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{{Short description|Health profession}}
'''Psychiatric nursing''' or '''mental health nursing''' is the appointed position of a [[nursing|nurse]] that specialises in [[mental health]], and cares for people of all ages experiencing [[mental disorder|mental illnesses]] or [[mental distress|distress]]. These include: [[neurodevelopmental disorders]], [[schizophrenia]], [[schizoaffective disorder]], [[mood disorder]]s, [[addiction]], [[anxiety disorder]]s, [[personality disorder]]s, [[eating disorder]]s, [[suicidal ideation|suicidal thoughts]], [[psychosis]], [[paranoia]], and [[self-harm]].
[[Mental health nurse|Mental health nurses]] receive specific training in [[psychotherapy|psychological therapies]], building a [[therapeutic alliance]], dealing with [[challenging behaviour]], and the administration of [[psychiatric medication]].
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 associate (ASN) degree, or a bachelor's (BSN) degree.
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)]].
== History ==
[[File:Civilian Public Service -93, Harrisburg, Pennsylvania, psychiatric nursing class (8389167373).jpg|alt=Civilian Public Service -93, Harrisburg, Pennsylvania, psychiatric nursing class (8389167373)|thumb|Civilian Public Service -93, Harrisburg, Pennsylvania, psychiatric nursing class (8389167373)]]
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
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
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
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"/>
In 1975, the government published a document called "Better Services for the Mentally Ill" which reviewed the current standards of psychiatric nursing worldwide and laid out better plans for the future of mental health nursing.<ref name=":0">{{Cite book|url=https://books.google.com/books?id=vo46Jqvu_8oC|title=A History of Mental Health Nursing|last=Nolan|first=Peter|date=2000-10-01|publisher=Nelson Thornes|isbn=9780748737215|language=en}}{{page needed|date=January 2018}}</ref>
Global health care underwent huge expansions in the 1980s
In 1982, the Area Health Authorities was terminated.<ref name=":0" />
In 1983, better structure of hospitals was implemented. General managers were introduced to make decisions, thus creating a better system of operation. The year 1983 also saw a lot of staff cuts which
The 2000s have seen major educational upgrades for nurses to
== Interventions ==
Nursing interventions may be divided into the following categories:<ref name="Boyd, M. 1998">{{cite book|last1=Boyd|first1=Mary Ann|last2=Nihart|first2=M|title=Psychiatric Nursing: Contemporary Practice|date=1998|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=978-0-397-55178-1|url-access=registration|url=https://archive.org/details/psychiatricnursi0000unse_g1y2}}{{page needed|date=January 2018}}</ref>
=== 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 ====
Psychiatric mental health nurses are also involved in the administration of the treatment of [[electroconvulsive therapy]] and assist with the preparation and recovery from the treatment, which involves
==== 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 |volume=25|issue=12|pages=696–7|doi=10.12968/bjon.2016.25.12.696|pmid=27345074|url=https://eprints.soton.ac.uk/399398/1/Improving%2520the%2520physical%2520health%2520of%2520people%2520with%2520mental%2520health%2520problems.docx}}</ref> To fix this problem, mental health nurses are urged to encourage patients to get more exercise to enhance their physical health, along with their mental health by improving the patients confidence and lowering stress levels, improving their mental health which has been a focus for mental health nurses because many patients do not get enough exercise.<ref name=":1" /> Nurses may also need to help the patients with alcohol or drug abuse because mental health patients are at a higher risk for this behavior.<ref name=":1" /> Mental health nurses need to be able to communicate to patients about this. The alcohol and drug abuse could cause the patient to also have a higher risk of sexually transmitted diseases because alcohol and drugs can lead to more sexual behavior.<ref name=":1" />
=== Psychosocial interventions ===
Psychosocial interventions are increasingly delivered by nurses in mental health settings.
