The essay aims to emphasis the importance of mental health education as a generic skill for all nurses regardless of setting. There is increasing importance of mental health to the role of the general nurse due to the high incidences and prevalence of mental illness and also the link between the mind and body. One quarter of the world’s population suffer from mental and behavioural disorders at least once during their life (Lawrence et al 2001). A growing awareness of the impact of mental health problems has become evident in recent years and there is no denying that nurses within the general health care system will encounter and be required to provide care for people experiencing mental health problems. The main focus of this essay will be on both caring for the mental health patient within the general setting and the importance of mental health to the physically ill patient. Perhaps the best place to begin is to consider how mental health has been defined.
Mental health influences how we think and feel, about ourselves and others and how we interpret events (Basford and Slevin 2001). Haber et al (1992) believes that it affects our capacity to learn, to communicate, and to form and sustain relationships. It also influences our ability to cope with change, transition and life events. Mental health may be central to all health and well being, because how we think and feel has a strong impact on physical health (Barker 2004). The World Health Organisation defines mental health as:
“a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (WHO 2001).
Poor mental health and mental disorders are present at all ages, for both genders and in different cultures and population groups. Although mental health nurses are more likely than general nurses to be dealing with it, such disorders can influence an individual’s ability to recover from another illness and so knowledge of this area is relevant in all settings (Roche and Duffield 2007).
For instance according to the World Health Organisation every year the number of people reported to experience a mental health problem increases (WHO 2005). The WHO also predicts that mental illness will become a leading health problem, second to heart disease (WHO 2003). Many of these people experiencing mental health problems access general hospital settings but their condition is not always recognised (Roy-Byrne et al 2000). According to Happell and Platania-Plung (2005) the specific need of patients cannot be addressed if the illness itself is not identified. By virtue of their role nurses have the highest contact with patients and potentially play an important role in the detection of mental health problems and subsequent care (Sharrock and Happell 2000). Due to the close relationship nurses have with their patients, they are the main source of encouragement for proper self-care and educator on beneficial practices that promote mental heath, for example physical activity (Happell and Platania-Plung 2005). Paluska and Schwenk (2000) believe that physical activity appears to lower the level of depression and anxiety.
The shortage of mental health beds has led to mental health patients being diverted to general wards. The impact of this falls onto general nursing staff, who are not specially trained in dealing with these patients. Despite the fact that during their training general nurses are exposed to mental health and the subject is discussed at lengths, the realisation is that, as human beings everybody is individual and it is impossible to predict outcomes among certain groups (Davis et al 1997). However, the available literature also suggests that general nurses tend to place a higher priority on physical care than in mental health care (Roy-Byrne et al 2000) and do not have the adequate skills nor a understanding to meet the specific needs of a patient experiencing mental health problems (Sharrock and Happell 2000). Without the appropriate knowledge and understanding of the needs of patients with mental health problems segregation and avoidance can occur (Slevin and Sines 1996).
The needs of patients with mental health problems cannot be met by standardised protocols, which can be easily learned and carried out to perfection (Brinn 2000). All nurses need to perceive themselves as being competent in caring, whether psychiatric or general trained. Working with this client group can elicit negative emotions such as fear, with which greater experience and understanding of mental health might provide a protective effect (Brinn 2000). Selvin and Sines (1996) found that nurse’s who had more experience in caring for patients with challenging behaviour, expressed increased positive attitudes towards them. Newly registered nurses who have been exposed to psychiatric wards during their training often have more realistic attitudes towards mental health problems. This implies that the stigma of mental illness can be reduced by education and experience, and that examination of attitudes towards mental illness should be included in training (Corrigan et al 2005).
In general hospital psychiatric care is attended to by referring to a mental health liaison team who provide a mental health assessment. This implies that general nurses need not have the psychological skills to help those with mental health problems. However, nurses have initial and lasting contact with the patient compared to any other health care provider (Happell and Platania-Phung 2005). Also when a nurse has to explain a treatment plan or obtain a patients cooperation or consent for any kid of procedure, he or she must know whether the patient is capable in participating in this process. The nurse must evaluate a patient’s competence to consent to any procedures. In order to do so, the nurse must be aware of the differences among the mental disorders and have the skills to understand and communicate with the patient (Arnold and Boggs 1999). As for all types of nurses good communication is the most important aspect of care (Arnold and Boggs 1999).
According to Vazquez (2001) whenever a patient is not accepted as a unique human being and their communication efforts are not acknowledged in a caring, honest manner, they may feel that their legitimate needs have not been sufficiently fulfilled. The patient who is experiencing a mental health problem needs to know that the nurse is attempting to understand the message that they are verbally and behaviourally conveying (Arnold, Hallinan 2001).
It is essential for nurses to be aware of the close association between body and mind in order to treat the whole person (WHO 2005). Many people make a distinction between physical health and mental health or the mind and body. Although this may have been the case in the past, it has been increasingly recognised that the distinction is arbitrary, that each component affects the other and to prioritise any one risks prolonging unnecessary suffering and leads to suboptimal treatment outcomes (Barker 2004).
Nurses are now doctor’s colleagues, their eyes and ears, and their primary goal is patient advocacy. But in order to care for someone, nurses must have knowledge not only of procedures, diagnosis, and treatment, but they must also understand what is going on with the patient on a mental level (Barker 2004). Medical conditions may aggravate or trigger psychological issues, such as depression in patients who are scared of what they are going through (Ferns 2007). It is important for nurses to be able to spot such conditions, so doctors can be alerted and interventions planned.
