Challenges in mental health nursing

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Challenges in mental health nursing

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Challenges in Mental Health (Psychiatric) Nursing:

Challenges in Mental Health (Psychiatric) Nursing Dr. Riaz.K.M . MSc (N), PhD. Assistant Professor, Govt. College of Nursing, Thrissur , Kerala [email protected]

Objectives :

Objectives Describe misconception as a challenge in mental health Explain scope and challenges in mental health Lists the priorities of the Helsinki Declaration Lists the challenges on Roles and Responsibilities Explain Challenges in Providing Care within Psychiatric Wards Describe the challenges in Improving Psychiatric Care Explain the challenges related to Role of mental health nurses Describe the challenges related to Lack of clinical guidelines Explain the challenges in Creating international network of mental health nurses Explain the challenges in Recovery-Focused care Describe the challenges in Values-based education

Challenge :

Challenge Noun A call to someone to participate in a competitive situation or fight to decide who is superior in terms of ability or strength. A call to prove or justify something Verb Dispute the truth or validity of. Invite (someone) to engage in a contest

“Future nursing” – challenge?:

“Future nursing ” – challenge? “Transformational nursing”, “Translational nursing”, “Interdisciplinary nursing”, “Multidisciplinary nursing”, “Multileveled nursing,” “Integrative nursing”,

A former student’s view :

A former student’s view Mr X, 29, studied mental health nursing. He now works in an adult acute admission ward “Throughout my studies and career so far it has been clear there are still many misconceptions of mental health nursing and patients - the expectation of violence as a daily feature of my job is still, without a doubt, a strong one. In my spare time I practice kung fu and during one training session received a black eye; I was surprised by how many people assumed I’d received the injury at work.

Slide 6:

“I think the most powerful tool we have in changing these misconceptions is challenging stigma as it arises. Advertising campaigns are all very well, but it’s in conversation with the general public that, as professionals, we can address these misconceptions and negative stereotypes. ”

Priorities of the Helsinki Declaration (1964 & 2013):

Priorities of the Helsinki Declaration (1964 & 2013) Foster awareness of the importance of mental well-being Collectively tackle stigma, discrimination and inequality support people with mental health problems and their families to be actively engaged in treatment process Design and implement comprehensive, integrated and efficient mental health systems (promotion, prevention, treatment and rehabilitation) Address the need for a competent workforce, effective in all settings and areas

Scope/Challenge:

Scope/Challenge Misconceptions (both the public and fellow nursing professionals) - fuel for stigma and discrimination The mental health nursing profession - subject of many misconceptions The mental health nursing profession - “brand” The responsibility for challenging misconceptions lies with each member of the mental health nursing community

Scope/Challenge :

Scope/Challenge Shift of practice from mental illness to mental health, leaving a vacuum in the care of serious mental illness . Deinstitutionalization of mental illness care, with emptying out or closure of many public mental hospitals . Limited access to urgent psychiatric care Marked decline in hospital stays for patients with psychiatric disorders.

Scope/Challenge:

Scope/Challenge Inadequate reimbursement for time-consuming “talk therapy” without compensatory procedural reimbursement. Lack of parity of coverage for physical and mental illness. Rapid decline of psychotherapy and shift toward drug therapy and “med checks” practice.

Scope/Challenge:

Scope/Challenge Expansion of criteria for psychiatric disorders in subsequent Diagnostic and Statistical Manual of Mental Disorders editions. Growth of various mental health professions in practices not supervised by psychiatrists . Criminalization of the seriously mentally ill, with misuse of jails as mental hospitals.

Scope/Challenge:

Scope/Challenge Income inequality and class differences have reached historic highs in recent years- lack of health insurance we can no longer afford the waste, duplication, and profits of private payers. Public payers are more efficient, provide more value, and control costs better than private payers a larger role of government and public financing of health care Progress of single-payer initiatives

Scope/Challenge:

Scope/Challenge Broadening scope and the shift to community based mental health services introduce greater levels of complexity, affecting the role Planning and management will take a more central place , and accountability is likely to become more transparent.

Challenges in :

Challenges in Community characteristics MH configuration Prevalence of disorders Demand of services Demographics Institutional characteristics Ownership Facility type Organization of services Size and occupancy Staff patient ratio Source of payment Provider characteristics Demographics Specialty training Method of payment Patient characteristics Demographics Insurance coverage Risk factors Protective factors

Challenges in:

Challenges in Entry status Clinical Legal Diagnostic evaluation Diagnosis Severity co morbidity Treatment approach style of treatment intensity frequency appropriateness Treatment response Compliance Change in symptoms Medication effect complication Disposition Clinical Legal Follow up / Placement

Challenges in:

Challenges in Specific outcomes Clinical Functioning Mortality Quality of life Societal costs

Challenges in Roles and Responsibilities:

Challenges in Roles and Responsibilities Therapeutic role Membership of multi-disciplinary team Functioning in diverse roles and settings Broadening societal scope of psychiatric nursing Partnership working Leadership Information systems Research Competence Career development Status and funding Legislation Stigma

Challenges in Providing Care within Psychiatric Wards:

Challenges in Providing Care within Psychiatric Wards Politics and Rules of Organization, Safety and Security Issues, Uncertainty about the Role, Lack of Trained Staff, Socio cultural Issues, Limited resources, Complexities in role, Pre - licensure , post- licensure challenges, Professional obstacles, Public perception

Challenges in Improving Psychiatric Care:

Challenges in Improving Psychiatric Care Empowerment across Psychiatric Nurses, Mentally Ill Patients and their Families, The Psychiatric Mental Health System, and the Cultural Context.

