Concepts of psychiatric and mental health nursing Mihaela E. Olson, APNC, PMHRNC Family Nurse Practitioner Associate Professor of Nursing

Chapter 1 Practicing the Science and Art of Psychiatric Nursing

Psychiatric and mental health nursing (PMHN) Focuses on the treatment of human responses to mental health problems and psychiatric disorders “ A core mental health profession, employs a purposeful use of self as its art and a wide array of nursing, psychological and neurobiological theories and research evidence as its science.” (ANA, 2007)

Method for using treatment approaches to medical and mental health illness that are scientifically grounded or evidence based In psychiatry, this focus extends to treatment approaches in which there is scientific evidence for psychological and sociological treatment approaches as well as for evidence related to the neurobiology of psychiatric disorders and psychopharmacology Evidence based practice nursing

Refers primarily to managing symptoms, reducing psychosocial disability and improve role performance (Pratt, et al., 2006) Views recovery as personal journey of healing Goal is to empower those with mental illness to find meaning and satisfaction in their lives, realize personal potential and function at their optimum level of independence Supportive relationships, social inclusion, attain coping skills, recovery oriented services, and sense of hope for future can lead to high quality of life with this illness Mental health recovery model

Florence Nightingale ( ) founder of modern nursing, her philosophy was a reflection of evidence-based practice Nightingale proposal (1860) resulted in the 1 st model for systemic collection of hospital data using a uniform classification of diseases and operations and was to form the basis of “International Statistical Classification of Diseases and Related Health Problems” used worldwide today (Keith, 1988) The science of nursing: finding the evidence for practice

Hildegard Peplau ( ) Considered the mother of psychiatric nursing Former professor at Rutgers University Developed the art and science of professional nursing practice Believed that a scientific approach was essential to practice psychiatric nursing Introduced the concept of advance nursing practice and promoted professional standards and regulation through credentialing among other significant contributions to nursing (Tomey, 2006)

Multistep process of integrating evidence-based practice into clinical practice 1. Ask a question: identify a problem or need for change 2. Acquire literature: search literature for scientific studies and articles that address the area of concern 3. Appraise the literature: evaluate and synthesize the research evidence as to its validity, relevance and applicability using criteria of scientific merit 4. Apply the evidence: Interventions based on best available evidence with patient preference and needs 5. Assess the performance: Evaluate outcomes, use clearly defined criteria, reports, and document results The 5 A’s of EBN

Hierarchy of evidence and grading of recommendations Each recommendation has been allocated grading that directly reflects the hierarchy of evidence on which it has been based Hierarchy of evidence: includes level and type of evidence Grading of recommendations: includes level and type of evidence

Guidelines for practice Mental Health Web Resources: focus on sites maintained by professional societies or org whose quality is evidenced based Clinical Practice Guidelines; systematically dev statements that identify, appraise and summarize best evidence Clinical Algorithms: step by step guidelines prepared in a flowchart format Clinical/critical pathways: usually specific to the institution using them

The art of nursing: developing the skills for practice 1. Caring: involves how we relate to one another, how we show concern in daily life  Evidenced by empathetic understanding, actions, and patience on another's behalf  Caring for one another by actions, words, and being there leads to happiness and touches the heart  Defined as giving of self while preserving the importance of self  A nurse must demonstrate a level of competence and the art of caring  Absence of caring can leave memorable scars and make pts feel distrustful, disconnected, uneasy, and discouraged

2. Attending: refers to the intensity of presence, being there in tune with the pt When a human connection is made between the nurse and the pt, the pt sense of isolation is minimized or eliminated Attending behaviors include listening, touching, or giving attentive physical care Through active listening skills and effective communication we can fully understand another persons immediate experience and distressing fears, perceptions and concerns The art of nursing: developing the skills for practice

3. Patient advocacy: One who speaks up for another ‘s cause, who helps another by defending and comforting them, especially when the other lacks knowledge, skills, ability to stand up for themselves Ethical role Patient advocate in 1976 ANA Code of Ethics Advocacy in nursing includes commitment to pts health, well-being, and safety across the life span, the alleviation of suffering and promoting a peaceful, comfortable and dignified death (ANA, 2001)

In order to become successful... “We must all suffer from one of two pains: the pain of discipline or the pain of regret. The difference is discipline weighs ounces, while regret weighs tones.” Jim Rohn, motivational speaker