FINDINGS ABOUT MENTAL HEALTH ISSUES CULTURAL DIVERSITY IN AUSTRALIA AND NEW ZEALAND CULTURAL DIVERSITY AND MENTAL HEALTH HOSPITAL CONCLUSION.
What mental health nurses can do to help
Copyright
Notice
Shifting how and where mental health nurses' workplaces will actually take place can be one of the biggest challenges. The rise of the consumer movement in mental health and increased legislation to recognize human rights aimed to place the consumer at the center of your work on a daily basis.
Introduction
One of the unique features of psychiatric and mental health care has always been nurses' stories. We thank the students, academics and mental health professionals who have supported us and accepted what we have to say.
About the authors
Anthony's PhD research examined variation in the use of mental health legislation, including the role of social deprivation, clinical decision-making and service delivery. Areas of research include media coverage of suicide, advance directives, and the use of community orders for treatment.
Contributors
Charles Harmon, RN, BHS (NURSING), MN, PHD (NURSING), FACMHN, Joint Lecturer, School of Nursing and Midwifery, Faculty of Health, University of Newcastle, New South Wales. Sessional Lecturer and Clinical Research Nurse, University of Newcastle and Charles Sturt University, New South Wales.
Reviewers
OUTLINE
THE EFFECTIVE NURSE
LEARNING OUTCOMES
Mental health nurses are expected to develop effective therapeutic alliances while maintaining clear professional boundaries. Supportive collegial relationships can enhance the skills and confidence of mental health nurses at all stages of their careers.
INTRODUCTION
Legal aspects of mental health add an additional layer of complexity to the role of mental health nursing. Skilled mental health care requires a sound knowledge of human physiology, health and disease, and a biopsychosocial understanding of mental illness and its treatment, including pharmacology.
Nurse’s Story 1.1
KATRINA’S STORY OF CHOOSING MENTAL HEALTH NURSING
There were two 'light bulb moments' that led me to decide to work in mental health after graduation. I would like to work on one of the community mental health teams in the future.
COMPASSION AND CARING
From a mental health perspective, there are even more issues to consider regarding nursing care. Godin (2000) captured the dilemma of mental health nurses when he asked the question of the discrepancy between the nurturing and coercive roles assumed by mental health nurses.
HOPE AND SPIRITUALITY
Hope has particular relevance to mental health care, and there is growing recognition of the concept of hope and its relationship to health, well-being and recovery after illness or traumatic life events (Duggleby et al. 2012). The need for further research to generate knowledge and increase understanding about suffering, hope and spirituality in relation to mental health care is recognized in the literature (Cutcliffe et al. 2015; Schrank et al. 2008).
Critical thinking challenge 1.1
2015) emphasizes the importance of recognizing and responding to clients' needs for spiritual care and urges nurses to develop skills in supporting clients to understand and find meaning in their experiences. This leads us to the question: What skills do nurses need if we are to care for the spiritual needs of our patients and clients.
ETHICAL DILEMMA 1.1
She says that her mother and uncle died two years ago in a car accident, and that her husband died of a heart attack six weeks ago. How might Margaret's recent family and social history be related to her current state of health.
Questions
THERAPEUTIC USE OF SELF
Studies of clients' experiences of mental health services demonstrate that understanding and listening in a thoughtful and sensitive way affirms their humanity and provides hope for their future (Shattell et al. 2006; Gunasekara et al. 2014). Similarly, studies of nurses' experiences find that nurses see therapeutic collaboration as a sign of good practice in mental health settings (Cleary et al. 2012; McAndrew et al. 2014).
Empathy and therapeutic use of self
Studies of the experiences of both mental health nurses and consumers of mental health services overwhelmingly testify to the importance of therapeutic relationships. Consumers identified the need to feel cared for with compassion, to have meaningful contact with nurses, to be listened to, and for nurses to know them as people and understand their predicament (Gunasekara et al.
The therapeutic alliance
This level of empathic attunement allows the client to participate in identifying those aspects of their illness and health care experience that are problematic (see also Chapter 24).
SELF-AWARENESS
It is awareness of these self-attributes that can improve the way we relate to others. Lack of awareness can cause nurses to respond to client distress and behavior in ways that may not be helpful.
