Mental Health Nursing: Mental Health and Nursing Care - Research Paper Example

Mental Health Nursing: Mental Health and Nursing Care Introduction World Health Organization (2007) defined mental health as more than the state of lack of mental disorder but also a foundation of well – being for individual and community’s effective functioning. Moreover, mental health is regarded as the individual and community foundation for well – being and effective functioning. It is determined by social, psychological, and biological factors that interact with one another, and its evidence is associated with poverty indicators that include low educational levels as well as poor housing and income (World Health Organization, 2007). Risks to mental health recognised include individual’s socio – economic disadvantages that are increasing and persisting over the passage of time. In each community, the disadvantaged people’s vulnerability to mental health disorders are explained as insecurity and hopelessness they experienced, rapid social changes, risks of violence and physical illness. According to Watkins (2000), mental health nursing is taking a more holistic view and sees human distress as person - centred. Nurses are privileged to have a role of standing alongside in the landscape of people’s lives and witness their clients’ journey as they offer companionship, comfort, and encouragement while they empathetically listens to them (Watkins, 2000). In the 20th century, mental health is a term used to substitute to refer mental illness (Elder, et al, 2004). This term has been carried on to date despite of the fact that this has led to debates all over the over the world (Elder, et al, 2004). However, up to the present time, the term mental health is continuously used to refer the mental illness (Elder, et al, 2004). Qualities of a Nurse who cares for Individuals with Mental Health Problems A psychiatric or mental health nurse is a registered nurse in an advanced practice that concentrates its clinical practice towards individuals, families, or population who are risk of acquiring psychiatric disorders or mental health problems (National Panel for Psychiatric-Mental Health NP Competencies, 2003). Its practice calls for continuous and comprehensive services that promote mental health, maintenance of health, as well as psychiatric disorders’ prevention and treatment. A registered nurse is competent to integrate promotion and protection of individual’s health, prevention of diseases, and treatment focus, and to assess and manage health and illness states. A registered nurse is capable of synthesizing its theoretical, scientific, and clinical knowledge (National Panel for Psychiatric-Mental Health NP Competencies, 2003). A psychiatric nurse empathetically listens to their clients, witnesses their client’s journey and offers them companionship, comfort, and encouragement as they continue their journey to a path that is more sustaining (Watkins, 2000). The primary function of a mental health nurse is to secure further improvement in the status of a mentally ill individual. One of the most challenging and interesting areas in the practice of nursing is mental health nursing (Elder, et al., 2004). Mental health nursing requires fusion of knowledge from different professions, and for an effective health nursing, the key is to develop therapeutic alliances with clients for growth and recovery while at the same time maintaining a clear professional boundaries with their clients (Elder, et al., 2004). According to Elder, et al. (2004), the fundamental skills needed in mental health nursing are self – awareness, insight, and reflexivity. A mental health nurse cares for their clients’ spiritual needs, empathises with their clients, cares, and establishes therapeutic alliance with their own clients (Elder, et al., 2004). Mental health nursing is an artistic craft that cares physically and emotionally disturbed individuals (Tilley, 1997). Tilley added that the compassionate gift of this craft that cares developed in a nurse – client relationship more than that of a contractual relationship. Moreover, a psychiatric health nurse is expected to have the following characteristics: (1) Help the family manage the client (2) Serves as the link between the client and the hospital so that a speedy medical attention can be provided (3) Provides continuous care to all clients (4) Maintains the prescription of the clients (5) Recognises side effects of the medications and be able to take suitable actions Develop an Understanding of Society’s Attitudes to Abnormal Behaviour The most politically powerless and vulnerable in the society are the individuals who are mentally ill (Evans et al., 2004). Mentally ill persons manifest as individuals with low self – esteem, has the tendency to withdraw from situations, is in doubt to oneself, and possess a distorted thinking (Evans et al., 2004). According to Doebbeling (2007), at some point of the lives of adults, around 30 – 50 percent of them experienced mental illness. This holds true among individuals aged 5 years and older. Mental health disorders became the 4th leading cause of disability having depression as the number one cause of mental disability. Sadly, only around 20 percent of these individuals seek professional help for their mental illness (Doebbeling, 2007). The burden of mental illness accounts to over 15 