Challenges in Role of mental health nurses:

Challenges in Role of mental health nurses

Challenges in Role of mental health nurses :

Challenges in Role of mental health nurses Assessment Care planning Drug administering (Even Prescribing) Advocacy Case management Community care Psycho education Psychotherapy

Challenges towards de institutionalization:

Challenges towards de institutionalization Reallocation of staff from hospital to community based services Development of new set of competencies are needed

Challenges related to Lack of clinical guidelines:

Challenges related to Lack of clinical guidelines Absence of national guidelines for mental health nurses Lack of evidence based practice Lack of research Activity of professional bodies

Challenges in Creating international network:

Challenges in Creating international network A lack of core indicators leads to invisibility and marginalization of people affected by mental disorders Mental illness is not perceived as amenable to quick solutions Human resource planning Integration of mental health into the social development sector Avoiding a narrow focus on psychosocial issues Access to mental health interventions

Challenges in Recovery-Focused care :

Challenges in Recovery-Focused care Recovery-focused care gives professionals an insight into service users’ needs Involving family members in care and discussing how mental illness affects all areas of a person’s life can help to build trust A lack of time is often cited as a reason for nurses not focusing on recovery Nurses can provide person- centred care by involving service users in making decisions about their care

Challenges in Values-based education:

Challenges in Values-based education Acknowledging and respecting values are important for building relationships between staff and patients Training to improve values-based practice has been developed in Scotland Providing training outside a clinical environment helps reduce distractions Group discussion helps increase awareness Evidence on how mental health nurses are applying values-based care should be collected

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MULTI PLAYER V/S SINGLE PLAYER

Challenges in Future Measurement Criteria:

Challenges in Future Measurement Criteria Utilizes ethical principles to create a system of advocacy for access and parity for mental health problems, psychiatric disorders, and addiction services. Influences health policy to reduce the impact of stigma on services for prevention and treatment of mental health problems and psychiatric disorders. Works to influence decision-making bodies to improve patient care Provides direction to enhance the effectiveness of the healthcare team

Challenges in Future Measurement Criteria:

Challenges in Future Measurement Criteria Provides direction to enhance the effectiveness of the healthcare team Initiates and revises protocols or guidelines to reflect evidence-based practice, to reflect accepted changes in care management, or to address emerging problems. Promotes communication of information and advancement of the profession through writing, publishing, and presentations for professional or lay audiences. Designs innovations to effect change in practice and improve health outcomes.

“online disinhibition effect”:

“online disinhibition effect” excessive Internet use may be correlated with social anxiety, depression, and introversion Examinations of Facebook pages detailed, publically accessible postings describing depressive symptomatology and ongoing patterns of substance abuse STUDY among aged between 10-17 found that the 5% of subjects who reported symptoms of major depression spent more time online and were more likely to post identifiable information (if they were male) and pictures (if they were female)

“online disinhibition effect”:

“online disinhibition effect” Disclosure of patient-related information is often problematic health professionals “behaving badly” may call their clinical judgment into question, raising doubts in patients' minds about the quality of the treatment they will receive. Such behavior can have negative consequences for the psychiatrist, including discipline by licensing boards Unreflective and excessive self-disclosure by psychiatrists, especially when they are engaged in psychotherapy, is another concern inherent in their use of social media.- “ black state” breakdown of boundaries in the physician-patient relationship

“online disinhibition effect”:

“online disinhibition effect” groups of health professionals with similar interests; share resources with colleagues (e.g., the SlideShare website, which allows users to upload and share Powerpoint presentations and other educational materials)

“online disinhibition effect”:

“online disinhibition effect” “Twenty-first century psychiatric nurse should be able to be a cautious but vigorous participant in the social media revolution”

The giant ship engine that failed?:

The giant ship engine that failed? The ship’s owners tried one expert after another, but none of them could figure but how to fix the engine. Then they brought in an old man who had been fixing ships since he was a youngster. He carried a large bag of tools with him, and when he arrived, he immediately went to work. He  inspected the engine very carefully, top to bottom. 

The giant ship engine that failed?:

The giant ship engine that failed? Two of the ship’s owners were there, watching this man, hoping he would know what to do. After looking things over, the old man reached into his bag and pulled out a small hammer. He gently tapped something. Instantly, the engine lurched into life. He carefully put his hammer away. The engine was fixed

The giant ship engine that failed?:

The giant ship engine that failed? A week later, the owners received a bill from the old man for ten thousand dollars.“What?!” the owners exclaimed. “He hardly did anything!” So they wrote the old man a note saying, “Please send us an itemized bill.”

Slide 41:

The man sent a bill that read: Tapping with a hammer ………………… $             2.00 Knowing where to tap ………………………. $       9998.00 Effort is important, but knowing where to make an effort in your life makes all the difference.

Take home message :

Take home message misconception is a challenge in mental health Lists the priorities of the Helsinki Declaration Lists the challenges on Roles and Responsibilities Explain Challenges in Providing Care within Psychiatric Wards Describe the challenges in Improving Psychiatric Care Explain the challenges related to Role of mental health nurses Describe the challenges related to Lack of clinical guidelines Explain the challenges in Creating international network of mental health nurses Explain the challenges in Recovery-Focused care Describe the challenges in Values-based education

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