, TM. & Jorm, AF., 2001). Reference List Andrews, M., & Boyle, J. S. (2002). Transcultural concepts in nursing care (4th ed.). Philadelphia: Lippincott Williams & Wilkins. Australian Nursing and Midwifery Council, (2006). National Competency Standards for the Registered Nurse. Byrne, P., (2001). Psychiatric stigma. Br J Psychiatry;178:281-284 Caldwell, TM. & Jorm, AF. (2001) Mental health nurses' beliefs about likely outcomes for people with schizophrenia or depression: a comparison with the public and other healthcare professionals. Australian and New Zealand Journal of Mental Health Nursing, 10, 42-54.. Mendyka, B. (2000). Exploring culture in nursing: A theory-driven practice. Holistic Nursing Practice, 15(10), 32-41. Mental Health Branch Aged Community and Mental Health Division, Department of Human Services (July 1998). Undergraduate Nursing Education in Victoria. Psychiatric Knowledge, Attitudes and Skill Requirements for Beginning Level Division 1 Nurses. Psychiatric Nursing Part B Reflect on your own longstanding beliefs and values which will affect delivery of mental health care. Draw on current literature and (to a lesser extent) your reflective journal to support your discussion. This is a reflective journal about my own longstanding beliefs and values about mental illness. Being a psychiatric nurse, it is almost embarrassing to reflect on my own beliefs, and since I am writing in an analytic mode, I will keep to the truth and shall explore how it can affect delivery of effective mental health care. When I was beginning my career as a trainee nurse in the mental health department, I believed at that time, and perhaps still believe that family members were the causes of mental illness of any psychiatric patient. Therefore, while interviewing the patients, I used to tend to keep the family members away, though I could sense that they are very interested and keen to be involved in the patient's care. Even though as a nurse I need to come in close contact with patients with mental illness, I must accept that both personally and professionally, I tend to maintain a social distance with these individuals. This is acclaimed to be one of the most significant components of stigmatization, but the fact is that I keep off from them. I do not know the reasons for this, but somehow, it appears to me that they would not be able to communicate with me or understand me, and therefore, there is no point socializing with them. After beginning nursing and experiencing the care of many patients, I have found that the patients with schizophrenia can be belligerent, aggressive, and abusive, and they also pose sometimes a physical threat. This has resulted in some aversions in my mind regarding these patients, mainly due to the fact that my apprehension is that they could physically hurt me or others (Eisenberg, L., 2005). Although these are basically very descent people that I have seen them behaving very reasonably following successful drug treatment, I still see that I cannot convince myself to be mingling with them without any inhibition. Comparatively, the patients with depression are docile. I am aware that this social distance is another form of stigmatization, and this needs to be avoided while providing care. Moreover, in all the movies about the crazy people or thriller movies, I have seen that the schizophrenics kill people, may be that fear is playing some role in this kind of belief. Reflecting on these now, it is clear that things are not that bad as it appears, and it is very important for a mental health nurse to get rid of her own beliefs and values while providing care to such patients. Respect and understanding of the ethnically diverse client and family must be demonstrated while communicating with a patient with mental illness. Nurse's own belief or value should not be allowed to hamper the care, since demonstration of disrespect to family and alienation of the family from the care process may influence the outcome negatively. Client and family expression of satisfaction with nursing care is important and is the final measure of the success of incorporating cultural considerations in the nursing process. The key to successful nursing care is establishing a trusting relationship with the patient. If the nurse feels distance from the patient, and if the nurse's own false belief about the disease causes a social distance between the patient and the nurse, factually no trusting relationship can build up. The communication on the part of the nurse would be disjointed leading to even a wrong diagnosis and a treatment delivered that is not at all indicated. A respect for the patient is necessary for an effective nurse patient exchange, and stigmatization and wrong beliefs only hinder that (Evans, D. L., Foa, E. B., Gur, R. E., Hendin, H., O'Brien, C. P., Seligman, M. E. P., et al. (Eds.), 2005). The ideal mental health nursing should have the goal of an identical outcome as in any other physical illness, and a mentally ill patient would desire similar recovery. The previous belief that a person would never recover from chronic and relentless mental illness has been replaced by the belief of complete recovery with advancement of knowledge. Mental illness no longer is a life long illness, and the concept of recovery has actually gained wide acceptance by psychiatric nurses. Therefore, all these individuals who continue to be interpreted by the beliefs of others have a fair chance to lead a meaningfully social life, a scope to develop relationships, and an idea of reclaiming a sense of self identity. Recovery involves not only the patient's unique attributes, but also support from the carer and providers and from the society (Mead, S., & Copeland, M. E., 2000). For these people, research has demonstrated that recovery is considerably hindered by the pervasive influence of stigma. There are many reasons of stigma, but the results of stigma universally are disapprovals that result in discrimination against individuals who are excluded from the mainstream of the society. These lead to fear and mistrust by others, prejudice, discrimination, and exclusion (Bolton, J., 2003). Benbow has mentioned that stigma surrounding mental illness is deeply ingrained and reinforced by various media that have portrayed individuals with mental illness as unpredictable and dangerous. The subtle effects of stigma and its effects are not known, but the effect of discrimination is very vivid. Many mentally ill patients are discriminated and restricted from social life (Benbow, A. , 2007). Before being applying their own false beliefs in rating these patients, psychiatric nurses can help the patients with severe mental illness in several ways, and to be able to do this they must develop an awareness about these patients, can participate in evidence-based practice such as assertive community treatment or family therapy, and they can be advocates of these patients (Wiersma, D., 2006). Conclusion: Personal cultural beliefs and values regarding mentally ill patients may affect the care of such patients as far as mental health nursing is concerned. Before stigmatizing these people, the nurses must consider the evidence and frame their decisions about them, Respect for these individuals is the key to build up a trusting relationship that can provide support to these patients, and awareness about these factors would allow the nurses to entertain evidence-based practice that could go a long way to remove discriminating stigma and false beliefs about their disease, and mental health nurses can be instrumental advocates for a social change that can convert these chronic lifelong illnesses to diseases that can be cured. Reference List Benbow, A. (2007). Mental illness, stigma and the media. Journal of Clinical Psychiatry, 68(suppl 2), 31-35. Bolton, J. (2003). How can we reduce the stigma of mental illness BMJ Career Focus, 326, S57a. Eisenberg, L. (2005). Violence and the mentally ill. Archives of General Psychiatry, 62, 825-826 Evans, D. L., Foa, E. B., Gur, R. E., Hendin, H., O'Brien, C. P., Seligman, M. E. P., et al. (Eds.). (2005). Treating and preventing adolescent mental health disorders: What we know and what we don't know. Oxford, UK: Oxford University Press. Mead, S., & Copeland, M. E. (2000). What recovery means to us. Community Mental Health Journal, 36(3), 329-331. Wiersma, D. (2006). Needs of people with severe mental illness. Acta Psychiatrica Scandinavica, 429(suppl), 115-119. Read More