REFLECTION
This growing self-awareness must take place against a background of self-compassion; developing the ability to empathize with others requires 'the ability to be sensitive, non-judgmental and respectful of oneself' (Gustin & Wagner 2013).
Developing reflective practices
The reflective phase involves comparing the narrative with the nurse's beliefs, prejudices and knowledge. It also allows for the development of greater understanding of the influence of the context on the nurse's actions.
PROFESSIONAL BOUNDARIES
This involves identifying the nurse's knowledge base, values and belief systems and enables the identification of gaps in knowledge, as well as previously unexamined beliefs about the client and situation or the nurse's role and intentions. The critical/emancipatory phase allows the nurse to identify differences between intentions and actions, thoughts/feelings and espoused values, values and practices, client needs and the nurse's actions.
Consumer Story 1.1 Therese
Mental health nurses must be able to maintain professional boundaries while developing close therapeutic relationships with clients based on empathy and positive connection. Professional boundaries are violated when interventions and interactions lose their therapeutic purpose and are instead primarily for the benefit of the nurse.
Self-disclosure
Participants in her study commented that the nurse 'was more like a person than a nurse' (p. 178), and Welch (2005) also identified self-disclosure as part of the therapeutic relationship. At issue is the nature of the disclosure and whether the nurse burdens the client with her own personal problems.
ETHICAL DILEMMA 1.2
In a study of nurse-client relationships between mental health nurses and clients with long-term mental health conditions, nurses described the use of self-disclosure: 'The nurses used their own experiences of living a life to: be seen as ordinary people; be credible; illustrate aspects of being in the world; let the clients identify with them; and to normalize the client's fears and difficulties' (O'Brien 2000, p. 188). Concerned for her safety, you go to the staff tea room to report her absence to the team leader who is on break, to visit the client and the team leader in the tea room.
STRESS AND BURNOUT Stress
Later, the team leader approaches you and says that he is doing individual therapy with the client and that her psychiatrist is aware of this; however, you notice that this.
Burnout syndrome
It can be seen that burnout syndrome is an undesirable condition, not only because of the detrimental impact it has on the nurse-patient interaction, but also because of the negative effects on the affected nurse and their immediate colleagues. From the perspective of the affected person, there is nothing worse than going to work feeling unhappy and despondent.
AVOIDING BURNOUT SYNDROME
It is important that we give ourselves the same care that we give to those we care for. It is therefore also important to ensure that institutions and managers adopt policies and practices that support nurses rather than contributing to stress and burnout (Hunsaker et al. 2015; Sawbridge & Hewison 2015).
PROFESSIONAL SUPPORTIVE RELATIONSHIPS
Nursing is a stressful profession, so it is necessary to be active in managing stress. Although it can be difficult to balance leisure activities with shift work and study, it is important to maintain a balanced and healthy lifestyle and make time to participate in enjoyable leisure activities.
Clinical supervision
Workforce Development Position Paper: The Role of Supervision in the Mental Health and Addictions Support Workforce 2013, www.tepou.co.nz/resources/search/terms/supervision/12.
Preceptorship and mentoring
Mentors and preceptors need additional skills, such as problem solving; clinical currency and expertise (in the case of preceptors or clinical mentors); appropriate scientific, administrative or research expertise; the ability to provide constructive criticism and other feedback; understanding professional boundaries and relationships; and the ability to maintain confidentiality where appropriate.
Nurse’s Story 1.2
CLINICAL SUPERVISION
Nicola decides to talk to the client about how the client felt last night and what provoked the self-harm incident.
CONCLUSION
Acknowledgement
Exercises for class engagement
How do they inform my understanding of what it means to be human in this world. What are the prevalent societal attitudes towards people in mental distress or with mental illness.
Therapeutic kindness and the development of therapeutic influence by mental health nurses in community rehabilitation settings. The centrality of personal relationships in the development and amelioration of mental health problems: the current interdisciplinary case.
RECOVERY AS THE CONTEXT FOR PRACTICE
Mental health nursing practice is ultimately influenced and developed by the nurse's attitudes, values and beliefs. This chapter addresses some of the major shifts in thinking that affect our understanding of what nursing practice entails.
