Wednesday, October 21, 2009

Mental Illness and Nursing: Roles and Operations

The condition of mental illness is actually an equal-opportunity illness, affecting people from every race, age, gender, economic status, etc., people who are suffering from some kinds of mental illness, in general need assistance to cope up with their daily life.
This paper in particular is laying emphasis over the roles and responsibilities of a nurse in dealing with patients with mental illness. The core approach is to find out the basic characteristic of this profession and the contribution that one can make in creating a balanced space for all those people who are treated specially in the society. Moreover, the basic categories of Mental illness are also explored in the process.
This paper has been distributed under various subheadings. These are noted as follows-

1.Recent developments in Nursing Profession
2.Roles and Responsibilities in Nursing
3.Governing, Awarding Guidelines
4.Comparison with Other Professionals
5.Multidisciplinary Teams
5.1 Activities  
5.2 Operations
          6. Legislative Policy and Practice
All these subheadings are structured in order to attain a better understanding about nursing issues related to mental illness and the kind of professional assistance that one can offer in this sector.

1.Recent developments in Nursing Profession
In recent days, there is enormous seriousness noted in the field of nursing people with mental illness. Some of the recent developments concentrating over nursing profession lay importance over development of skill with holistic recovery. This assessment has some risk towards inform mode of clinical judgment, along with intervention of psycho-social instances and attaining leadership attributes in both clinical and professional domains. For a well defined status in of nursing profession, there are many current postgraduate degrees added by continuous development of professional programmes. In recent times, all such programmes are subject to get evaluated in order to confirm that they relevant recovery values and principles are aptly followed. There also the addition of interdisciplinary training over the process of recovering professional proceeding and principles at both undergraduate and further at the postgraduate level. Emphasis are led upon the culture and psychology of learning throughout life and the same is initiated for promoting as well as developing services in the mental health domain. These services are recently made integral part of standard package of insurance under Universal Health Insurance and comprise of community development in reference to the teams that are initiating mental health patients. The aim is to create prompt and early access towards the delivery of more determined services for people from all ages. This is further generated with improved integrated module of services related to primary care.

2.Roles and Responsibilities in Nursing
The role of a nurse in offering assistance to a person with mental illness is a matter of great responsibility. It needs excessive amount of carefulness and patience. This is definitely not a profession for just anybody. Enough dedication and knowledge is needed to be a nurse to a mentally ill patient. Responsibilities initiated by a mental health nurse must be backed up with right nursing qualification and experience.  As for instance, there are LPNs (or the Licensed Practical Nurses) who offer assistance in terms of dispensing medication and also personal care to the mentally ill patient. There are highly qualified RNs (or the Registered nurses) who are capable to examine and further perform assessments and can even assist in counseling patients and people and families close to the patients. The nursing practitioners for mental health follow similar kinds of duties as any psychiatrists. They are efficient in diagnosing respective conditions, making arrangements for psychotherapy and even are capable of prescribing right medication. There are some professional nurses, dealing with mental health and specializing treatment from children to adults. There are some who can also handle the cases with eating disorders, memory problem, etc.
However, irrespective of any proficiency in a specialized domain, the nursing profession for mental health conditions is about dealing with all kinds of disability and making provision for positive changes in the lives of the patients.    

3.Governing, Awarding Guidelines
Under the initiation of policy related to contemporary social and health care provisions, there are the demands noted in reference to the health of the respective population health and further the process of service plan. According to the documents under National policy, like those of Report of the Commission on Nursing, maintained by Government of Ireland (1998), there is the strategy for maintaining national health, that is termed as Quality and Fairness: A Health System for You (DoHC 2001) and further research initiated by Begley et al. (2010) referred to the development of advanced practice in nursing and posts of specialist in the department of mental health.
Moreover, World Health Organisation and Wonca (2008) states that RPNs who are into the work in a healthcare system are developing with biomedical approach towards the domain of mental illness, which is enlisted as integral sector to the wide-ranged healthcare system. The emphasis is more towards biomedical persuasions. For reformed nursing practices in the mental healthcare sector, there were provisions created for support towards recovery-oriented functionalities. Management and review over organisational culture for refined ‘recovery orientation’ as well as plan for such frameworks were developed in reference to the entire.
Formation of National Council for the Professional Development of Nursing and Midwifery in the year 1999, offered the dominance of population-oriented healthcare approaches and with special preferences to the mental healthcare services. Many care-giving models were reformed in accordance to the epidemiological as well as demographic profile of the patient. Necessary service requirements were enlisted and advanced nursing practices were developed under the supervision of Clinical Nurse Specialist (or the CNS) and Advanced Nurse Practitioner (or the ANP) (NCNM, 2010).