percent in established market economies such as the United States. According to Doebbeling (2007), the stigma that surrounds mentally disabled individuals remains to be tremendously high despite of the advances made to understand and treat their mental illnesses (Doebbeling, 2007). As an example, mentally ill individual can be viewed as lazy and irresponsible individuals by the society and community they are in and they are seen as less legitimate than physically ill clients (Doebbeling, 2007). These led to reluctance of insurance company to take part for their treatment. In addition to these, parents may be blamed for the mental handicap of their children and the public may turn away from clients with mental illness. Others may avoid living with them or near their vicinity as well as avoid working and socialising with them (Doebbeling, 2007). Strong social support improves significantly physical and mental recovery of clients. Hence, to satisfy the human need of everyone, every individual is required to have social network to care for them, accept them, and support them emotionally especially during times of stressful situations (Doebbeling, 2007). Discuss the Implications of Labelling Persons with a Mental Illness The society upholds normative values, and among individuals with mental illnesses, they became the victims of societal interactions to their behaviour (Andersen et al, 2005). At some point, once an individual has been labelled as mentally sick, he is forced into the role of being sick (Andersen et al, 2005). Labelling an individual with mental illness oftentimes leaves a powerful social effect that illuminates the consequences of individual’s behaviour (Andersen et al, 2005). Most commonly, people who are labelled with certain mental illness became hopeless and the possibility of leaving a valued life ceased (Mason, 2001). These individuals have given up hope because they regard and given up looking toward their future believing that they are living in a hopeless situation. On the other hand, there are people who do not accept the way they are labelled to and regard themselves the other way around. On the lighter side, some clients rejects the way they are being labelled as mentally ill and discounts the manifestations of the said pathology (Mason, 2001). Additionally, Mental Health Foundation noted that labelling mental illness is highly stigmatising to the client that leads an individual to think mental illness as a different entity rather than conceptualising it as severe emotional difficulty that an ordinary person must learn to cope with (Mental Health Foundation, undated). Moreover, the media stereotypes mentally ill clients as dangerous and violent individuals that contradict the qualities of ordinary people’s description having mental health problems (Mental Health Foundation, undated). Hence, it is misleading to stigmatise an individual as mentally ill when mental health problems are caused by several factors such as complex biological, social, and psychological interaction (Mental Health Foundation, undated). Watson, et al. (2007) added that mentally ill individuals experience decreased self – esteem and self – efficacy that limits the prospects of their recovery that lead them to isolation, unemployment, and lowered income. Kroska and Harkness (2004) stated that the identity of mentally ill individual is believed to be devaluated and discriminated using the identity’s evaluation, potency, and activity. Stigma beliefs are expected to be positively related to self – meaning several dimensions of most respondents, and are related positively to their coping behaviours social interaction withdrawal, concealing of history of treatment, and mental health education (Kroska and Harkness, 2004). Oftentimes, mentally – ill individuals are stigmatised being “psycho and schizo” or being referred to in jokes. Mental health stigma is oftentimes painful and shameful that leaves an individual angry and upset (Mayo Foundation for Medical Education and Research, 2007). This consequently causes mentally ill individuals to be misunderstood by the public. Despite of this, ways to cope and combat mental illness labelling offers reassurance to the client and gains client’s acceptance and empathy (Mayo Foundation for Medical Education and Research, 2007). An example to this, is a mentally ill patient who can openly talk in the public regarding their health condition, hold fundraising activities and wears shirt to express their support. Mayo Foundation for Medical Education and Research (2007) noted that as others were thinking that individuals who are mentally ill are weak or lazy. Some may also think that mentally ill individuals are said to be dangerous and violent; however, statistics have shown that mental illness and violence does not bear connections and mentally ill are neither criminals nor violent individuals (Mayo Foundation for Medical Education and Research, 2007). As a result, fear and mistrust are fuelled because of this distorted perception that eventually leads to vicious cycle. Examine the Process of Deinstitutionalisation and its Impact on People Experiencing a Mental Illness Developments in the understanding and treatment of problems in the mental health problem and trends in the social and economic over the past three decades have shaped the Canadian Health Care System restructuring. Deinstitutionalisation