Psychiatric Nursing, the evolving role in mental health
Psychiatric nursing is an evolving profession which was introduced relatively late in Malta. The roles of psychiatric nurses are diverse and at times difficult to quantify. There has been a need to clearly define these roles for the ever growing number of Maltese psychiatric nurses. This need was fulfilled with the creation of the standards for graduate level psychiatric nurses, which clearly defines the roles and responsibilities of nurses specialised in psychiatry. The Maltese Association of Psychiatric Nurses plays a vital role in creating awareness of the role the psychiatric nurse holds.
Psychiatric nursing is a nursing specialty focusing on the fulfilment of the client’s needs in mental health in any setting, in partnership with family, significant others and the community.1
The roles of the Psychiatric Nurse
Psychiatric nursing is an interpersonal process that promotes and maintains patients’ behaviour that results in an integrated functioning of the individual. Stuart and Laraia2 state that the patient can be an individual, family, group, organisation or the community at large. This obviously implies that the role of the psychiatric nurse is very vast and a clear definition of the role depends on the situation and circumstances the nurse is in. This ranges from a psychiatric emergency in an acute admission ward to a talk given by the psychiatric nurse to the general public on post natal depression. The work of psychiatric nurses is divided into high and low visibility functions. Brown and Fowler3 identified these functions.
High visibility functions relate to the technical aspects of nursing work, such as giving injections and medications. These functions are valued most by the management as they are tangible and easily related as active nursing skills.
Low visibilities on the other hand, are functions that are associated with building interpersonal relationships, such as warmth and empathy. These skills help to identify and discover the person not the disease.4 Low visibility functions are most of the time described as non-quantifiable tasks.
Locally, psychiatric nursing can still be considered to be a developing speciality, although the advances in this sector have been significant. The first diploma course specialising in psychiatric nursing started in 1992. Up till then, nurses working at Mount Carmel Hospital were trained in general nursing and had little training in psychiatric care, except for the few who had training in mental health abroad.5 To date, (March 2007) there are between thirty-five and forty-five psychiatric nurses in Malta. Moreover, the first post-graduate degree in psychiatric nursing started three years ago. Response to this course has been very positive and in December 2006 eleven students successfully completed it while another twenty five are undergoing their studies.
Unfortunately, despite the progress that occurred in recent years, the roles of this speciality are still poorly defined. This could be attributed to the fact that, since mental health care has been operating with virtually no psychiatric nurses for such a long time, some of the responsibilities which are generally attributed to this profession worldwide, were being carried out by various other professionals.
For this reason it was felt that the role of psychiatric nurses should be clearly defined. As a result of this, Mr. Martin Ward, consultant psychiatric nurse and coordinator for mental health courses at the Institute of Health Care (IHC), helped the first group of degree psychiatric nurse to develop standards for graduate level psychiatric nurses in Malta (Table 1). Although these standards are not yet enshrined in the legislation surrounding registration as a psychiatric nurse, they are the excepted areas of practice and responsibility. In future, all the education programmes developed for the discipline at IHC will use these as the basis of the competencies for final qualification – in other words the course is designed to enable nurses at the end of their programme to follow these standards satisfactorily and effectively. Standards can serve to foster a sense of unity and identity in the nursing profession.6 Although standards may vary from one country (or organisation) to another, common standards can be identified; in fact, many of the standards applied in Malta have been adopted from similar standards around Europe, North America and Canada.
Perception of the general public on Psychiatric Nursing
Despite great advances in psychiatric nursing, little research was conducted on the general population’s perception of the psychiatric nursing roles. Barker et al7 performed a pilot study in the form of a face to face survey regarding the role of psychiatric nurses to a convenience sample of 100 passers-by in a shopping area in the centre of Newcastle, England. The pedestrians were asked one simple open ended question, “What do you think a psychiatric nurse does?” The researches found that there is a generally positive perception of the role of the psychiatric nurse, but detected that stigma still surrounds mental illness in general and the professionals working in the mental health field. Almost one third of those interviewed had either no idea what the psychiatric nurse’s roles are, or were only able to give vague answers, example, they look after people in psychiatric hospitals. Barker et al7 argued that it is of concern that so many people would not know what to expect from psychiatric nurses, given the number of people with a lifetime chance of developing mental illness and therefore coming into contact with psychiatric nurses. The researchers also divided their findings into negative and positive comments. Negative comments on psychiatric nurses seem to relate to the historical, biomedical model of psychiatric care relating mainly to restraining people and the subordinate role of nurses to medical staff. Positive comments included talking to patients, counselling, caring, supporting, helping, listening, rehabilitating and treating the person as a whole, and were thought to represent a fairly accurate representation of the psychiatric nurse role.7
Despite the great advances that have taken place in psychiatric nursing in Malta there is still a long way to go. To this end, a group of psychiatric nurses have set up the Maltese Association of Psychiatric Nurses (MAPN) which aims to act as a point of reference for all nurses working in a mental health setting. The concepts of the association are awareness, education and recognition. MAPN is also helping in the process of defining the important role that psychiatric nurses play in the care of individuals suffering from mental illness and is part of a concrete effort to improve psychiatric nursing as a profession.
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2. Stuart WG, Laraia MT. Principles and Practice of Psychiatric Nursing (7th ed.). Missouri: Mosby Inc., 2001.
3. Brown M, Fowler G. Psycho-dynamic Nursing: A Biosocial Orientation. Philadelphia: BB Saunders Co, 1979.
4. Kitwood T. Lowering our defences by playing the part. Journal of Dementia Care 1994; 2(5):12-4.
5. Incorvaja J. A comparative study of educational attitudes between first, second and third working in psychiatric practice in Malta. 1999. Available from: http://www.um.edu.mt/pub/articlejinc.doc.
6. Lakeman, R. What psychiatric nurses do differently: A discussion on the blurring of roles in the mental health profession. 1995. Available from: http://www.geocities.com/HotSprings/8517/mhnse.htm.
7. Barker P, Jackson S, Walker L. Perceptions of the psychiatric nurse’s role: a pilot study. Nursing Standards 1998; 12(16):35-8.
Hamblet C. Obstacles to defining the role of the mental health nurse. Nursing Standards 2000; 14(51):34-7.
Registered Psychiatric Nurses Association of Saskatchewan. Psychiatric nursing. 1999.