Group Therapy Ideas - page 2

by Delz

53,022 Views | 16 Comments

Hi I'm new in the area of psych and the ward I work on runs regular group therapy sessions. I'm just wondering if other nurses who work in the area would mind sharing what type of group sessions they run within their work... Read More


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    FAQ’s About Psychiatric Nursing

    What do psychiatric nurses do?
    The clinical practice of Psychiatric-Mental Health Nursing occurs at two levels :Basic and Advanced. At the basic level, registered nurses work with individuals, families, groups and communities, assessing mental health needs, developing a nursing diagnosis and a plan of nursing care, implementing the plan and finally evaluating the nursing care. Basic level nursing practice is characterized by interventions that promote and foster health and mental health, assist clients to regain or improve their coping skills or abilities, and prevent further disability.

    In working with psychiatric clients or patients, basic level nurses assist then with self care, administer and monitor psychobiologic treatment regimens, teach about health and mental health individually or in groups, including psycho-education. Basic level nurses are also prepared to assist with crisis intervention, counseling and work as case managers.

    Advanced Practice Registered Nurses (APRN) have a Master’s degree in psychiatric-mental health nursing and assume the role of either Clinical Nurse Specialist or Nurse Practitioner. Psychiatric-Mental Health Nursing (PMHN) is considered a “Specialty” in nursing. Specialty practice is part of the course work in a Master’s Degree Program. In addition to the functions performed at the basic level, APRN’s assess, diagnose, and treat individuals or families with psychiatric problems/disorders or the potential for such disorders. They provide a full range of primary mental health care services to individuals, families, groups and communities, function as psychotherapists, educators, consultants, advanced case managers, and administrators. In many states, APRN’s have the authority to prescribe medications. Qualified to practice independently, Psychiatric-Mental Health APRN’s offer direct care services in a variety of settings: Mental Health Centers, community mental health programs, homes, offices, HMOs, etc.

    Because of their broad background in both the biological, including pharmacological, sciences as well as the behavioral sciences, APRNs in PMHN are a rich resource as providers of psychiatric-mental health services and are advocates of and partners with the consumers of their services.

    Psychiatric Nurses who earn doctoral degrees (PhD, DNSc, EdD) often are found teaching, doing research, or as administrators in hospitals, agencies or schools of nursing.
    http://www.apna.org/faq/aboutnursing.html

    The above is from the APNA (American Psychiatric Nurses Association) website. The ANA standards of practice also delineate psychotherapy as an advanced practice role (graduate-prepared), and psychoeducation as a generalist role, but, since the ANA sells the standards of practice booklets for all the specialties, I can't find a website I can copy and paste the actual language from (plenty of websites where you can order the booklet, though! ). The standards are not legally binding, of course, and people can choose to ignore them ...

    Most of us in the therapy biz consider "process group" to be a synonym for group psychotherapy (as opposed to psychoeducation groups, which, as CliveUK points out (thank you, CliveUK! ), are probably a lot more pertinent and helpful for inpatients).
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    Quote from Hukilau
    5) I would like to see the reference that says group therapy is beyond the scope of practice of nurses. I've never seen it.
    I would like to see the reference that says brain surgery is beyond the scope of practice of nurses. I've never seen it, and yet it is generally accepted that it is, and nobody would be advocating nurses just having a rummage around in someone's cranium, but calling it something other than brain surgery so it's OK.

    It's my personal opinion that sitting round in a large group with a bunch of acutely ill people all experiencing wildly different things and "talking about feelings" is highly inappropriate. I fail to see how this helps patients.
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    Quote from elkpark
    http://www.apna.org/faq/aboutnursing.html

    The above is from the APNA (American Psychiatric Nurses Association) website. The ANA standards of practice also delineate psychotherapy as an advanced practice role (graduate-prepared), and psychoeducation as a generalist role, but, since the ANA sells the standards of practice booklets for all the specialties, I can't find a website I can copy and paste the actual language from (plenty of websites where you can order the booklet, though! ). The standards are not legally binding, of course, and people can choose to ignore them ...