RECOVERY AS THE CONTEXT OF PRACTICE
In fact, it is argued that the principles that underpin recovery-based mental health practice also underpin all areas of nursing practice. How well recovery is understood and the leadership that occurs across service and community systems affects the rate of transformation in mental health.
Recovery as a personal journey
The National Framework for Recovery-Oriented Mental Health Services: Policy and Theory defines recovery as “being able to create and lead a meaningful and contributing life in a community of one's choice, with or without the presence of mental health problems.” To enhance novice nurses' understanding of recovery, the different contexts in which the term 'recovery' is used in mental health care will be explored.
Recovery paradigm
Recovery framework
Terms used to describe people who experience mental health challenges
Defining personal recovery
The definitions above show that people with mental health problems want to live a life like any other citizen. The difference for people with mental health problems is the additional significant barriers they face.
TENSIONS IN DEFINING RECOVERY
Students need to be aware of how they use language and terms such as “recovery” with the people they work with. A crucial point here is that it doesn't matter what the term is; it is the meaning people give to their own experiences and the principles and values underpinning recovery that really matter.
Consumer Story 2.1
Similarly, Morrow (2011) found that consumer advocates argued that the recovery paradigm was co-opted into the biomedical frame. When this happens, the biomedical framework becomes dominant and diminishes the social determinants of health, structural disadvantage and social exclusion that are so critical to mental well-being.
Simon’s story: living with difference and mental health challenges
I was trying to make meaning and sense in a life that was increasingly chaotic. Just as people with mental health challenges need to reflect on their own issues, nurses need to do so too.
WHAT RECOVERY IS NOT
None of these conditions apply to recovery from mental health problems for the following reasons. The mental health crisis or challenge may arise from the need to recover from one situation to another.
PERSONAL NARRATIVES
Mental health professionals found no value in helping Mary make sense of her madness. Mary's experience of care within the mental health services was one of "skilled at lowest expectations"; for example,
BRIEF HISTORY OF RECOVERY MOVEMENT AND RESEARCH
At the same time, the anti-psychiatry movement, initiated by psychiatrist Thomas Szasz's book The Myth of Mental Illness (1961), fueled the mental health debate. Basaglia (Babini 2014) was instrumental in the introduction of Law 180 in Italy, which led to the closure of all mental health institutions.
Critical thinking challenge 2.1
Please note that while recovery is the current context within Australian mental health services, consumers internationally who are the driving force behind recovery have progressed beyond recovery to focus on wellbeing (Ning 2010). This ongoing dynamic movement in the conceptualization of recovery is demonstrative of the rapidly changing focus on mental health mentioned at the beginning of this chapter.
RECOVERY-INFORMED PRACTICE
From 30 papers in six countries (USA, England, Scotland, Republic of Ireland, Denmark and New Zealand), they sought to identify a conceptual framework for key principles of recovery information-based practice. This includes ensuring that the organizational culture shifts from a focus on services to a focus on the needs of the person.
Nurse’s Story 2.1
Individuality, informed choice, peer support, strengths focus and holistic approach are included in this practice area.
A CASE FOR CHANGE
Although this is a dramatic example, it illustrates the need for practice that seeks the meaning of the experience for the person rather than practice limited to observing signs and symptoms. To communicate positive expectations, promote hope and optimism so that the person feels valued, important, welcome and safe.
Translating recovery-informed practice into action
Supporting social inclusion, defending social determinants, tackling stigmatizing attitudes and discrimination, and developing partnerships with.
CITIZENSHIP
This is a societal problem that goes far beyond the practice of mental health services, but one that needs to be remembered. Keeping people in employment as much as possible mitigates against them becoming dependent on mental health services (Davidson et al. 2010).
SOCIAL INCLUSION
It expands the concept of social inclusion, which is part of citizenship, as a person can be socially included, but not treated as an equal member of society. The concept of social inclusion is also linked to the opposite concept of social exclusion, which is a set of things that limit the capabilities of individuals and include stigma and discrimination, unemployment, low income, isolation, poor housing and lack of access to opportunities. (Clifton et al. 2012).