=== Spiritual interventions ===
The basis of this approach is to look at mental illness or distress from the perspective of a [[spiritual crisis]]. Spiritual interventions focus on developing a sense of meaning, purpose, and hope for the person in their current life experience.<ref>{{cite book|last=Swinton|first=John|title=Spirituality and Mental Health Care|publisher=Jessica Kingsley|year=2001|isbn=978-1-85302-804-5}}{{page needed|date=January 2018}}</ref> Spiritual interventions involve listening to the person's story and facilitating the person to connect to [[God]], a greater power or greater whole, perhaps by using [[meditation]] or [[prayer]]. This may be a [[religious]] or non-religious experience depending on the individual's own spirituality. Spiritual interventions, along with psychosocial interventions, emphasize the importance of engagement, however, spiritual interventions focus more on caring and 'being with' the person during their time of crisis, rather than intervening and trying
=== Therapeutic relationship ===
As with other areas of [[nursing practice]], psychiatric mental health nursing works within [[nursing theory|nursing models]],
▲As with other areas of [[nursing practice]], psychiatric mental health nursing works within [[nursing theory|nursing models]], utilizing [[nursing care plan]]s, and seeks to care for the whole person. However, the emphasis of [[mental health]] nursing is on the development of a therapeutic relationship or alliance.<ref name="multiple">Wilkin P (2003). ''in:'' {{cite book | author=Barker, P (ed)| title=Psychiatric and Mental Health Nursing: The craft of caring| location=London | publisher=Arnold | pages = 26–33|isbn=978-0-340-81026-2 | year=2003}}</ref> In practice, this means that the nurse should seek to engage with the person in care in a positive and collaborative way that will empower the patient to draw on his or her inner resources in addition to any other treatment they may be receiving.<ref name="multiple"/>
===Therapeutic relationship aspects of psychiatric nursing===
[[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">{{Cite journal |last1=Berg
====Understanding and empathy====
Understanding and empathy from psychiatric nurses reinforces a positive psychological balance for patients. Conveying an understanding is important because it provides patients with a sense of importance.<ref name=
====Individuality====
====Providing support====
Successful [[therapeutic
====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
====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====
To develop a quality therapeutic relationship
====Demonstrating clear boundaries====
[[professional boundaries|Boundaries]] are essential for protecting both the patient and the
====Demonstrating self-awareness====
Psychiatric nurses
==
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. One out of five children experience a mental disorder in a given year, but only 20% receive treatment of said disorder.<ref>{{Cite web|title=Resources|url=https://ipedsnursing.org/resources|access-date=2021-09-20|website=IPN|language=en}}</ref>
== Profession status ==
▲{{See also|Psychiatric and mental health nurse practitioner|Registered psychiatric nurse|}}
===Canada===
The ''registered psychiatric nurse'' is a distinct nursing profession in all of the four western provinces.
===Ireland===
In [[Ireland]], mental health nurses undergo a 4-year honors degree training programme. Nurses that trained under the diploma course in Ireland can do a post graduation course to bring their status from diploma to degree.{{citation needed|date=January 2018}}
===New Zealand===
Mental Health Nurses in New Zealand require a diploma or degree in nursing.
===Sweden===
▲Mental Health Nurses in New Zealand require a diploma or degree in nursing. All nurses are now trained in both general and mental health, as part of their three-year degree training programme. Mental health nurses are often requested to complete a graduate diploma or a post graduate certificate in mental health, if they are employed by a District Health Board. This gives additional training that is specific to working with people with mental health issues.
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</ref>
===
{{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
===
{{Main|Psychiatric-mental health nurse practitioner}}
{{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
* [[Tidal Model]] - model developed for mental health nursing
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==References==
{{Reflist|30em}}
==External links==
{{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=fNHAocMQRHw |archive-url=https://ghostarchive.org/varchive/youtube/20211221/fNHAocMQRHw |archive-date=2021-12-21 |url-status=live|title=Creating a Nursing Portfolio|website=[[YouTube]] }}{{cbignore}}
* {{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|website=[[YouTube]] }}{{cbignore}}
* {{cite web|url=https://www.youtube.com/watch?v=w1DJJ0Ew-hQ |archive-url=https://ghostarchive.org/varchive/youtube/20211221/w1DJJ0Ew-hQ |archive-date=2021-12-21 |url-status=live|title=Nursing Careers: A Career in Mental Health Nursing|website=[[YouTube]] }}{{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 }}
{{Div col end}}
{{DEFAULTSORT:Psychiatric And Mental Health Nursing}}
[[Category:Psychiatric nursing]]
[[Category:Counseling]]
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