Advance Psychiatric Nurse

The Advance Psychiatric Nurse also known as Mental Health Nurse is a graduate who provides comprehensive mental health care to the patients suffering from mental illness, psychiatric disorders, or substance abuse problem. Their main role is the provision of mental health care services in clinical settings. They are specially trained in physical assessment, diagnosis, and continuous management of patient.

The advanced psychiatric nurse can be a Nurse Practitioner or Clinical Nurse Specialist or both. In case of Psychiatric Mental Health Nurse Practitioner (PMHNP), focus is on diagnosis of psychiatric condition, including differential diagnosis of medical disorders, which may be present along with psychiatric symptoms, and on medication treatment for such disorders. Psychiatric Mental Health Clinical Nurse Specialists (PMHCNS) focuses not only on psychotherapy but also on leadership skills, education, and training of the staff, development program and on improvement of quality.

In 1947, for the first time, eight programs were introduced, to develop advance nurses, to deal with psychiatric patients. In 1954, Hildegard Peplau developed the first masters program in clinical nursing along with Sullivanian framework for practice of psychotherapy. The certification for the specialty of (PMHCNS) began in 1979 by American Nurses’ Association (ANA). In 2003, American Nurses Credentialing Center (ANCC) granted certification to PMHNP (Wheeler, 2007). The role of advanced psychiatric practice nurses as psychotherapist is not new but their prescribing role is recently established in the course of evolution of this discipline. (Bailey, 1999)

The educational requirements for becoming Advanced Psychiatric Nurse include four-year college degree first. This will result in obtaining the degree of Bachelors of Science of Nursing (BSN). The candidate then applies for license from state to practice as registered nurse. After which the candidate may apply for Masters Degree advanced nursing education program to become advance psychiatric nurse. After supervised postmaster’s clinical practice, they can get certification of specialty in child, adolescent or adult psychiatric mental health nursing (Nursesource.org, 2009).

The advanced psychiatric nurse may work in various settings, which includes inpatient psychiatry, outpatient mental health services, emergency psychiatry and psychiatric consult or liaison services. Advance practice psychiatric nurses may even get certification in sub specialties of adult, child, adolescent, geriatric, forensic, substance abuse, consult, or liaison etc through ANCC and other sub specialty organizations. Many theories, nursing as well as non-nursing, are being presented which provides support for the advanced psychiatric nurse practitioner’s role. Some of them are discussed below.

Hildegard Peplau, also known as mother of psychiatric nursing contributed enormously to the field of nursing particularly through her contributions to psychiatric nursing. In 1952, she presented theory of interpersonal relations that emphasized the significance for a nurse to develop interpersonal relationship with her patients. The theory emphasizes the importance of the ability of nurse to understand her own behavior, to assist others to recognize their difficulties.

In her theory, she discusses four phases, which help in development of interpersonal relationship with patients. These four phases include orientation, identification, exploitation, and resolution (Tomey, 2005). Peplau also gave six nursing roles, which are stranger, resource person, teacher, leader surrogate, and counselor. Moreover, she also proposed four psychobiological experiences, which are needs, frustrations, conflicts, and anxieties that may induce either constructive or destructive outcomes (Tomey, 2005).

There are many non-nursing theories also which supports the role of psychiatric nurse practitioner. Physiologic theory of Harry Helson is one of them. In this theory, Helson presented concept of adaptation and considered it as a way to respond positively to environmental changes. Focal, contextual, and residual are three kinds of stimuli that are proposed by him in his theory. Roy’ adaptation model is influenced by the theory of Helson in which she tried to derive the concept of adaptation in situation of health and illness (Meyers, 2008). Roy’s model discusses about goals of action, which in case of nursing, is to promote and support the adaptation of patient, which may include assessment and intervention for the promotion of adaptation. In the intervention mode, patient’s response potential is changed which promotes adaptation (Meleis, 2006).

Johnson Behavioral System (JBS) Model also sheds light over the role a nurse should play and supports the role of a psychiatric nurse. Dorothy E. Johnson presented this model in 1980. She views the human as bio-psycho-social being, represented in behavioral system, which in turn consists of seven behavioral subsystems. These behavioral subsystems include achievement, affiliative, protective, ingestive, dependency, eliminative and sexual. The effective functioning of these subsystems is necessary to achieve behavior balance so that human can cope with the demanding life. The maintenance of the integrity of this behavioral subsystem’s functions, regaining, and restoration after patient’s illness is the prime objective and must be carried out by a nurse (Parker, 1993). The same role is applicable to mental health nurse also who can do this in much-specialized manner as she is well trained in this regard.