KEEPING HOPE ALIVE
They note that the complexity of the concepts is linked to important socio-economic and political issues. These authors suggest that mental health clinicians should shift their focus from “doing activities” to efforts that promote individual rights and access to supports that reduce health inequities.
PERSONAL AGENCY
Actively involving the person in their care utilizes and draws on their strengths and promotes resilience, personal agency and their sense of overcoming adversity. For Simon Champ, visual art is one of the most important areas that drives his personal dynamism.
SELF-DETERMINATION
Maximize the person's capacity to make informed choices and ensure they are involved in decisions that affect them.
RELATIONSHIPS ARE CRITICAL
Watch the first 5½ minutes of the clip by Dr. Amy Banks on Understanding Relationships: www.wcwonline.org/Videos-by-WCW-Scholars-and-Trainers/forming-healthy-thriving-. The internal environment of the people providing care and the culture of the healthcare settings you work in are also important.
TRAUMA-INFORMED CARE
You need to take time to find out how the person feels and what they need to feel safe and secure. There is a strong need to focus on what happened to the person, rather than pathologizing the symptoms.
Facilitating self-help and personal responsibility
Mental Health Coordinating Council, Trauma Informed Care and Practice, http://mhcc.org.au/sector-development/recovery- and-practice-approaches/trauma-informed-care-and-. Soon the person's identity would be taken over and consumed by IT - 'the problem', 'the disease'.
ASKING QUESTIONS AND SHARING
The professional would ask questions about 'the problem' (usually disease symptoms) and thus build an increasingly bigger picture of 'the problem'. The problem would become bigger and bigger and made worse by the person's family or by others asking about it.
Previous mental health practice focused on the illness to the exclusion of the person experiencing the illness. Within Australia and New Zealand there are a number of consumer organizations that provide advice, advocacy, support and services.
Te Puni Kōkiri provides policy advice to government and other agencies and links to other M ori-related websites, www.tpk.govt.nz. Judi Chamberlin, www.youtube.com/watch?v=FGT4xJXgmoE A number of alternative support groups have been created to support those consumers who cling strongly to their experiences, such as voice-hearing groups and groups to support people exploring faith unusual without having to label their experiences in professional jargon.
Focus on personal strengths
The nurse will also encourage the person to think of ways that will work for them. The nurse will not impose their own ideas but can make suggestions and will work with the person to explore and create options.
Nurse’s Story 2.2
For example, the nurse will want to know what the person has done in the past to overcome life's difficulties and how he or she can use the strengths he or she used previously to overcome current challenges. The nurse works with the person. The nurse's role is to reinforce the person's plan and remind them if they do start to feel unwell.
MOVING FROM DEFICITS-BASED TO STRENGTHS-BASED PRACTICE
Sarah's admission was very brief and she reported that she felt encouraged by the nurse and her family when they reminded her of the resources she had in her family and friends and how they were there to support her. She appreciated the time the nurse took to patiently wait to communicate.
The importance of reflection in relationship to recovery-informed practice
This was achieved by having her family members stay with her until she needed to sleep. She was able to make arrangements the next day with her family and asked that her belongings be taken to the hospital and that friends be contacted.
EXTERNAL ENVIRONMENTS THAT FACILITATE RECOVERY
Mental health professionals have much to learn from them about the nature of mental distress and the most important factors in helping them move on with their lives in a way that is meaningful to them. These stories suggest that recovery can occur without the involvement of mental health professionals and, unfortunately, despite it in some cases.
Nurse’s Story 2.3
MY EXPERIENCE AS A NURSE WITH MENTAL HEALTH PROBLEMS: VICKI
How did my experience of mental illness impact on my ongoing work as a nurse?
A significant reason for my resignation was the extreme reluctance I felt, as well as my colleagues in the mental health service, to discuss in any way my needs as a mental health worker with mental health problems. It was like dancing around an insurmountable question, and this change in my relationship with my colleagues had a negative impact on my identity.
How did I manage working in an acute clinical setting?
How could I discuss this with my colleagues?
The fact that we do not discuss this means that we do not benefit from the wealth of experience and perspectives of nurses who have recovered from mental illness and have woven these experiences into our practice. Having a dialogue about this can help future nurses feel that they can engage in recovery and continue as nurses.