    Most of us in the therapy biz consider "process group" to be a synonym for group psychotherapy (as opposed to psychoeducation groups, which, as CliveUK points out (thank you, CliveUK! ), are probably a lot more pertinent and helpful for inpatients).
    "Basic level nursing practice is characterized by interventions that promote and foster health and mental health, assist clients to regain or improve their coping skills or abilities, and prevent further disability."

    If you read my original response in this thread, I suggested that didactic "education" groups might be the best way to go. Then I gave some suggestions about how to start learning something a little more complex.
    I have always felt that staff who do not feel comfortable leading process groups should not do them, but the idea that there is some magical barrier that prevents line staff from learning how to be effective group leaders is absurd.
    One of the interesting things I have learned working in psychiatric units in many states across the USA is that in some units where people are used to doing things a certain way, they can't be convinced that any other way won't be catastrophic. It is unfortunate because this rigid, dogmatic thinking tends to squelch creativity in new staff members who want to stretch their knowledge.
    I don't expect to convince any of you who are set in your thinking about this subject, but I hope that perhaps people new in the field might learn, as I did on my very first psych unit, that you can reach beyond the limitations of those around you.
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    Your reply assumes that process groups are effective for acutely-ill patients. I have yet to see any evidence that this is the case.
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    Quote from CliveUK
    Your reply assumes that process groups are effective for acutely-ill patients. I have yet to see any evidence that this is the case.
    As I said, if you haven't seen it I don't expect you to believe it, but that doesn't mean it isn't so.
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    Is there published evidence Hukilau - do you have a reference?
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    Well, this debate can go on forever, depending on your leaning. Let me tell you first about my training and experience, then my opinion. I have a masters in both mental health nursing and in counseling. I've worked in outpt and inpt psych, partial hosp, individual and group therapy, acute and chronic psych. "Counselor or counseling" as a title is a protected title in some states like RN, were in others it is not. Know your state. Therapy or therapist is a general catch all title that is not protected and is ok to use. Now, what kind of groups are appropriate. In acute inpt psych, psychoeducational groups are the most appropriate due to acuity of symptoms and short length of stays. Partial hospitalization groups, sort of like a step down from inpt units, have a little bit more luxury to add in more process oriented groups due to the acuity of symptoms being less (hopefully) and generally a longer length of stay provided. Outpt groups can be as varied as the rainbow. Some outpt groups are single focus with one agenda, often educational. Some are open (allowing anyone in who is interested in) and some are closed ( being accepted after an interview, meeting certain admittance criteria that best serves that group). Some outpt groups are short term and have a limited number of sessions and some are open ended till the group as a whole decides to terminate. Some are solely support groups where members bring any thing and everything to the table. Group leaders in the community are just as varied. Many community support groups have non-professionals leading the group. Others are led by acknowledged professionals in the field. Some group leaders take an active, dominant role where other groups the opposite is true. The goal of group depends on what setting you are in, the topic that is agreed upon, the amount of time you have, the type of patients/members that are included, and who is leading it. Now, my opinion. Effective groups are structured, everyone knows what is expected from beginning to end. Each member of the group is provided time and encouraged to participate in order to get the maximum benefit. The group leader structures the group "with" the group regarding ground rules or guidelines for that group in order to keep it a safe and productive environment. The group leader models the expected behavior, appropriate feedback and the cultural norm for the group. Now, regarding psych nurses being group leaders in treatment groups. Some are born group leaders in this type of milieu and some are not (and get way over their heads). In general, I would have to say that the Masters prepared nurse is probably the most adequately prepared nurse because they have had more training in this than the generalist. I do not recommend a generalist nurse just jumping in, doing a group beyond a typical psychoeducational one, without any type of preparation or training. The dynamics (or "the beast" as I've called it ) of a (psycho)therapy group can easily get out of hand for a generalist. People can walk out of a group HARMED if inappropriately managed. In fact, many outpt settings require a Masters just that for that reason. I hope this answers some of your question.
    Last edit by Thunderwolf on Oct 12, '04


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