Health involves being physically, mentally, socially and spiritually healthy and not just the absence of disease. Hence, a nurse who is responsible for providing total patient care should be able to provide both physical and mental care. As physical health is directly proportional to mental health, a nurse has to understand the basic concepts of mental health so as to provide holistic care. According to me, a nurse has to understand what is mental illness, its classification (DSM), integrating mental- health care with primary health- care as well as importance and methods of practicing advocacy in mental health field before caring a mentally ill person. This essay discusses about the application and importance of selected concepts that are most important for a nurse to practice in mental- health field.
At first, a nurse has to understand what is mental illness, its causes and features to provide optimal mental- health care. Hence, she has to be able to distinguish between mental-health and mental-illness. A person is said to have mental-illness, if he/she has maladjustment in normal living (Bowins, 2016). A nurse has to evaluate for the presence of any disharmony in an individual’s ability to meet his/her needs comfortably and effectively and function in a culture to determine whether a person has mental-illness or not. The diagnosis of mental-illness is crucial for a nurse to provide specialized care. A nurse should be able to determine that a mentally-ill patient may lose his/her ability to respond based on the expectations what he has about himself as well as the demands that community has for him. Generally, an individual is considered to be mentally-ill, if the patient’s behavior causes distress with suffering to self and others and when a persons’ behavior causes disturbances in daily activities, work and relationships with others.
An efficient nurse has to rule out the causes for mental- illness to provide nursing care accordingly. She has to clearly determine the factors causing mental- illness by analyzing predisposing factors (as genetic inheritance, physical injury to central- nervous system, adverse psycho-social influence) (Schwab, 2013), precipitating factors (as physical or psycho-social stress) and perpetuating factors (as chronic stress, marital disharmony) in a patient to plan for nursing care based on the etiology as targeting care is more powerful than non- targeting care.
A nurse has to clearly determine the signs and symptoms of mental- illness based on disturbances in various aspects to clearly diagnose the disorder. The disturbances in motor behavior involve features of motor retardation, stupors, flexibility (waxy), negativism, excitement, agitation, echopraxia and ambi-tendency. The disorders of thought, language with communication involves pressure of speech, clang associations, tangentiality, thought- block, thought–insertion, thought- broadcasting, echolalia, incoherence, neologism, poverty of speech, dysarthria, delusions, loosening of association, obsessions and phobia. The perception disorders involve features as illusion, de-realization, etc and disorders of emotion involve blunt affect, euphoria, dysphoric mood, depression, etc. The disturbances of consciousness include reduced consciousness, delirium and coma and disturbances in attention involves distractility and selective inattention (Shives, 2008). A nurse should rule out disturbances in attention (distractibility), problems in orientation , disorders of memory (amnesia), impaired judgment and disturbance in biological functioning (vomiting, loss of appetite, insomnia).
Diagnostic- and Statistical- Manual of Mental- disorders (DSM)
Secondly, a nurse should clearly understand the DSM classification to work in mental- health field. DSM is the classification of mental-illnesses by the American- Psychiatric Association. It provides a common language as well as standardized criteria for classifying mental illnesses. It is used by all the mental- health physicians, nurses, researchers, psychiatry-drug regulatory agencies, health-insurance companies, pharmaceutical-companies, legal-system and policy framers as it follows multi-axial patterns. A nurse has to use DSM with other alternative classifications (as ICD-10 classification) to classify mental illness and provide nursing care accordingly.
The nurse has to follow the latest DSM-V classification that was published in 2013 as there were lots of revisions since from its first publication (APA, 2013). It evaluates a patient in 5 different dimensions rather than just analyzing one broader aspect of mental illness. Its dimensions are related to physical, psychological, societal with other aspects and hence DSM-V classification will guide a nurse to provide mental-health services based on various dimensions. Though, International-classification of diseases is also used for classifying mental-disorders, DSM is considered as more perfect to provide optimal mental- health care because of its holistic involvement.
Though there are various criticisms in DSM classification system as unscientific and subjective system, its reliance on superficial features, lack of validity and reliability, using artificial divisions between categories and cultural bias; it is used as best classification system to rule out the disorders so as to provide accurate nursing care (Kendell, 2003). A nurse has to use this classification to determine and evaluate the mental- illness to provide mental-health care and also help to communicate the person's diagnosis to hospitals, nursing clinics and insurance companies. DSM can also be used to classify patients for research studies.
Thirdly, a nurse should be competent enough to provide mental- health care by integrating with primary health- care as they are the basic front- line services provided to a person at his home. A nurse should be able to provide both physical and psychological health as per WHO’s recommendations, which involves integrating specialized health- services (such as mental-health services) into PHC (WHO, 2001, Funk, 2008). In providing mental- health services in PHC, the nurses play a great role in diagnosing as well as treating persons with mental illnesses and developing strategic plans to prevent mental illnesses. A person working in mental- health should be able to apply psycho-social with behavioral skills (as interviewing, patient counseling with inter-personal skills) in their daily work to promote health-outcomes in primary health-care (WHO, 2007b).
