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{{Short description|Health profession}}
'''Psychiatric nursing''' or '''
In most countries, after the 1990s, a psychiatric nurse would have to attain a [[bachelor's degree]] in nursing to become a [[Registered nurse|Registered Nurse (RN)]], and specialise in mental health. Degrees vary in different countries, and are governed by country-specific regulations. In the United States one can become a RN, and a psychiatric nurse, by completing either a diploma program, an
Mental health nurses can work in a variety of services, including: [[Child and Adolescent Mental Health Services|Child and Adolescent Mental Health Services (CAMHS)]], [[Acute medical unit|Acute Medical Units (AMUs)]], [[Psychiatric intensive-care unit|Psychiatric Intensive Care Units (PICUs)]], and [[Community mental health service|Community Mental Health Services (CMHS)]].
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The history of [[psychiatry]] and psychiatric nursing, although disjointed, can be traced back to ancient philosophical thinkers. [[Marcus Tullius Cicero]], in particular, was the first known person to create a questionnaire for the mentally ill using biographical information to determine the best course of psychological treatment and care.<ref name="Alfredo, D. 2009">{{cite book |last=Alfredo |first=D. |year=2009 |title=The History of Psychiatric Nursing}} {{full citation needed|date=January 2018}}</ref> Some of the first known psychiatric care centers were constructed in the Middle East during the 8th century. The medieval Muslim physicians and their attendants relied on clinical observations for diagnosis and treatment.<ref name="Alexander, F. 1967">{{cite book |last1=Alexander |first1=F. |last2=Selesnick |first2=S. T. |year=1967 |title=The History of Psychiatry: An Evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present |location=Michigan |publisher=Allen and Unwin}}{{page needed|date=January 2018}}</ref>
In 13th century medieval Europe, psychiatric hospitals were built to house the mentally ill, but there were not any nurses to care for them and treatment was rarely provided. These facilities functioned more as a housing unit for the insane.<ref name="Alexander, F. 1967"/> Throughout the high point of Christianity in Europe, hospitals for the mentally ill believed in using religious intervention. The insane were partnered with
In the colonial era of the United States, some settlers adapted community health nursing practices. Individuals with mental defects that were deemed as dangerous were incarcerated or kept in cages, maintained and paid fully by community attendants. Wealthier colonists kept their insane relatives either in their attics or cellars and hired attendants, or nurses, to care for them. In other communities, the mentally ill were sold at auctions as slave labor. Others were forced to leave town.<ref name="Levine, M. 1981">{{cite book |last=Levine |first=M. |year=1981 |title=The History and Politics of Community Mental Health |url=https://archive.org/details/historypoliticso0000levi |url-access=registration |location=United States |publisher= Oxford Press}}{{page needed|date=January 2018}}</ref>
The 1790s saw the beginnings of [[moral treatment]] being introduced for people with mental distress.<ref name="Videbeck, S. L. 2008">{{cite book |last=Videbeck |first=S. L. |year=2008 |title=Psychiatric- Mental Health Nursing |url=https://archive.org/details/psychiatricmenta0000vide |url-access=registration |location=Philadelphia |publisher=Lippincott Williams & Wilkes|isbn=9780781764254 }}{{page needed|date=January 2018}}</ref> The concept of a safe asylum, proposed by [[Philippe Pinel]] and [[William Tuke]], offered protection and care at institutions for patients who had been previously abused or enslaved.<ref name="Videbeck, S. L. 2008"/> In the United States, [[Dorothea Dix]] was instrumental in opening 32 state asylums to provide quality care for the ill. Dix also was in charge of the Union Army Nurses during the [[American Civil War]], caring for both Union and Confederate soldiers. Although it was a promising movement, attendants and nurses were often accused of abusing or neglecting the residents and isolating them from their families.<ref name="Videbeck, S. L. 2008"/>
The formal recognition of [[psychiatry]] as a modern and legitimate profession occurred in 1808.<ref name="Alexander, F. 1967"/> In Europe, one of the major advocates for mental health nursing to help psychiatrists was Dr. William Ellis. He proposed giving the
The discrepancy between the founding of [[psychiatry]] and the recognition of trained nurses in the field is largely attributed to the attitudes in the 19th century which opposed training women to work in the medical field.<ref name="Alfredo, D. 2009"/>
In 1913 [[Johns Hopkins University]] was the first college of nursing in the United States to offer psychiatric nursing as part of its general curriculum. The first psychiatric nursing textbook, ''Nursing Mental Diseases'' by [[Harriet Bailey]], was not published until 1920. It was not until 1950 when the National League for Nursing required all nursing schools to include a clinical experience in [[psychiatry]] to receive national accreditation.<ref name="Videbeck, S. L. 2008"/> The first psychiatric nurses faced difficult working conditions. Overcrowding, under-staffing and poor resources required the continuance of custodial care. They were pressured by an increasing patient population that rose dramatically by the end of the 19th century. As a result, labor organizations formed to fight for better pay and fewer hours.<ref name="Nolan, P. 1993"/> Additionally, large asylums were founded to hold the large number of mentally ill, including the famous [[Kings Park Psychiatric Center]] in Long Island, New York. At its peak in the 1950s, the center housed more than 33,000 patients and required its own power plant. Nurses were often called
In 1963, President [[John F. Kennedy]] accelerated the trend towards deinstitutionalization with the [[Community Mental Health Act]].