4.Comparison with Other Professionals
Since, mental health is inclusive of wide-ranged elements; its scope of practice varies greatly in reference to different professionals in this field. Like any nurse in the field of mental illness, the Psychiatrists are those physicians in the mental health sector, who specialize as well as professionally certified in the act of treating people with mental illness. However, the difference is in grade of studying and learning more and for longer duration against any nurse. They use biomedical approaches in handling mental disorders and uses medications for curing. The professionals with clinical psychologist researches and implements psychology in order to understand their problems, relieve and further prevent psychology-based dysfunction or distress to improve subjective development of the person.
There are also professional similarities between nurses from mental health domain and psychotherapy and the profession of counseling psychology. All these professionals aim in assisting people with mental illness and offers them the status of being “moderate” or "normal". The later however, is dealing with people who already have some control, but fir a nurse the instances of mental illness are in general, severe and sometimes full of risks.
The role of behavior analysts is vital as they initiate services to all those clients who have developmental disabilities, substance abuse and above all mental illness. This is a kind of profession that offers evidences based on applied analysis of behavior, behavior therapy, and behaviorism. However, in case of nurse dealing with mental illness are more practical in offering assistance t he patient than the doctors in particular.

5.Multidisciplinary Teams
A very notable statutory functions initiated by Mental Health Commission (2006) is in the process of fostering and further promoting higher modes of standards of best practices and care in the delivery of nursing and other services while dealing with mental health conditions. The Commission created some working groups in order to investigate complex issues related to the mental health concerns. Multidisciplinary teams stand for “members of different professions working together” (ibid, p.10). According to Jefferies & Chan (2004), it is
“the main mechanism to ensure truly holistic care for patients and a seamless service for patients throughout their disease trajectory and across the boundaries of primary, secondary and tertiary care”.
            Moreover, Carrier & Kendall (1995) state it as,
“a group of people with complementary skills who are committed to a common purpose, performance goals, and approach, for which they hold themselves mutually accountable.”

In reference to nursing profession, the concern is more about developing empowered mental or psychiatric health to attain full participation of multidisciplinary teams. The members of the teams are liable to offer contributions, strategic planning and research in order to prevent poor mental health. The nurses keep a track of health policy added by the popularizing information among public about all kinds of psychiatric nursing responsibilities and creates the hope for futuristic progression in this field of nursing profession.

5.1 Activities  
The activities of a multidisciplinary team is to lay focus on the process of assessing needs and demands of those people who are suffering from mental illness. The sole responsibility lies in terms of creating appropriate care plan and further making it suitable as per the arrangements of medication and nursing. The team needs to lead and manage suitable care-giving provisions to the patients. They are also responsible for monitoring aspects of quality-check while offering care. Maintenance of contact and regular correspondence with the patients are some of the integral activities that must be maintained by the team. Basic principles that are followed by this team in initiating relevant activities of offering assistance to the mentally ill patients is about being sensitive and dedicating services. Creation of sub-teams and home-based nursing facilities are considered by many teams for an effective result-oriented outcome. 

