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Job Role Within Mental Health Nursing

Job Role Within Mental Health Nursing

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Introduction

Mental health nurses are experts who play critical roles in health care, including the assessment, diagnosis, and treatment of mental and psychiatric disorders. The nurses are part of an interdisciplinary treatment team that has the responsibility to offer person-centred medical care for the client. The professionals usually evaluate the mental health needs of patients and coordinate care with physicians, families, and other caregivers (American Psychiatric Nurses Association, APNA 2016). The National Health Service (NHS) published a five-year forward plan in 2014, which is a strategic plan that seeks to transform the care that people receive for their mental health. There has been a considerable amount of change within mental health services. There are more community-based support alternatives instead, of hospital provision (NHS, 2014).  General Practitioners, nurses, and other specialists will join together to provide integrated out-of-hospital care. This will be known as the ‘multispecialty community provider’ team. Further to this primary and acute care will come together for the first time. For this to be possible more funding will be provided.

The plan targeted people of all ages with wide-ranging individual needs. It recognises that mental health needs cannot be solely dealt with by the NHS, and professionals need to work in partnership with other agencies, to achieve positive outcomes. The plan sets 12 areas for the plan to be implemented at both local and national objectives. These include children’s and young people’s mental health, adult mental health, within secure care, and suicide prevention. Local policies will need to reflect the national plan for the objectives to be met (NHS, 2014). The purpose of this report is to discuss the role of the community mental health nurse, the rationale for choosing this role, what is needed for me to achieve this role, contemporary issues relating to the role, and critique current literature.

The Rationale for Looking At This Role

After completing a placement within the community mental health team, as part of my Mental Health Nursing degree, I was determined to make this my goal for the future. Both my mentor and the wider team inspired me to realize my desired goal, with their never-ending diligence and dedication they showed towards their patients and the nursing profession, which were underpinned by nursing values. I was able to learn how patient-centred care worked in practice and delivering holistic care is paramount for recovery (NICE 2016). In regard to personal and professional development, the placement within a community mental health team improved my professional competencies. For instance, as a community mental health nurse, I worked with an interdisciplinary team, including social workers, psychiatrists, carers, and physicians, and such kind of collaboration was based on effective communication. The topic is important because it has played a major role in helping me develop appropriate skills and knowledge via experience needed to meet the evolving health and medical needs of the affected population.

Topic of Interest

Community mental health nurses practice is important to me because it comprises a wide range of behavioural health care settings, such as community mental health centres, group homes for individuals with mental retardation, detoxification centres, and residential substance abuse treatment programs (Kudless & White, 2007). Thus, working as a Community mental health nurse is a topic of interest because it revolves around working with people with mental conditions with the intent to improve their wellbeing.  Moreover, emphasis is required because the population cared for has continued to grow as well as their care needs. As the population ages and comorbid conditions also rise, various skills may be required accompanied by different roles in order to take care of this population (Kudless & White, 2007).  Mental health jobs, especially community mental health nursing are complex because the nurses have to work with all sectors of society, and in most cases manage their own caseload within a particular team.

The roles played by community mental health nurses are complex and numerous. As established by Huang, Ma, Shih, and Li (2008) there are fourteen nursing roles of community mental health nurses: “assessor, supporter, educator, consultant, counsellor, negotiator, harmoniser, collaborator, advocate, placement coordinator, resource provider, care provider, case manager, and case finder”(p. 666). In this context, the topic is of importance because community mental health nurses are involved in caring for people with mental health issues, whereby some of them have been listed while others have never been established.  Community mental health nursing is a rewarding career, which has the capability to offer a variety of working environments. Moreover, community mental health nurses have the responsibility to attempt to prevent avoidable hospital admissions through the treatment of people prior to the need for hospital care. Thus, community mental health nurses help to ensure that persons diagnosed with mental illnesses such as dementia or schizophrenia can easily manage their care at home after they have been discharged from the hospital.