The first developed standard of care was created by the psychiatric division of the [[American Nurses Association]] (ANA) in 1973. This standard outlined the responsibilities and expected quality of care of nurses.<ref name="Videbeck, S. L. 2008"/>
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=== Physical and biological interventions ===
==== Psychiatric medication ====
[[Psychiatric medication]] is a commonly used intervention and many psychiatric [[mental health nurse]]s are involved in the administration of medicines, both in oral (e.g. tablet or liquid) form or by [[intramuscular injection]]. [[Nurse practitioners]] can prescribe medication.
==== Electroconvulsive therapy ====
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==== Physical care ====
Along with other nurses, psychiatric mental health nurses will intervene in areas of physical need to ensure that people have good levels of personal hygiene, nutrition, sleep, etc., as well as tending to any concomitant physical ailments. In mental health patients, obesity is not rare because some medications can have a side effect of gaining weight which can cause the patient to have low confidence and lead to other health issues.<ref name=":1">{{Cite journal|title=Improving the physical health of people with mental health problems|last=Glasper|first=Alan|date=2016|journal=British Journal of Nursing
=== Psychosocial interventions ===
Psychosocial interventions are increasingly delivered by nurses in mental health settings. These include [[psychotherapy]] interventions, such as [[cognitive behavioural therapy]], [[family therapy]], and less commonly other interventions, such as [[Integrative milieu model|milieu therapy]] or [[psychodynamic]] approaches. These interventions can be applied to a 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 approach|recovery]] and help manage any future [[existential crisis|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<ref name="pmid12199882">{{
=== Spiritual interventions ===
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[[File:Navy nurse corps 1908.jpg|thumb|In 1913, [[Johns Hopkins University]] was the first college of nursing in the United States to offer psychiatric nursing as part of its general curriculum.]]
The most important duty of a psychiatric nurse is to maintain a positive therapeutic relationship with patients in a clinical setting. The fundamental elements of mental health care revolve around the interpersonal relations and interactions established between professionals and clients. Caring for people with [[mental disorder|mental illnesses]] demands an intensified presence and a strong desire to be supportive.<ref name="Berg">{{
====Understanding and empathy====
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====Providing support====
Successful [[therapeutic relationship]]s between nurses and patients need to have positive support. Different methods of providing patients with support include many active responses.<ref name=pmid17635627/> Minor activities, such as shopping, reading the newspaper together, or taking lunch or dinner breaks with patients can improve the quality of support provided.<ref name=pmid15720494>{{cite journal |doi=10.1111/j.1365-2850.2004.00774.x |pmid=15720494 |title=Trust as a foundation for the therapeutic intervention for patients with borderline personality disorder |journal=Journal of Psychiatric and Mental Health Nursing |volume=12 |issue=1 |pages=23–32 |year=2005 |last1=Langley |first1=G. C |last2=Klopper |first2=H }}</ref> Physical support may also be used and is manifested through the use of touch.<ref name=pmid15720494/> Patients described feelings of [[haptic communication|connection]] when nurses hugged them or put a hand on their shoulder.<ref name=pmid17635627/> Psychiatric nurses in Berg and Hallberg's study described an element of a working relationship as comforting through holding a patient's hand.<ref name="Berg" /> Patients with depression described relief when the nurse embraced them.<ref name=pmid12956021/> Physical touch is intended to comfort and console patients who are willing to embrace these sensations and share mutual feelings with nurses.
