“Health is not merely the absence of disease but a sense of physical, psychological and social well being”. Physical and mental health are like two sides of a coin and both are interdependent. A nurse who is responsible for total health care of a person must take care of the emotional aspect also. The nurse should develop a basic understanding and skill in psychiatric nursing to achieve total health care. She should learn to care for patients with varying degrees of personality deviation and she should understand her role in contributing to positive mental health. This step will enable her to exercise effectively in all areas of nursing.
NEED FOR PSYCHIATRIC NURSING
Psychiatric nursing concepts are an integral part of general nursing. Every nurse who performs the simplest nursing duty gives the patient some psychiatric nursing care whether she is aware of it or not. For example giving medication. What is important in the nursing role includes not only her knowledge of the properties of the drug, and methods of administration correct dosage but also what and how she explains to the patient when giving the drugs and how the patient reacts to it.
- Psychiatric nursing makes a nurse aware of what she is doing to a patient psychologically.
- It educates her how to observe her patient.
- It equips her with appropriate techniques to meet the patients psychological needs and manage the nurse-patient relationship.
Psychiatric training for nurses is essential not only to manage the severely mentally ill or psychotic patients in psychiatric wards or hospitals, which forms only a part or group, but psychiatric nursing concerns itself with the care of the psychiatric patients 2extending beyond the walls of the psychiatric hospital to encompass the needs of the family and of the community. She may also have to work in a general hospital that has a psychiatric department/ward. Apart from major mental illnesses there are many other psychological problems which include depression, anxiety and other neurotic disturbances, psychosomatic disorders, problems due to alcohol and drug abuse, emotional problems of children, adolescents and elderly population.
Apart from these psychiatric disorders, every medical or surgical condition is accompanied by some emotional problem. The nurse who spends her considerable time with the patient cannot afford to ignore this aspect of the illness. Often patients suffer more from their psychological problems than actual physical pain. Because of the intimate relationship of the body and mind, it is difficult for anything to affect the body without affecting the mind.
The broad principles of psychiatric nursing can thus be applied to patients with medical, surgical, obstetric, orthopaedic, paediatric and psychosomatic conditions as well as patients suffering from neurosis, psychosis, personality disorder and drug dependence.
ROLE OF A NURSE IN THE CARE OF THE PSYCHOLOGICALLY ILL
More usually the nurse acts as a part of a therapeutic team, where, in addition to her traditional work, she has the opportunity to take an active part in other aspects of treatment. Her job is to work with the team to enable each patient get better and return back to the community.
The following are some important tasks of a nurse in a psychiatric set-up.
- The nurse often has the opportunity to intervene a behaviour problem on the spot which if ignored or allowed to continue would aggravate the patient's psychological condition.
- The nurse should conduct brief counselling with patients and their families. Such counselling may be formally structured or may take place in informal situations keeping main focus on helping the patients in communicating more clearly.
- Reporting is another main task. The nurse has to record, assess and report to the psychiatrist her observations regarding the patient's behaviour, the interaction between the patient and members of his family, the effects of drugs and other forms of treatment, the patient's physical status etc.
- The nurse plays the role of a surrogate mother when she takes care of the activities of daily living. She keeps him clean, helps him in the elimination, exercise his inactive limb, makes sure that he gets sufficient nourishment by well-balanced diet. Exploiting this relationship to the fullest can result in considerable therapeutic benefit to the patient.
- Health education is another important role. The nurse helps patients learn physical and mental hygiene.
- The nurse motivates the patient to participate actively in rehabilitation programmes like occupational therapy, industrial therapy and recreation therapy.
- The nurse in a psychiatric set-up also guides and supervises the functions of other paramedical personnel in the ward. These staff members work closely with the patients and depend on the nurse for directions and guidance.
- The nurse as a helping and caring person makes the patient feel supported and reassured. Thus, the nurse acts as a psychotherapist. Nurses also conduct family therapy and group therapy in a cotherapist situation or alone or as part of a team. Nursing role in crisis intervention and suicide prevention is very vital.
- A psychiatric nurse has to play different roles according to the setting. Her job may be looking after demented elderly in-patients at one set-up and working in a therapeutic community run for adolescents in another. Other varied situations include the acute admission ward of a large psychiatric hospital, community work where patients are seen in their own homes, attachment to a psychiatric department in a general hospital, administrative work, and work in a day hospital or out-patient clinic.
Thus, in the care of the psychologically ill, the nurse has many roles to play. She is:
- an assistant
- a caretaker
- a listener
- an observer
- a therapist
- a motivator
- a teacher
- a surrogate mother
- an administrator, and
- a healer
NURSING ROLE—DIFFERENCE BETWEEN PSYCHIATRIC SET UP AND OTHER MEDICAL SET UP
- The nurse does more for a patient physically in medical or surgical nursing. But in psychiatric nursing she has to be psychologically active but physically passive much of the time. Listening to an emotionally disturbed patient with pain in his mind may be profoundly touching.
- In taking care of physical illnesses the signs and symptoms are generalised and mostly uniform in all patients.
- However in psychiatric patients, for the same disease, the symptoms may vary from individual to individual depending on the nature of the disease, the individual's personality and complex psychobiosocial implications.
- Physically ill patients respond to the reassurance given by the nurse they are satisfied with the care they are getting and co-operate during the treatment programme.
Emotional disturbance make many psychiatric patients fail to respond to ordinary reassurance in the beginning. Because of impaired human relationships these patients often show reactions like mistrust, suspicion and hostility. Patients suffering from major mental illnesses lack insight. They are not aware that they are ill. Hence, they may not co-operate fully during the treatment programme. It requires special skills and experience for a nurse to work with such patient.