The National Health Service

The NHS has delivered care for over 64 years, and the government believes that health care should remain free and accessible to everyone in the future. They also acknowledge that the NHS delivers world-class care, seeks to reduce inequalities in care, and is a transparent fair system of care. For this to continue the government states that it will spend more money each year to maintain the high standards of care that are provided by the NHS. Furthermore, the core ethos of the NHS is the patient, meaning that the patient is at the centre of their care. This might involve providing information to the patient so that they feel in control and that they are better informed about the choices they have in what organisation delivers their care. It is important that the integrity of the NHS is upheld. Liberating the NHS (DOH, 2010) details how people are living longer, and consequently, patients need advice on how to live healthier and be reassured that if things do go wrong with their health, they will be safe and be fully informed with ongoing support. Furthermore, this needs to be undertaken through multi-disciplinary partnerships. The government wants the patients to be involved with what works best for them, as listening to people’s views on their care is paramount for quality care to continue.

Critical Review of Literature Related To Area

Literature Search

A literature search was undertaken to examine job roles within mental health nursing, especially the responsibilities of community mental health nurses. The literature review was based on secondary sources gathered from ProQuest, Google Scholar, books, and relevant government reports and websites related to mental illness. The following search terms were included in the search: Mental Illness in the UK, Role of Community Mental Health Nurses, Approaches to Mental Health, Rationale for studying Mental Illness, Community Mental Health Nurse and History, Patient centred Care in Mental Health, and educational and Skill Requirement for Community Mental Health Nurses.

The search of the materials was limited to research currently published and in English. Nonetheless, studies published before 2010 were only used to provide adequate knowledge related to the history of community mental illness. All non-English articles published before and after 2010 were excluded. After the literature search, the student read them in order to remove all relevant articles. Then, the student skimmed the articles paying attention to the purpose, findings, and how they related to mental illness. An examination was also conducted via reading the articles and books to have a better understanding of the research and how they related to the topic for better analysis. An analysis of the literature examined was carried out to provide a better understanding of the area of study.

Role of the Specialist Nurse to Meet Level 6 Criteria

Over the last three decades, there has been a major transformation in services, which has seen people being moved out of institutions and cared for in community settings. In the early 1950s, a hospital in Croydon was one of the first hospitals to introduce nurses into the community specifically to treat patients with schizophrenia (Gournay (2000). It was not until many years later that major changes were seen. The Mental Health Act of 1983, introduced a Community Treatment Order (CTO) in 2008, thus allowing people to be treated in their own homes, this order was compulsory and posed conditions, which meant that if the patient was, not complying with the treatment then they would have to return to hospital (Gilbert & Plant, 2010).

A community nurse can offer support in various ways from motoring medication, discussing thoughts and feelings, and assessing presentation. Visiting someone in their own home can offer a relaxing non-clinical setting which allows a therapeutic trusting relationship (Huang et al., 2008; Royal College of Psychiatrists, 2017). According to the APNA (2016), “it is the responsibility of the community mental health team to try to prevent unnecessary hospital admissions by treating people before they require hospital care, or to manage their care as they are discharged from hospital” (p. 1). Thus, the community mental health nurses are responsible for the diagnosis and treatment of mental illness as well as ensuring that the care provided is effective and the patient can self-manage the treatment.

Under Level 6 criteria, the knowledge of the specialist is acquired across a wide range of work procedures and practices that are underpinned by relevant practical experience or theoretical knowledge. The role of community mental health nurses to meet level 6 criteria is to work with other professionals to achieve the necessary knowledge. For instance, in order to achieve person-centred care for mental illness, the approach must be practised by all members of the nursing team. A shared philosophy is required whereby person-centred behaviour is prioritised with patients and people who are important to them (Gee, Scott, & Croucher, 2012). For a shared philosophy to be achieved, an effective workplace culture and person-centred systems have to be put into place. An effective workplace culture ensures that a nurse is able to gain the necessary skills and experience required to promote the care and well-being of persons with mental illness.