All nurses have a role in addressing the mental health needs of their patients (Ramirez 1997). Patients handle pain, discomfort and stress to sickness different. Some take it in their stride while others become discouraged, depressed, fearful, or complaining, out of all proportion to the severity of the condition (Barker 2004). Nurses’ must be aware that mental health may be disrupted by a consequence of a physical illness such as mood disorders in cancer patients, a cause of the physical illness or as a coincidental occurrence (Frazier 2000). People may also suffer post – traumatic stress following traumatic medical or surgical procedures (Tompkin 2007). An important fact to note is that post-traumatic stress tends to emerge 3-6 months following the trauma, so nurses must recognise the potential for this disorder and provide psychological support (Varcolis et al 2006).
Chronic illness which general nurses encounter on a daily basis throughout general hospital wards also has a negative impact on mental health (Frazier 2000). The negative effects may result from the life changes the individual will have to contend with or the level of functional impairment caused by the illness i.e. level of pain, physical limitation and level of dependence on others (Saratino 2002).
A failure to acknowledge or meet mental health needs of patients could mean that people receive a poorer quality of care. Recognition of needs relating to both mental and physical could make all the difference to someone’s care (Barker 2004). Furthermore nurses are said to aspire to a holistic model of care so they are trained to balance care between medical and psychological support (Barker 2004). In fact all models of nursing stress the importance of the holistic approach and caring for the patients physical, psychological, social and spiritual needs. According to the World Health Organisation integrating the skills of mental health nurses and general nurses and seeing the “whole person” is critical for the holistic care of a patient (WHO 2005).
The nurse’s management of the patient may influence emotional attitudes that accelerate or retard recovery. Ramirez (1997) states that nurses’ can minimise mental distress in their patients by; identifying worries and concerns, providing information and educating patients about their condition and its treatment, encouraging appropriate expression of anxiety and refer patients with persistent psychological difficulties to the mental liaison team. Study after study has shown that treating a patient’s mental health concerns improves the physical health (Barker 2004). Roy-Byrne et al (2000) reinforce the aforementioned statement by stating that by caring for patients mental health is likely to translate into better physical health outcomes.
Also if nurses can heighten their sensitivity to the patients mental health needs and increase their tolerance for the patients challenging behaviour, conflicts and stress that result from both nurses attitudes and patients behaviour, can be avoided or handled more effectively (Slevin and Sines 1996). Thus mental health problems can either be prevented or promptly identified and referred.
A greater ability of nurses to attend to the mental health needs of patient’s would in turn relieve the strain and stress on the nurses themselves (WHO 1998). Reducing stress is integral to nurses, as stress is especially associated with reduced mental health (Lambert and Lambert 2001). According to Chang et al (2007) stress occurs when environmental demands exceed individual resources. Basford and Slevin (2001) state that due to the mental and physical demands of the general nursing profession, nurses don’t often have the time to learn other disciplines, such as mental health. This can result in nurses feeling unsure what to do when faced with patients with psychological problems and often causes them to withdraw from interaction from them (Brinn 2000). There are then multiple sources of strain when caring for a person experiencing a mental health problem, from stress of dealing with challenging behaviour to lack of confidence, due to lack of training to provide mental health care (WHO 1998). According to Lambert and Lambert (2001) the detrimental effects of stress include burnout, job dissatisfaction and diminished morale. Again highlighting the value of mental health to the role of the general nurse.
Another reason that stresses the importance of mental health is the expected rise in the medical and psychiatric co-morbidity with the aging population (Atkin et al 2005). Ettner and Herman (1998) reiterate this fact by stating that there is a high prevalence in the elderly population of mental health problems including conditions such as delirium, dementia and depression. At present people aged 65 and over already occupy two thirds of general hospital beds and are prone to develop acute confusion after being admitted to hospital (Harrison 2007). This in turn increases the prevalence of mental illnesses within the general hospital setting, with rates ranging from 20% – 30% present at any one time (Harrison 2007). Nurses should be competent in caring for elderly people with a mental illness, as patients with conditions such as dementia have become common feature on general wards (Harrison 2007). The high incidences of such patients will give nurses the opportunity to broaden their skill base, reduce the level of stigma and discrimination in the hospital setting (Davis et al 1997).
In conclusion, general nurses need mental health skills just as much as mental health nurses need some of the physical skills of the general nurse. There are many life experiences that can adversely affect the mental health of individuals and require identification, support and interaction from nurses to prevent the occurrence of further problems (Basford and Slevin 1999). Also seen is that mental health problems often go unrecognised but are significantly more frequent in later life and can adversely affect physical health (Roy-Byrne et al 2000). The high dominance of mental health problems throughout the general hospital setting demonstrates the need to increase the knowledge of general nurses to care for people with mental illness and signifies the magnitude of mental health to their role (Roy-Byrne 2000). By acknowledging that there is a close relationship between the mind and the body nurses can improve their standard of care to patients, and increase their job satisfaction (Castledine 2004). Mental health care skills and an understanding of mental illness can also buffer stress for the nurse. So all in all, no matter what speciality a nurse chooses to work in, be it general, the will always have the opportunity to employ some part of psychology in their practice.
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