What was most helpful to personal recovery?
RECOVERY-INFORMED SERVICE PROVISION
Social inclusion means that people with mental illness can participate in the community as workers, students, volunteers, caregivers, parents, etc.
The mental health service
The consumers and carers in the study by Light et al. 2014) described community treatment orders as both providing access to services, but at the same time reported that access was a limited form of service dominated by medication and an involuntary process described by some as degrading. This tells us that being in the community setting does not in itself guarantee social inclusion.
Nurse’s Story 2.4
Nurses must be aware that the community environment has the potential to be a site where mental health care is experienced as disempowering and stigmatizing. 2014) describe the experience of people subject to community treatment orders in Australia, highlighting concerns that while receiving such care these consumers and carers continued to experience isolation, loss and trauma, vulnerability and distress and disempowerment.
WHAT NURSING CAN ACHIEVE IN THE COMMUNITY
The nurse used curious questions to help Johanna get in touch with ways she could manage her distress and overcome her fears about control with her son and family life. She felt less isolated, more connected to her family and other people, and wanted to heal because she was encouraged by the normal everyday activities around her.
Nurse’s Story 2.5
Johanna reported that this episode of depression was not as prolonged as her previous inpatient stay. Johanna felt convinced that, with the support of the people around her, she could explore her distress and learn to deal with the challenges it presented.
RECOVERY-INFORMED PRACTICE WITHIN AN INDIGENOUS SETTING
Within the framework of recovery, important elements in responding to Johanna included recognizing and emphasizing her strengths in her existing relationships with family and community.
Community-managed organisations
While it is essential to work in an integrated manner with CMOs and other providers, it is essential to remember that CMOs are not lifetime services, but rather stepping stones for those people who choose to use them . The goal is for people to develop natural supports within the community or use other established supports that are accessed by all community members.
Peer support workers in mental health
Contributing Life, a 2013 report on mental health and suicide prevention, recommends that the peer workforce be considered essential for all mental health support teams and recommends the development of a national mental health peer workforce development framework and targets. for peer support workers into the future. In addition to peer workers in mental health services, there are a growing number of services provided by peers.
Mental Health Australia (the peak independent national mental health authority with a wide range of important resources), www.mhca.org.au. National Standards for Mental Health Services 2010, www.health.gov.au/internet/main/publishing.nsf/content/mental-pubs-n-servst10.
HISTORICAL FOUNDATIONS
This chapter examines mental disorders, the ways in which they have been viewed and the ways in which they have been treated in the past, beginning with ancient Greek and Roman times. It is inevitable that in the millennia briefly covered in this chapter, attitudes towards mental disorder and mental disorders, and even mental disorders themselves, have changed over time.
THE VALUE OF HISTORICAL ANTECEDENTS
For example, psychiatry as a profession has evolved only slowly over the past 160 years since the 13-member American Psychiatric Association (APA) was founded in 1844. Nursing scholarship actually prides itself on being focused on the present in the belief that this equates to being innovative and progressive.
PAST IDEAS ABOUT MENTAL DISORDER
Metallic mercury poisoning in the felt hat industry produced toxic effects that gave rise to the expression "mad as a hatter." In the past, some people thought that mental illness was a punishment from the gods or God.
The ‘humours’
These theories are explained in more detail in the Hippocratic Corpus: The Nature of Man, Regimen I and The Sacred Disease. Some aspects of humor theory are quite advanced and in fact the four-factor theory of temperament and body function has not only survived but also been revived in the areas of personality assessment and the prediction of vulnerability to physical disease (Hawkins 1982; Lester 1990; Merenda 1987) .
Supernatural influences
GREECE AND ROME
Case Study 3.1
Cleomenes of Sparta—madness and suicide
Herodotus is personally unable to decide between a superstitious and a rational cause for Cleomenes' madness and death. Their attribution of Cleomenes' death to prosaic, organic causes, and their specific rejection of the theory that Cleomenes' madness was divinely caused, is evidence that mental illness was not universally believed. be the result of divine punishment.