According to the National Panel for Psychiatric-Mental Health NP Competencies (2003), “psychiatric-mental health nurse practitioner is educationally prepared to provide the full range of psychiatric services, including the delivery of primary mental health care services, as delineated in the competencies” (p. 3). Also, psychiatric-mental health nurse practitioners are required to provide services based on their competencies in order to promote the wellbeing of the patients. With the role of providing mental health care services, Community Mental Health Nurses are required to synthesize theoretical, scientific, and clinical knowledge in order to assess and manage both the health and illness states of the patient. The competencies of the Community Mental Health Nurse entail health promotion, disease prevention, health protection, and treatment of patients. Also, it is the role of the Community Mental Health Nurse to offer a personal, collegial, and collaborative approach in order to provide person-patient care. American Nurses Association (2012) noted that mental health nurses have to work within the Standards of Practice in order to meet level six criteria.

Approaches to Mental Illness

At the cutting edge of nursing practice, the roles of mental illness nurses have developed over the years, especially for direct care providers. The advancement has been enhanced by both research and education, and this has resulted in the use of Person Cantered Care for Mental Illness.

Royal College of Nursing (RCN) has pointed out that a person-centred approach is the “cornerstone of meaningful and long-lasting positive behavioural change for people who show challenging behaviour” (RCN, 2010, p. 10).  The model’s primary focus is to assist people with mental health illness to participate in meaningful activities and relationships. Thus, the concept of person centeredness makes sure that care is provided based on the health and social needs of the patient (McCance, McCormack, & Dewing, 2011; Health Innovation Network, 2013). The process of nursing care under the concept of person centeredness is important in mental illness because it allows a Community Mental Health Nurse to provide holistic care, shared decision-making, engagement, and sympathetic presence (McCormack, 2003). Persons with mental illness, especially schizophrenia require person-centred care that emphasizes the individual’s health and social needs of people. Additionally, a Community Mental Health Nurse is required to apply the concept of person-centeredness as the foundation for developing plans and relationships for care required to promote the well-being of the patients (McCance et al., 2011).

Person-centred care, according to Evardsson, Fetherstonhaugh, McAuliffe, Nay, and Chenco (2011) puts emphasis on the person living with dementia or schizophrenia and their preferences and needs, and as a result, it has been referred to as the ‘gold-standard’ for residential care for people with mental illness.  The rationale for person-centred education in mental illness moves beyond imparting knowledge, as it encourages a paradigm shift to person-centred care in practice and attitudes (Gask & Coventry, 2012). Thus, as a Community Mental Health Nurse, the primary role is not to provide medication, but to apply person-centred care, and to get closer to the client by considering the patient’s authenticity and adopting imperfect duties (McCormack, 2003). For example, in order to promote individualized care for the mentally ill person, a Community Mental Health Nurse would be required to perform imperfect duties, such as showing sympathy, respect, benevolence, concern, and compassion to the client. A Community Mental Health Nurse is also required to share information with patients so as to facilitate authentic consciousness. For instance, a Community Mental Health Nurse would be required to involve the patient in decision-making in order to promote individualized care, hence the idea of person-centeredness.

The traditional approach to residential care puts emphasis on achieving tasks that affect the patient directly. A person-centred care is based on four components. First, it requires nurses to value the patients and their carers (Kitson, Marshall. Bassett & Zeitz, 2013). For instance, Community Mental Health Nurses must value the efforts of the carers in residential homes and the patients as well. Second, persons with mental illness, such as those living with dementia as individuals must be respected and an individualised approach applied to asses and meets their needs. The third, person-centred approach requires nurses to treat their patients from the perspective of the person living with mental illness (Kitson et al., 2013; Lawton Rankin &  Elliott 2013). Also, they have to recognize the importance of interactions and relationships with other persons to promote their well-being and recovery (Mason, & Adeshina, 2011). British Medical Association (2010) pointed out that “a person-centered approach, rooted in good communication skills and respectful of each individual’s dignity and independence is likely to lead to optimal outcomes” (p. 12). Thus, the person-centred approach to mental illness is based on good communication skills, independence, and individual’s dignity. As an experienced, Community Mental Health Nurse, good communication skills, supported with respect, independence, and dignity are required to ensure person-centered approach is practiced.