5.2   Operations
According to Barker and Walker (2000) composition of multidisciplinary teams and related operations of the teams are strictly related to the process of creating connection with the mental health patients and their acquaintances, friends and families for the development of perceived hurdles and crises of the patient. The members of the staff are responsible for working as a team and follow necessary pre-determined norms for the proper functioning of the team. Mixture of adequate skills in the team offers higher range of interventions ad relevantly leads to strong connection and links with all the other domains and professions dealing with mental health services. The activities of the multidisciplinary team can turn effective only when the members are having adequate and good amount of general knowledge about all the possible local resources that they can use for the accomplishment of their plan. The participation of the local population is very vital in this reference. It is their explicit and clear concerns that can support in offering right kinds of assistance to the care-giving teams. The cases of mental illness are in general integrated conditions of social care-givers and medically trained staff members, especially the nurses in this domain. The team work concentrates in offering absolute notes and overall clinical assistance to the respective group of patients.

          6. Legislative Policy and Practice
Follow ups related to the laws and regulations determined by the government are very necessary for any multidisciplinary team. The team must have adequate knowledge and understanding about administrative and management regulations as set for their operations and activities (Mental Health Commission, 2006, p. 23). Comprehensive knowledge about the laws of mental health and legislation for the same must be followed strictly by the team. The policy and practices of multidisciplinary team in dealing with mental illness; must be kept in collaboration with civil rights, along with the laws of detention and compulsion in particular.

Conclusion
Eventually, it has been noted that the role and responsibilities of a nurse in the field of handling psychiatric or mentally ill patient is very vital. It is only through excessive knowledge, personalized dedication and right kind of knowledge about the government declared legislation, that the right kind of activities can be accomplished. Every step led by the nurse in this domain demands excessive patience and intelligence. This profession is definitely a great profession, but demands constant attitude of learning and handling patients with all tenderness. The risk related to this profession is very high, but with the cooperation of members from the multidisciplinary professions, the role turns more effective. It is necessary that the nurse dealing with mentally ill patient should e literate, professionally well trained and above all smart and dedicated enough in accomplishing the duties.    

Sources
Barker PJ, Walker L. (2000) Nurses' perceptions of multidisciplinary teamwork in acute psychiatric settings. Psychiatric Nursing Practice, University of Newcastle, Newcastle-upon-Tyne, UK. J Psychiatr Ment Health Nurs. 2000 Dec;7(6):539-46.
Begley, C., Murphy, K., Higgins, A., Elliott, N., Lalor, J., Sheerin, F., Coyne, I., Comiskey, C., Normand, C., Casey, C., Dowling, M., Devane, D., Cooney, A., Farrelly, F., Brennan, M., Meskell, P., MacNeela, P. (2010) Evaluation of Clinical Nurse and Midwife Specialist and Advanced Nurse and Midwife Practitioner Roles in Ireland (SCAPE) Summary Report. National Council for the Professional Development of Nursing and Midwifery in Ireland, Dublin.
Carrier, J.M. & Kendall, I. (1995) Professionalism and interprofessionalism in health and community care; some theoretical issues. In: Owens, P., Carrier, J., Horder, J. Eds.
DoHC (2001) Quality and Fairness – A Health System for You. Department of Health and Children. The Stationary Office, Dublin.
Government of Ireland (1998) Report of the Commission on Nursing- A Blueprint for the future. The Stationary Office, Dublin.
Interprofessional Issues in Community and Primary Health Care. Macmillan, London.
Jefferies, N. & Chan, K.K. (2004), Multidisciplinary team working: is it both hostile and effective? Int. J. Gynecol Cancer 14(2): 210-211
Mental Health Commission (2006, January) Multidisciplinary Team Working: From Theory to Practice. Discussion Paper. http://www.mhcirl.ie/documents/publications/Discussion%20Paper%20Multidisciplinary%20Team%20Working%20%20From%20Theory%20to%20Practice%202006.pdf [Retrieved on Oct. 19, 2013]
NCNM (2010) Clinical Outcomes- promoting patient safety and quality of care: implications for nurses and midwives. Discussion Paper 2. National Council for the Professional Development of Nursing and Midwifery, Dublin

World Health Organisation and Wonca (2008) Integrating Mental Health into primary care- A global perspective. WHO and Wonca, Geneva.

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