Case Study 3.2
Alexander the Great: dealing with delusions
In Plautus' (c. 254–184 BC) Menaechmi, the physician asks whether a patient's disorder was due to possession or hallucinations, indicating that although possession was a recognized 'disorder', the medical profession clearly knew the difference between possession. and hallucinations, as famous playwrights and their audiences did. This would be a situation similar to that in which today we can simultaneously believe in both medical technology and the "stars" or astrology.
Nurse’s Story 3.1
The medical term 'melancholia' was used by both the Greek comic dramatist Aristophanes (1964) (c. 457-385 BC) and the Greek politician Demosthenes (384-322 BC), demonstrating that ordinary people who watched plays or listened to politicians knew medical terminology as early as the 5th century BC. The public adopted and used medical terms that coexisted with superstitious and religious beliefs about possession and divine punishment.
WHO ARE THE BEST MIDWIVES?’
She will be well disciplined and always sober, as it is uncertain when she can be called to those in danger. She will have a calm disposition because she will have to share many secrets of life.
MENTAL ILLNESS AND THE SUPERNATURAL IN THE CHRISTIAN ERA
The rise of the women's liberation movement in the 1970s led early nursing researchers to explore the unrecorded and uncelebrated role of women as healers. However, it is difficult to find research evidence to support claims that 'millions' of witches or 'wise women' were killed in societies that were basically illiterate.
MENTAL DISORDERS DESCRIBED IN GRAECO-ROMAN SOURCES
Nor is there any indication that all witches who were persecuted were practicing healers, or that all healers were persecuted as witches. Atticus for most of the days they were separated, and his voluminous correspondence clearly documents three diagnosed episodes of major depression (Evans 2007).
Consumer Story 3.1 Cicero’s depression
Cicero seems to have himself discovered a self-help treatment method that really works and is recommended today for alleviating depression. Paradoxically, only narrative writing helps alleviate depression: writing poetry does not seem to help (Kaufman & Sexton 2006).
Consumer Story 3.2
Cicero’s depression and his exile
Cicero's first episode of depression appears to have occurred in 58 BC when he was exiled from Rome following a political dispute (Evans 2007). Cicero's houses in Rome and his country houses were destroyed, as well as those of his brother Quintus.
Consumer Story 3.3
He became deeply, clinically depressed as a result of his exile, which damaged his ambitions, self-importance and self-esteem. Cicero experienced his last and most severe episode of depression after the death of his daughter Tullia.
Cicero’s depression: death of Tullia
He had to stay more than 500 miles from Italy, people were forbidden to offer him support and he could be killed at any time before he reached this limit, so he had good reason to be pitifully unhappy.
Case Study 3.3 Phobias
Case Study 3.4
Posttraumatic stress disorder (PTSD)
There was evidence in ancient literature that epilepsy was believed to be associated with mental illness. Some psychotic disorders (see Chapter 16) were documented and recognized as such in ancient Greco-Roman literature, but research shows that the full range of criteria that would justify a modern diagnosis of schizophrenia (early onset, hallucinations, delusions, and a degree of chronicity) was nowhere evident in ancient Greek and Roman texts (Evans et al. 2003).
Mental disorders not found in the ancient literature
Epilepsy can have psychiatric consequences, but while it was considered a mental disorder in the ancient world, it is no longer considered that way today. The reporting of symptoms for all major mental disorders in the ancient literature was often inadequate to meet modern diagnostic criteria regarding the duration and range of symptoms.
Schizophrenia
They do not reach a definitive conclusion, but there is evidence of sequences associated with viruses in the brains of individuals suffering from schizophrenia (Yolken et al. 1997). Mental illness leaves no trace in skeletal remains; can only be traced in the surviving literature.
Critical thinking challenge 3.1
Polimeni and Reiss (2003) reviewed the data regarding the emergence of schizophrenia and cautiously assessed whether it is a disadvantageous byproduct of normal brain development or whether it may have an evolutionary advantage. It has been hypothesized that urban birth, household crowding and/or transmission of virus by household cats could aid the spread of the virus (Torrey & Yolken Torrey et al. 1997).