of individuals with serious mental illness from large psychiatric hospital institution to different types of facilities including tertiary care facility and supported housing in the community becomes the key feature in the reform of mental health. The period of deinstitutionalisation of mentally ill individuals started in 1950’s to date (Linhorst, 2006). A massive reduction in public hospital resulted from circumstances that arose in 1940’s to 1970’s (Linhorst, 2006). This resulted to inaccessible mental health support and care to those who are in need. A new wave of stigma has been promoted with deinstitutionalisation towards mentally ill individuals (Linhorst, 2006). As mentally ill patients became visible in the community, fear and hostility in particular, public fear for violence arose in the community (Linhorst, 2006). Serious consequences among severe mentally ill individuals resulted due to failure of deinstitutionalisation. Dangerous, oppressive, and unhealthy environment that lack rehabilitative and therapeutic services were awaiting to clients who moved from one institution to another. Failure of deinstitutionalisation led to homeless mentally ill individuals (Linhorst, 2006). They are incarcerated in jail and prison. Furthermore, the need of long term care in the psychiatric hospital were not eliminated due to failure of deinstitutionalisation, and many individuals continue to experience psychiatric symptoms despite of being placed in a community facility (Linhorst, 2006). Examine the Nursing Assessment, Intervention and Evaluation of Persons with Mental Illness A biopsychosocial and spiritual assessment that is accurate and thorough is believed to be the cornerstone of mental health nursing (Elder, et al., 2004). Nursing care plan, a fundamental component of nursing practice, functions to communicate the need of the patients to the team of nurses to ensure that needs of the patient are met (Medi – Smart, 2006). Nursing care plans that were documented into writing serves as a manuscript to the condition and the responses of treatment of the patient (Medi – Smart, 2006). Nursing Assessment: Subjective Complaint: “I heard my sister talking that my mother is trying to kill me; however, an angel came to rescue me,” as verbalised by the client. The client also expressed that she felt to have low self – respect and is helpless about her current mental condition. Objective finding: The client is observed to have agitated behaviour, restless, anxious, and disoriented with time, place, and person. Vital signs taken were as follows: T – 37.4 degrees Celsius; PR – 80 per min; RR – 20 per min; BP: 130/100 mmHg. Nursing Diagnosis revealed the following: (1) Mood – altering substances abuse as evidenced by disorientation to time and place, visual and auditory hallucination, and suspiciousness. (2) Chronic low self – esteem (3) Inadequate coping (4) Helpless regarding her current situation Nursing Evaluation: Short – term Goal includes: (1) After 8 hours of nursing intervention, for a specified time, the client becomes oriented with time, place, person, and circumstance with the assistance of a registered mental health nurse. (2) After 8 hours of nursing intervention, the client will be able to gain back his self esteem. (3) After 4 hours of nursing intervention, the client will learn how to cope with his present situation and will gain the confidence he had lost. Long – term Goal The client will be able to demonstrate accurate perception towards his environment and will gain back the confidence he had lost The following Nursing Intervention and Rationale include: (1) A registered nurse must help his client reality by not reinforcing complaints of hallucination. This is done by reorienting the client and focusing him on the real situation and the people that surrounds him by not sharing with the perception that he is currently experiencing. Through this, forming the possibility of false and inaccurate perception is decreased or abolished. (2) If the client is responding with fear by way of perception that is not accurate, a mental health nurse must provide reassurance of his client’s safety. The priority of a registered nurse remains to be his client’s safety and security. (3) A registered nurse must be able to correct the inaccurate perception of his client and describe the real existing situation. This is done because the ability of the client to respond to hallucination is interfered through the explanation of a registered nurse with real activities and situation. (4) Care towards the client must be catered by registered nurse to provide a feeling of stability and security. (5) A registered nurse must identify and assess the negative thoughts of his clients by reviewing perceptions that are negative. (6) Client’s beliefs and characteristics that are positive must be identified by the mental health nurse (7) Clients must be encouraged to participate in all activities that include planning of treatment. Integrate Knowledge of Legal and Ethical Issues in the Nursing Care of Persons with Mental Illness A registered nurse assesses the clients and is responsible in creating nursing diagnosis and nursing care plan (Barry, undated). A registered nurse is expected to work with the clients, families, groups, and communities as well as administer medications and evaluate medical outcomes (Barry, undated). Ethical and legal