Person-centred planning approach (PCP) is applied by Community Mental Health Nurses when dealing with patients with mental illness. Kennedy, Sanderson, and Wilson (2002) has defined PCP “as ‘the collective term for a variety of techniques used to get to know a person, develop an understanding of that person’s hopes for the present and the future, and to set priorities for change” (p. 12). The use of PCP makes it possible to give patients with mental illness control in order to understand current needs. Kennedy et al (2002) further added that PCP was used to help carers to understand the patients and to balance what is significant to someone. As quoted by Manley, Hills, and Marriot (2011), the Fourth Principle of Nursing Practice, Principle D states that “Nurses and nursing staff provide and promote care that puts people at the centre, involves patients, service users, their families and their carers in decisions, and helps them make informed choices about their treatment and care” (p. 3). Based on this requirement, the Community Mental Health Nurse has the role of ensuring that patients make informed choices in terms of their treatment and care. In this context, the Community Mental Health Nurse makes use of various processes to work with patients’ beliefs and values, engage patients and mental health service users, have a sympathetic presence, a shared decision-making, and accommodate the physical needs of the patients (McCormack & McCance 2010).

Community mental health nurses provide community-based mental health treatment that is available to all patients diagnosed with mental health conditions through respite care facilities, a day centre, and in their own homes (Huang et al., 2008). Thus, a shared approach to decision-making is applicable when providing mental care to patients. Shared decision-making is “A collaborative process through which a health care professional supports a patient to reach a decision about a specific course of action” (Health Foundation, 2014, p. 22).  Therefore, it is a process of decision-making that involves patients with mental illness in order to promote patient-centered care. A shared decision-making allows collaboration between patients, the nurse, family members, and carers in decision-making. A patient-centered care is thus necessary because it “moves beyond the traditional model, in which the healthcare professional is viewed as the expert, to a collaborative relationship, in which the patient or service user is acknowledged as an expert in their condition” (Madsen & Fraser, 2015, p. 51).  For example, in order to promote a quick recovery, community mental illness nurses usually apply person-centered approach which promotes shared decision-making. This is necessary to ensure that patients are comfortable and able to recover easily.

Recommendations for Developing Novels and Innovation within The Speciality

In order to develop novel and innovative mental nursing care and satisfy patients, it is imperative to adopt person-centered care and share decision-making practices. As pointed out by Health Innovation Network (2014), when community mental health nurses offer care in a more person-centred way, it is even possible to improve outcomes for professionals. McMillan et al. (2013) noted that some of the ways used to improve person-centred care approach as such as assisting people to learn more about their conditions, promoting persons to be involved in health consultations, and training professionals to assist care and empower patients. Person-centered care impacts the quality of care and when adopted by community mental health nurses improves satisfaction and confidence, encourages people to be more involved in decision-making, and improves people’s experience in regard to care. Additionally, it is recommended that professionals develop effective communication skills required when dealing with a person with mental illness (Lawton et al., 2013). Working in a team is also recommended in mental illness nursing because Community Mental Health Nurses work in the form of a team. Thus, the nurses must be trained to work effectively in a team that is composed of other disciplines other than nursing in order to improve the quality of life and well-being of others.

In accordance with APNA recommendations, when people work as a team, each member is recommended to have the required skills, competencies, and knowledge required to provide quality care to patients (Manley K et al., 2011). Also, Community Mental Health Nurses are recommended to apply Principle A by focusing on dignity, compassion respect, and human rights in order to provide person-centred care to patients (Jackson & Irwin 2011). This can be achieved through education and work experience through practice. The development of good relationships with colleagues and patients needs team members to possess well-developed communication and interpersonal skills and be self-aware. The possession of such skills enables the Community Mental Health Nurses to know the patient as an individual and allows the interdisciplinary team members to know these insights via better working relationships and effective documentation. In the field of mental nursing knowing a patient is a requirement for nursing expertise and it is recommended to possess such a skill (Hardy, Titchen, McCormack, & Manley, 2009).