Hysteria: a translation error
Hippocratic Corpus in the mid-19th century, when the psychiatric condition "hysteria" began to become a debated ideology. When hysterikos, which in Greek means 'tormented by suffering in the womb', is translated as 'suffering from hysteria', it is clear that the translation is not influenced by the original language of the text, but by the meaning that Charcot, Freud and Breuer linked the psychiatric diagnosis of hysteria in predominantly female patients at the end of the 19th century (Evans 2000).
ANCIENT MENTAL HEALTHCARE
He expected to find hysteria in the text, and of course he did, and composed his titles accordingly. Recognition of the importance of dreams as an expression of the unconscious is surprisingly sophisticated and not equaled until Freud's work in this area 2,500 years later.
Violent behaviour
He recommended that the patient not be frightened and kept in a soothing environment, either in light or in darkness, whichever was "the most soothing to the soul" for the patient. It is better, then, to try both, and to keep in the light that patient who is afraid of the dark, and the one in the dark who is afraid of the light" (III.18.5).
ETHICAL DILEMMA 3.1
Celsus prescribed various remedies for the frightened, the violent, the melancholic, and those who "laughed out of time" (III.18.10). Celsus forbade restraint for longer than absolutely necessary, saying: '[sometimes] nothing remains but to restrain the patient, but when circumstances permit, help must be given in haste' (III.18.6).
Counselling
Other suggestions included reading to the patient, playing games and stories, 'especially those to which the patient was accustomed to be drawn when he was sane', and praising any work the patient was able to produce. People whom the patient liked and esteemed were encouraged to eat with them to stimulate their appetites and to 'gently rebuke his depression as without cause' (Celsus, De Medicina, III.18.18).
Early Christian healthcare
ANCIENT DOCTORS AND NURSES
Furthermore, it is impossible to distinguish between psychiatric mental nurses and general nurses until relatively modern times, because the distinction between disorders of the mind and disorders of the body is of relatively recent origin. The Hippocratic Corpus states that in the absence of the physician, the patient was attended to by family members, slaves, or medical students, who reported the patient's progress to the physician.
Nurse’s Story 3.2
There was no form of licensing, but students were bound by an agreement: the Hippocratic Oath is an early form of private contract (Hornblower & Spawforth 1996). The sensitive advice in the Hippocratic Corpus (see Nursing Narrative 3.3) would be useful to anyone caring for an individual who was physically or mentally ill.
BEING PERSON-CENTRED
Women
Indeed, women probably received little medical care unrelated to reproductive matters, and would have treated themselves and their relatives in seclusion in the women's quarters. We can assume that much of the information given in the clinical histories, such as the epidemics, is the result of their observations and those of the family or carers.
Nurse’s Story 3.3
INTERPERSONAL SKILLS
Midwives and nurses
However, Soranus wrote in favor of the female midwife and the wet nurse, who both fed the baby and treated childhood illnesses. Soranus can describe the ideal modern nurse (or nursing student) and it is significant that many of the skills she must possess, such as sympathy, reassurance and the sharing of secrets, will encourage a therapeutic relationship that promotes the mental health of the client.
Nurse’s Story 3.4
The 1956 translation of The Gynecology by Owsei Temkin, professor emeritus of the history of medicine and former director of the Johns Hopkins Institute of the History of Medicine, is clearly a product of a time and culture in which the midwife played a subordinate role. with that of the doctor, who, as the natural leader of a 'medical team', made the management decisions. Please note that the midwife must be a woman, while elsewhere in the work it is assumed that the doctor is a man.
WHAT PERSONS ARE FIT TO BECOME MIDWIVES?’
Temkin did nurses and nursing a disservice by obscuring the true role of the ancient Greek midwife as an independent professional practitioner. Many centuries after Soran, Charles Dickens included the character of nurse and midwife Sairey (or Sarah) Gamp in his novel Martin Chuzzelwit (1844).
RESURGENCE OF MEDICAL KNOWLEDGE
Perhaps Gamp was intended as a caricature in the tradition of midwives in classical Greco-Roman comedy writers, in much the same way that nurses are depicted in modern television dramas, films, books and advertisements in roles ranging from skilled professional to scantily clad seductress.
The asylum
The asylums were characterized as 'warehouses for the unwanted', the old, destitute vagrants, alcoholics and syphilitics. All the 'lunatics' in the new colony were sent there, and by 1825 this facility was overcrowded.