The mental-health nurses working in primary health centers should strive to reduce stigma of receiving integrated care and should improve accessibility to mental-health services as well as treatment of co-morbid physical disorders leading to mental illnesses as HIV/AIDS, cancer, tuberculosis, etc (WHO, 2007a). The mental health nurse should be able to attend physical-health needs of persons having mental illness and the mental-health needs of persons with physical illness to enhance better outcomes. She has to help to prevent development of mental illness so as to provide holistic approach, improve financial and physical accessibility to care, to reduce chronicity and improve societal integration both for persons with mental illnesses and their family (WHO, 2008). Ultimately, a nurse should be able to provide primary (mental) care services in community area to protect human rights.
Next, advocacy is a fundamental philosophical-foundation for nursing- profession that all the nurses should be capable of practicing in all settings (ICN, 2000). Australian Nursing- Council (2002) has stated that advocacy is one of the core- competencies of an Australian registered nurse (MacDonald, 2006, Kubsch, 2004). World Health- Organization has developed the concept of mental- health advocacy in- order to promote the human- rights of people with mental illnesses and to minimize stigma as well as discrimination which every nurses should practice in mental- health field. It involves different actions that are aimed at modifying majority of the structural with attitudinal barriers to achieve positive mental-health outcomes in humans (Jugessur, 2009).
Advocacy is one among the 11 action areas in the mental- health policy due to its benefits on mentally-ill persons and their relatives (WHO, 2001). The nurses has to exercise advocacy that involves various principal elements as advocacy actions involving increasing awareness, providing information, education, training, mutual helping, counseling, mediating, defending as well as denouncing and drawing attention to tackle barriers for mental-health. The nurses have to take effort to manage the issues as lack of mental- health services, unaffordable cost, lack of parity of mental with physical health, poorer quality-of-care in mental- hospitals, lack of housing for mentally-ill persons, stigma, improper implementation of mental-health policies, etc. Hence, mental- health nurses should assume an active role in protecting the rights of mentally-ill patients and improving awareness about improved services by adapting advocacy roles, which are related to the clinical work based on patient and family perspectives, participating in the patient and family activities, supporting their development. The aim of advocacy actions should involve modifying stigma with negative attitude about patients and families and to improve the quality of mental health services and of the treatment and care provided (Jugessur, 2009). The two areas of nursing-advocacy involve advocacy for mental-health that aims to promote mental-health in the daily lives of individuals, families, groups and communities and advocacy for mental illnesses aims to promote the knowledge and acceptance of mental illness by general population.
Thus, nursing is a divine profession that involves providing optimal care to each and every people irrespective of caste, race, color and creed including type of illness (physical or mental). A professional nurse can provide complete care to a person, only when his/her physical with psychological needs are met. A nurse should understand the above discussed four concepts to be an effective Mental-Health Nurse.
Australian Nursing Council. (2002). National Competency Standard for the Registered and the Enrolled Nurse. ANCI: Australia.
Bowins, B. (2016). Mental Illness Defined: Continuums, Regulation, and Defense. Retrieved from https://books.google.co.in/books?isbn=1315514117
Funk, M. (2008). Integrating mental health into primary healthcare: Mental Health Family Medicine. 5(1): 5–8. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777555/Jugessur, T. (2009). Advocacy in mental health nursing: an integrative review of the literature: Journal of Psychiatric and Mental Health Nursing. doi: 10.1111/j.1365-2850.2008.01315.x
Kendell, R & Jablensky, A. (2003). Distinguishing Between the Validity and Utility of Psychiatric Diagnoses: American Journal of Psychiatry. 160 (1): 4–12. doi:10.1176/appi.ajp.160.1.4.
Kubsch, S.M et al. (2004). A holistic model of advocacy: factors that influence its use: Complementary Therapies in Nursing and Midwifery.10: 37–45.
MacDonald, H. (2006). Relational ethics and advocacy in nursing: literature review: Journal of Advanced Nursing. 57: 119–126.
Schwab, J. (2013). Socio-cultural Roots of Mental Illness: An Epidemiologic Survey. Retrieved from https://books.google.co.in/books?isbn=1468424335
Shives, L.R. (2008). Basic Concepts of Psychiatric-mental Health Nursing. Retrieved from https://books.google.co.in/books?isbn=0781797071
WHO. (2007a). Integrating mental health services into primary health care. Geneva: World Health Organization-2007. Retrieved from https://www.who.int/mental_health/policy/services/en/index.html,
WHO. (2007b). Advocacy For Mental Health. Retrieved from https://www.who.int/mental_health/policy/services/1_advocacy_WEB_07.pdf?ua=
WHO. (2008). Integrating mental health into primary care: A global perspective. Retrieved from https://www.who.int/mental_health/resources/mentalhealth_PHC_2008.pdf
World Health Organization. (2001). Mental health: new understanding, new hope. Geneva: World Health Organization. Retrieved from https://www.who.int/whr/2001/en/whr01_en.pdf
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