====Being there and being available====
In order to make patients feel more comfortable, the patient care providers make themselves more approachable, therefore more readily open to multiple levels of personal connections. Such personal connections have the ability to uplift
====Being genuine====
The act of being genuine must come from within and be expressed by nurses without reluctance. Genuineness requires the nurse to be natural or authentic in their interactions with the patient.<ref name=pmid12801401>{{cite journal |doi=10.1046/j.1365-2648.2003.02677.x |pmid=12801401 |title=Being professional and being human: One nurse's relationship with a psychiatric patient |journal=Journal of Advanced Nursing |volume=43 |issue=1 |pages=101–8 |year=2003 |last1=Hem |first1=Marit Helene |last2=Heggen |first2=Kristin }}</ref> In his article about pivotal moments in therapeutic relationships, Welch found that nurses must be in accordance with their values and beliefs.<ref>{{cite journal |doi=10.1111/j.1440-0979.2005.00376.x |pmid=16181152 |title=Pivotal moments in the therapeutic relationship |journal=International Journal of Mental Health Nursing |volume=14 |issue=3 |pages=161–5 |year=2005 |last1=Welch |first1=Mark }}</ref> Along with the previous concept,
====Promoting equality====
For a successful therapeutic relationship to form, a beneficial co-dependency between the nurse and patient must be established. A derogatory view of the
====Demonstrating respect====
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====Demonstrating clear boundaries====
[[professional boundaries|Boundaries]] are essential for protecting both the patient and the nurse, and maintaining a functional therapeutic relationship. Limit setting helps to shield the patient from embarrassing behaviour,<ref>{{cite journal |doi=10.1111/j.1440-0979.2005.00363.x |pmid=15896254 |title=The attitudes, knowledge and skills needed in mental health nurses: The perspective of users of mental health services |journal=International Journal of Mental Health Nursing |volume=14 |issue=2 |pages=78–87 |year=2005 |last1=Rydon |first1=Sharon E }}</ref> and instills the patient with feelings of safety and containment.<ref name=pmid15720494/> Limit setting also protects the nurse from "[[occupational burnout|burnout]]
====Demonstrating self-awareness====
Psychiatric nurses recognise personal vulnerability in order to develop professionally.<ref name=pmid12801401/> Humanistic insight, basic human values, and self-knowledge improves the depth of understanding the self.<ref name=pmid12358707>{{cite journal |doi=10.1046/j.1365-2850.2002.00538.x |pmid=12358707 |title=Swedish forensic nursing care: Nurses' professional contributions and educational needs |journal=Journal of Psychiatric and Mental Health Nursing |volume=9 |issue=5 |pages=531–9 |year=2002 |last1=Rask |first1=Mikael |last2=Aberg |first2=Jonas }}</ref> Different personalities affect the way psychiatric nurses respond to their patients. The more self-aware, the more knowledge on how to approach interactions with patients nurses have.<ref name="ReferenceA"/> Interpersonal skills needed to form relationships with patients were acquired through learning about oneself.<ref name=pmid16737499/> Clinical supervision was found to provide the opportunity for nurses to reflect on patient relationships,<ref name="ClearyEdwards1999">{{cite journal |doi=10.1046/j.1440-0979.1999.00141.x |pmid=10661080 |title=Factors influencing nurse-patient interaction in the acute psychiatric setting: An exploratory investigation |journal=Australian and New Zealand Journal of Mental Health Nursing |volume=8 |issue=3 |pages=109–16 |year=1999 |last1=Cleary |first1=Michelle |last2=Edwards |first2=Clair |last3=Meehan |first3=Tom }}</ref> to improve clinical skills,<ref name=pmid12358707/> and to help repair difficult relationships.<ref>{{cite journal |doi=10.1111/j.1744-6163.1998.tb00998.x |pmid=9847826 |title=Factors Influencing Movement of Chronic Psychiatric Patients from the Orientation to the Working Phase of the Nurse-Client Relationship on an Inpatient Unit |journal=Perspectives in Psychiatric Care |volume=34 |issue=1 |pages=36–44 |year=1998 |last1=Forchuk |first1=Cheryl |last2=Westwell |first2=Jan |last3=Martin |first3=Mary-Lou |last4=Azzapardi |first4=Wendy Bamber |last5=Kosterewa-Tolman |first5=Donna |last6=Hux |first6=Margaret |doi-access=free }}</ref> The reflections <ref name=pmid14629636/> articulated by nurses through clinical supervision help foster self-awareness.
== Pediatric
Nurses are vital to the evaluation and treatment of children with mental illness. Pediatric mental health nursing is the treatment/nursing of mental illness in pediatric patients. Family nurse practitioners (FNPs) are typically expected to evaluate and treat pediatric patients struggling with their mental health.
== Profession status ==
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===Canada===
The ''registered psychiatric nurse'' is a distinct nursing profession in all of the four western provinces.