issues were proposed to predetermine psychiatric care during psychotic crisis (Melillio and Houde, 2005). A registered nurse must learn to promote autonomy of the patient, learn how to enhance communication between the family of the patient and his respective caregiver regarding the issues of treatment of the patient and be able to prevent crisis that would result to involuntary commitment (Melillio and Houde, 2005). Additionally, legal issues in nursing care of persons with mental illness include “commitment, least restrictive alternative, confidentiality, freedom from restraint and seclusion, and right to treatment and right to refuse treatment” (San Jose State Universtiy, 2009). The following are the legal and ethical rights of the psychiatric clients (Riverside Health System, 2009): (1) All the tests and treatments to be performed must be explained to the clients in a way they understands them. (2) Clients must be handled with great respect and utmost care. (3) Experimental and investigational treatments must not be made available unless consent from the parents and guardians are provided ahead of time by means of writing. (4) Clients have the right to communicate with their family through letters and telephone conversation. (5) Clients have the right to read their medical records with their physicians. (6) Clients can refuse being the subject of research and medical studies (7) Clients past and present wishes and feelings must be respected (Mental Health Act, 2007). (8) Diversity of religion, culture, sexual orientation must be respected (9) Clients must be involved in care and treatment planning, developing, and delivery. (10) Unlawful discrimination must be avoided (11) Clients’ well – being and care as well as public safety must be given importance. Conclusion In conclusion, a registered health care nurse who cares for mentally ill individuals must learn how to approach his clients in a holistic point of view. Clients deserve to be treated well not only physically and mentally but also emotionally, socially, spiritually, and all aspects of his well – being. Registered nurses must possess the values needed in their craft, and in doing so, his love for his chosen career path must surface all the hardships he is going through during his nursing practice, and this must be replaced with love and compassion to his chosen career path. References Anderson, M. and Taylor, H. (2005). Sociology: Understanding a Diverse Society. 4th Edition. Cengage Learning. Doebbeling, C. (2007). Mental Illness in Society. Retrieved 18 May 2009 from http://www.merck.com/mmhe/sec07/ch098/ch098b.html Elder, R., Evans, K., and Nizette, D. (2004). Psychiatric and Mental Health Nursing. Australia: Mosby. Forster, S. (2001). The Role of Mental Health Nurse. Nelson Thrones. Kroska, A. and Harkness, S. , 2004-08-14 "Exploring the Modified Labeling Theory of Mental Illness Using Affect Control Theory Measures and Predictions" Paper presented at the annual meeting of the American Sociological Association, Hilton San Francisco & Renaissance Parc 55 Hotel, San Francisco, CA, Online . 2009-03-04 from http://www.allacademic.com/meta/p110021_index.html Linhorst, D. (2006). Empowering People with Severe Mental Illness. Oxford: Oxford University Press. Mason, T. (2001). Stigma and Social Exclusion of Healthcare. Routledge ISBN 0415221994, 9780415221993 Mayo Foundation for Medical Education and Research. (2007). Mental Health: Overcoming the Stigma of Mental Illness. Retrieved 20 May 2009 from http://www.mayoclinic.com/health/mental-health/MH00076 Medi – Smart. (2006). Nursing Care Plan Resources. Retrieved 20 May 2009 from http://www.medi-smart.com/carepl.htm Melillio, K. and Houde, S. (2005). Geropsychiatric and Mental Health Nursing. Massachusetts: Jones & Bartlett Publishers Mental Health Foundation. (undated). Mental Illness. Retrieved 19 May 2009 from http://www.mentalhealth.org.uk/information/mental-health-overview/mental-illness National Panel for Psychiatric-Mental Health NP Competencies. (2003). Psychiatric Mental Health Registered Nurse Competencies. Retrieved 18 May 2009 from http://www.aacn.nche.edu/Accreditation/psychiatricmentalhealthnursepractitionercopetencies/FINAL03.pdf Office of Public Sector Information. (2007). Mental Health Act 2007. Retrieved 17 May 2009 from http://www.opsi.gov.uk/acts/acts2007/ukpga_20070012_en_2#pt1-ch1-pb4-l1g8 Riverside Health System. (2009). Your Rights: Psychiatric Patients. Retrieved 19 May 2009 from http://www.riversideonline.com/patients_guests/psychiatric-patient-rights.cfm San Jose State University. (2009). School of Nursing. Retrieved 19 May 2009 from http://74.125.153.132/search?q=cache:OsHUY8MZ-eAJ:www.sjsu.edu/upload/course/course_350/course_reader_127_S_09.doc+Legal+Issues+in+the+Nursing+Care+of+Persons+with+Mental+Illness&cd=3&hl=tl&ct=clnk&gl=ph Tilley, S. (1997). The Mental Health Nurse. Oxford: Wiley-Blackwell Watkins, P. (2000). Mental Health Nursing: The Art of Compassionate Care. United Kingdom: Butterworth Heinemann. Watson, A., Corrigan, P., Larson, J., and Sells, M. (2007). Self – Stigma in People with Mental Illness. Retrieved 18 May 2009 from http://schizophreniabulletin.oxfordjournals.org/cgi/content/full/sbl076v1 World Health Organization. (2007). Mental health: strengthening mental health promotion. Retrieved 19 May 2009 from http://www.who.int/mediacentre/factsheets/fs220/en/ Read More