Nursing the Mind: Choosing A Career in Mental Health

July 24th, 2012


By , BSN, RN

The events in Colorado last week have us all wondering, what would lead someone to go from quiet neuroscience student to an alleged gun-toting killer? Why didn’t someone see it? Weren’t there any obvious signs that young man was on a dangerous edge?

These are all questions that will be addressed by healthcare professionals over the coming weeks; healthcare professionals who focus on mental health concerns and psychiatric diagnoses.

Psychiatric mental health nursing (PHMN) is a specialty area within the nursing realm. Like other areas it has its own language and its own special characteristics. Psychiatric mental health registered nurses work with individuals, families, groups, and communities, assessing their mental health needs. Like every other area of nursing, the psychiatric mental health nurse develops nursing diagnoses and plans of care, implements the nursing process, and evaluates it for effectiveness.

History of Psych Nursing

Care for the emotionally and mentally ill goes back centuries, but the formal recognition of psychiatry as a modern study really came to being in the early 1800s. One of the early advocates for mental health nurses to help psychiatrists proposed giving the “keepers of the insane” better pay and training so more respectable, intelligent people would be attracted to the profession.

In 1836, Dr. William Ellis said that an established nursing practice calmed depressed patients and gave hope to the hopeless.

Psychiatric nursing as a study was not really recognized in the United States until 1882 when Linda Richards opened Boston City College. This was the first school specifically designed to train nurses in psychiatric care. In 1913, Johns Hopkins University, in Baltimore, was the first college of nursing to offer psychiatric nursing as part of its general nursing curriculum.

The first psychiatric nursing textbook, Nursing Mental Diseases by Harriet Bailey was published in 1920. It was not until 1950 that the National League for Nursing required all nursing schools to include a clinical experience in psychiatry to receive national accreditation.

One nurse was a major player in the development of PHMN. Hildegard Peplau is universally regarded as the “mother of psychiatric nursing.” Her seminal book Interpersonal Relations In Nursing has been widely credited with the transformation of nursing from a group of skilled workers to a full-fledged profession.

Her model of “Psychodynamic Nursing Theory” was first published in 1952 and is still used today by clinicians when working with people who have psychological problems. The book was republished in 1991. It emphasizes the significance of the relationship between the patient and the nurse as a treatment modality.

What’s It Take To Be a Psych Nurse?

The A-number one attribute of a good psychiatric mental health nurse is the ability to communicate. And that often means asking simple, open-ended questions then sitting back and listening. Getting to know what is in the client’s mind and helping that client back to a place of mental wellness is the job of the mental health nurse.

A psych nurse must also be non-judgmental. You cannot bring your own prejudices and biases to the table. The patient must feel that you are open to anything they have to say and will provide a safe, accepting environment for them to work through their problems.

During the nurse-patient relationship, nurses assume many roles: stranger, teacher, resource person, surrogate, leader, and counselor. A large part of psych nurse work involves close observation.

Psych nursing calls for expert assessment skills. The general survey of appearance and behavior will tell the nurse much about the client’s emotional state. When further assessment is required psych nurses focus five major areas:

  1. Major Stressors – The nurse will ask about major changes in the client’s life in the past year or so and the client’s perception of those changes.
  2. Usual Coping Pattern – The nurse will investigate what the client normally does to cope with major problem or high level of stress.
  3. Communication Style – This is where the nurse’s observational skills really come into play. The nurse will assess the client’s nonverbal communication and ability to verbalize appropriate emotion.

    Nonverbal communication such as eye movements, gestures, use of touch, and posture can reveal much of what the client is actually feeling. The nurse, must in particular, note when the nonverbal behaviors and the verbal expression are not in synch.

  4. Self-concept – How does the patient see himself and his place in the world around him?
  5. Mood – The nurse may have to ask about mood if the client is underactive, flat, or unresponsive. Questions about sleep patterns, crying, or feelings of discouragement all fall in this category. The client’s answers help the nurse determine whether the client is depressed or anxious or any of a number of other diagnoses.

Besides strong communication and assessment skills, psych nurses need to be real. A good psych nurses is patient, empathetic and has a genuine attitude of caring. Confidence, patience, and a sense of humor come in handy too.

Where Will You Work?

Psych nurses are found in acute care hospitals, psychiatric facilities, community clinics, halfway houses, and rehabs, to name just a few places. There are state, county, and even city psych hospitals and there are private clinics. Specialty areas range from adults to children, addicts, veterans, or the homeless to name a few.

Being a psych nurse is a special calling. When I was in nursing school I had several different clinical instructors in my hospital rotations who were psych nurses. Even then, when I was completely absorbed in trying to figure out how to make a bed with a patient in it or changing a colostomy bag for the first time, I recognized the value of my instructors having focused their training in psych.

They were the nurses who, to this day, stand out in my educational experience. They taught all of the nursing skills, but they may have contributed more in our post clinical breakout sessions when they helped us all understand what in our day was intimidating or scary and built our confidence that we too would one day be comfortable in the role of healthcare providers. So, I guess there’s a place for psych nurses in education, too.

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