===Ireland===
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===New Zealand===
Mental Health Nurses in New Zealand require a diploma or degree in nursing.
===Sweden===
In [[Sweden]], to become a ''registered psychiatric nurse'' one must first become a registered nurse which requires a BSc. (Bachelor of Science) in Nursing (three years of full-time study, 180 higher education credits). Then, one must complete one year of graduate studies in psychiatric/mental health nursing (60 higher education credits), which also includes writing a MSc. (Master of Science) thesis.<ref>"Specialistsjuksköterskeprogrammet med inriktning mot psykiatrisk vård" (In Swedish). University of Gothenburg. Accessed: January 26, 2018. URL: https://utbildning.gu.se/program/program_detalj/?programid=V2PSV</ref> The registered psychiatric nurse is an evolving profession in Sweden. However, unlike in countries such as the US, there is no [[psychiatric-mental health nurse practitioner]], so in Sweden, the profession cannot for example prescribe pharmacological treatment.<ref>"Kompetensbeskrivning för legitimerad sjuksköterska med specialistsjuksköterskeexamen, inriktning psykiatrisk vård". (In Swedish). The Swedish Society of Nursing. Accessed: 26 January 2018. URL: https://www.swenurse.se/globalassets/01-svensk-sjukskoterskeforening/publikationer-svensk-sjukskoterskeforening/kompetensbeskrivningar-publikationer/kompetensbeskrivning.sjukskoterska.psykiatri.2014.pdf
===United Kingdom===
{{Main|Mental health nurse|Community psychiatric nurse}}
In the [[UK]] and Ireland the term ''psychiatric nurse'' has now largely been replaced with ''mental health nurse''. Mental health nurses undergo a
RMNs can continue into further training as Advanced Nurse Practitioners (ANPs): this requires completion of a 9
===United States===
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{{See also|Psychiatric and mental health nursing in the United States Army}}
In [[North America]], there are three levels of psychiatric nursing.
* The ''[[licensed vocational nurse]]'' (''[[licensed practical nurse]]'' in some states) and the ''[[Psychiatric technician|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 therapy.
* The ''[[advanced practice registered nurse]]'' (APRN) either practices as a [[clinical nurse specialist]] or a [[nurse practitioner]] after obtaining a master's degree in psychiatric-mental health nursing. Psychiatric-mental health nursing (PMHN) is a nursing specialty. The course work in a master's degree program includes specialty practice.
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 nursing.
=== Australia ===
In Australia, to be a psychiatric nurse a bachelor's degree of nursing need to be obtained in order to become a registered nurse (RN) and this degree takes
== See also ==
* [[List of counseling topics]]
* [[Mental health professional]]
* [[Psychiatric-mental health nurse practitioner|Psychiatric and mental health
* [[Tom Main]] - author of seminal paper on psychiatric nursing
* [[Hildegard Peplau]] - psychiatric nurse theorist
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{{div col|colwidth=30em}}
* {{cite web|url=https://nationalcareersservice.direct.gov.uk/job-profiles/mental-health-nurse|title=Mental Health Nurse Job Profile}}
* {{cite web|url=https://www.nmc.org.uk/standards/code/read-the-code-online/|title=The Nursing and Midwifery Council's Code of Conduct}}
* {{cite web|url=https://www.youtube.com/watch?v=
* {{cite web|url=https://www.youtube.com/watch?v=
* {{cite web|url=https://www.youtube.com/watch?v=
▲* {{cite web|url=https://www.youtube.com/watch?v=5qktwciqIvI |archive-url=https://ghostarchive.org/varchive/youtube/20211221/5qktwciqIvI |archive-date=2021-12-21 |url-status=live|title=A Day in the Life of a Psychiatric Nurse}}{{cbignore}}
*{{cite journal |last1=Keyes |first1=Corey L. M. |title=Mental health in adolescence: Is America's youth flourishing? |journal=American Journal of Orthopsychiatry |date=July 2006 |volume=76 |issue=3 |pages=395–402 |doi=10.1037/0002-9432.76.3.395 |pmid=16981819 }}
*{{cite journal |last1=Galderisi |first1=Silvana |last2=Heinz |first2=Andreas |last3=Kastrup |first3=Marianne |last4=Beezhold |first4=Julian |last5=Sartorius |first5=Norman |title=Toward a new definition of mental health |journal=World Psychiatry |date=2015 |volume=14 |issue=2 |pages=231–233 |doi=10.1002/wps.20231 |pmid=26043341 |pmc=4471980 }}
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