The Johnson Behavioral system can be used as a conceptual framework in clinical setting. When this system was used, for psychological need assessment of visually impaired children for practice of nursing, it served as a tool for the implementation of process of nursing keeping in view the feelings, needs, and desires of the children (Fruehwirth, 1989).

Many studies are carried out in the field of advanced psychiatric nursing, which are helping to strengthen the field based on outcome. One of them is a study, which is trying to delineate the role of psychiatric nurse practitioner versus clinical nurse specialist, along with crediting the role of psychiatric nurse in continually treating patients with anxiety disorders, depression, and other psychiatric disorders. The debate concludes with projecting and proposing a merged role model of a nurse (McCabe, 1999).

Studies are also being carried out to improve the curriculum of psychiatric nursing. The redesigning of an objective-based curriculum to a competency-based curriculum was carried out by the psychiatric mental health nurse practitioner (PMHNP) Program faculty at Oregon Health and Science University School of Nursing. They encountered benefits by implementing the new curriculum and are trying to promote development of better practices (LeCuyer, 2009).

Research and studies to find out the constraints of advanced psychiatric nursing practice are also carried out. For this purpose, certified psychiatric clinical nurse specialist took part in a survey. The findings obtained consisted of eight themes, which shed light upon barriers and constraints to advanced practice. These themes are reimbursement, privileges of admission, authority of prescription, bureaucracy, environment of practice, image, colleagues, and personal. These themes demanded individual and organizational action strategies (Howard, 1997).

More researches are required in future regarding the role of advanced psychiatric nursing. Several gaps exist in the current knowledge, which is not filled by the existing studies. Follow-up studies and replica studies are hardly ever done. Scientific and systematic studies are required to develop solid scientific basis for the field of nursing in general and psychiatric nursing in particular rather then depending on trial and error practices.

High priority issues should be researched first where advanced psychiatric nurses can be of value. More emphasis should be over areas, which lead to the improvement of care to the groups at high risk, health-promoting interventions, also from the point of view of consumer and upgrading of curriculum and evaluation systems. In addition, the needs of the clients must be known, so that planning of training and resources can be done effectively.

In today’s world, the concept of a nurse has changed dramatically and nurse practitioners are found providing their services in virtually every field including psychiatry. The nurse practitioners are starting independent practices also. In face of increasing demand, the nurses, specially advanced psychiatric nurse practitioners are getting more opportunities and their outlook in future is optimistic.

References

Bailey, K. (1999). “Framework for prescriptive practice.” Advanced practice nursing in psychiatric and mental health care. New York, Mosby.

Fruehwirth, S. E. (1989). “An application of Johnson’s behavioral model: a case study.” Journal of community health nursing, 6 (2), pp. 61-71.

Howard, P. (1997). Constraints to advanced psychiatric-mental health nursing practice. Archives of Psychiatric nursing, 11 (4), pp. 198-209.

LeCuyer, E. (2009). “From objectives to competencies: operationalizing the NONPF PMHNP competencies for use in a graduate curriculum.” Archives of psychiatric nursing, 23 (3), pp. 185-199.

McCabe, S. (1999). “Psychiatric nurse practitioner versus clinical nurse specialist: Moving from debate to action on the future of advanced psychiatric nursing.” Archives of Psychiatric nursing, 13 (3), pp. 111-116.

Meleis, A. (2006). Theoretical Nursing: Development and Progress. Philadelphia, Lippincott Williams.

Meyers, K. (2008, Aug. 22). In The Roy Adaptation Model. Retrieved Aug. 3, 2009, from http://www2.bc.edu/~royca/htm/ram.htm

Nursesource.org, (2009). In Nurses for healthier tomorrow. (Chap. Psychiatric-mental health nurse) Retrieved Aug. 3, 2009, from http://www.nursesource.org/psychiatric.html

Parker, M. (1993). Patterns of Nursing Theories in Practice (National League for Nursing Series (All Nln Titles). New York, Jones.

Tomey, A. (2005). Nursing Theorists and Their Work. Missouri, Mosby.

Wheeler, K. (2007). Psychotherapy for the Advanced Practice Psychiatric Nurse. Missouri, Elsevier Health Sciences.