Links to Career and Professional Aspects of Role Development

The educational and skill requirements in relation to the role of the Community Mental Health Nurse include a degree in mental nursing accompanied by skills that promote the welfare of other people. Mental health nursing is related to the promotion and support of a person’s recovery and enables them to have more control and involvement over their condition (Huang et al., 2008). As noted by the APNA (2016), the role of a Community Mental Health Nurse is to work in clinics, mental hospitals, and nursing homes to monitor the treatment and medication of patients diagnosed with mental illnesses or distress. Jones (2003) established that mental health nurses are required to train in risk assessment management of violence and aggression, working with people with personality disorders working with persons with a dual diagnosis, psychosocial interventions, working with persons with psychosis, and developing clinical leadership skills. In addition, a Community Mental Health Nurse is required to register with the Nursing and Midwifery Council (NMC) and be cleared by the Disclosure and Barring Service (DBS).

An associate’s degree in nursing (ADN) could be appropriate for a person willing to pursue psychiatric nursing, but also a Master of Science in Nursing (MSN) or Bachelor of Science in Nursing (BSN) with a specialty in psychiatric and mental health nursing could also offer more opportunities for an individual to advance to a community mental health nurse. Courses for psychiatric nursing include clinical pharmacology, child development psychopathology, and family psychotherapy. The nurses must also be ready to work with aggressive, disoriented, or uncooperative patients and meet the physical and emotional demands of the job. This is because people with mental illness require person-centered care and shared decision-making to enable treatment and recovery (Gee et al., 2012; Kitson et al., 2013). In order to offer person-centered care, one must possess skills such as excellent observation skills, communication and listening skills, empathy, assertiveness, and the ability to stay calm and represent the interests of the patients (McCance et al., 2011).

Through the placement and education, I have gained the skills and experience required to qualify as a Community Mental Health Nurse. The experience acquired as part of my Mental Health Nursing degree has played a major because I have learned that holistic care and patient-centered care are important for recovery (McCance et al., 2011; NICE 2016; Gee et al., 2012). Thus, as a Community Mental Health Nurse the course has been positive in terms of developing my communication skills. My mentor showed me the value of being able to reflect on my own practice and how this would help me to develop as a nurse, Nursing Midwifery Council. Jasper (2003) also discusses the benefits of being a reflective practitioner, and how it allows us to be able to learn where are limitations lie, and our strengths and identify areas of knowledge that might need improving. There are various Community teams, which are divided into different specialties; my experience was with the older adult’s team, where predominately the patients had a diagnosis of Alzheimer’s, vascular and front-temporal dementia, and some patients had a diagnosis of schizophrenia. As part of my personal development, I have gained the capability to deal with violence and aggression, work with people with personality disorders, ability to work with persons with a dual diagnosis and promote psychosocial interventions (Jones, 2003).

Conclusion

The primary roles of Community Mental Health Nurses are to undertake assessment, diagnosis, and treatment of mental and psychiatric disorders, in order to ensure recovery and wellbeing of patients. Community mental health nursing practice is crucial because it entails the provision of care at community mental health centers, group homes for individuals with mental retardation, and residential substance abuse treatment programs. Community Mental Health Nurses are required to apply skills such as dignity, compassion respect, and human rights in order to offer person-centred care to patients. Most of the skills are acquired through education and work experience through practice. These skills are important given the complexity of mental illness treatment. With advanced training, Community Mental Health Nurses can help in crisis intervention and also be the leading nurse in family and behavioural therapy sessions. It is recommended for nurses dealing with mentally ill patients to adopt person-centred care because it provides a different paradigm of mentally ill care whereby the person comes first.

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