Critical thinking challenge 3.2
The psychoanalytic theories initiated by Freud in the latter part of the 19th century and early 20th century were slowly adopted in Australia. What would be the benefits to the client and to society if the client's family were solely responsible for caring for the mentally ill?
PIONEERS AND PROFESSIONALISATION
In the asylums, more male servants were initially employed for their strength, although photographs of asylums in the 19th century clearly show female nurses, dressed in the starched general nursing dress of the period (Chatterton 2000). Since the introduction of neuroleptic medicine in the mid-20th century, and with the increasing emphasis on professional qualifications, maids have become nurses, endowing this branch of the nursing profession with an enduring tradition of male practitioners.
The United States
Asylums also ensured that mental health care developed along institutional lines in both the UK and its colonies.
The United Kingdom
In 1854, Florence Nightingale assembled and trained a force of nurses to care for English troops involved in the Crimean War in Turkey. In the asylums, both staff and patients were segregated by gender: men worked in the grounds or in the workshops under male servants who were ex-army, prison guards, or farmers; female patients performed housework indoors under female attendants or nurses (Chatterton 2000).
New Zealand
These numbers were inflated after 1913 by the implementation of the Mental Deficiency Act, which led to the admission of women to mental institutions, sometimes on the grounds of poverty, genital defects or unemployability (Walmsley 2000). Due to proximity and similar colonial histories and multicultural backgrounds, New Zealand and Australia shared a comparable training and professionalization agenda in the 20th century.
Australia
DEINSTITUTIONALISATION
This meant that in poor families who could not afford private care, family members who might previously have looked after their chronically mentally ill relatives were no longer available. But in the 20th century, a series of advances and innovations changed mental health care quite dramatically.
The anti-psychiatry movement
The first time clear diagnostic criteria were included in the DSM was in DSM III, published in 1980. People who would normally have been treated as inpatients were released, or returned to their families, or moved into some form of community, or in the worst case scenario, become homeless.
The aftermath of deinstitutionalisation
What aspects of mental health care in the past would you like to see incorporated into current mental health nursing practice. Back to the future: making a case for including the history of mental health nursing in nursing education programs.
PROFESSIONAL, LEGAL AND ETHICAL ISSUES
Mental health nurses have developed advanced and expanded roles, including nurse practitioner roles and prescribing. Psychiatric nurses are legally obliged to practice nursing in accordance with professional competences and social expectations.
REGULATION OF PROFESSIONAL PRACTICE
In both Australia and New Zealand there are two levels of nursing: registered nurse (EN) and registered nurse (RN). Mutual recognition agreements provide mechanisms for nurses to have their registration recognized between Australia and New Zealand.
AUSTRALIAN HEALTH PRACTITIONER REGULATION AGENCY
AUSTRALIAN NURSING AND MIDWIFERY ACCREDITATION COUNCIL
NURSING AND MIDWIFERY BOARD OF AUSTRALIA
NURSING COUNCIL OF NEW ZEALAND
In Australia, nurses with current nursing registration can work in mental health care even without a mental health qualification. Defining the scope of mental health care and protecting consumers by employing only practitioners trained within that scope are issues that require an assertive approach on the part of professional nursing organizations.
PROFESSIONAL AND INDUSTRIAL NURSING BODIES
Issues such as the number of beds offered by a mental health service and the number of staff allocated to different departments of the service show the overlapping functions of professional and industrial organisations. Some of the main professional and industry bodies in mental health care in Australia and New Zealand are listed in Box 4.2.
AUSTRALIAN COLLEGE OF MENTAL HEALTH NURSES
AUSTRALIAN COLLEGE OF NURSING
AUSTRALIAN NURSING AND MIDWIFERY FEDERATION
ANMF produces the Australian Journal of Nursing and Midwifery and the Australian Journal of Advanced Nursing (www.anmf.org.au).
HEALTH SERVICES UNION OF AUSTRALIA
NEW ZEALAND NURSES ORGANISATION
PUBLIC SERVICE ASSOCIATION
TE AO MARAMATANGA
STANDARDS OF PRACTICE
