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Topics About 'Mental Illness'.

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  1. Overview Psychiatric nursing, also known as Mental-Health nursing, is the provision of nursing care to patients with mental illnesses. Mental illness is a wide range of medical conditions that affect mood, thinking, and behavior. These conditions often result in a detrimental effect on a person's daily functioning. Examples of Mental Illnesses (not all-inclusive) The schizophrenias Depression Anxiety disorders Bipolar disorder Substance dependence and other addictions Post-traumatic stress disorders Personality disorders The Stigma Unfortunately, mental illness is still stigmatized in society, with illnesses and those suffering from them often seen in a negative light. Patients are viewed in terms of stereotypes: the maniac, the neurotic, the sad one. Or patients are viewed in terms of their illness: the borderline, the bipolar, the schizo. Terms such as "crazy", "cuckoo" and "lunatic" are readily used to describe psych patients. If someone shares that they are on a psychotropic medication, others question if they are truly stable, or they see the person in terms of liability. These patients are seen as being untreatable and incurable, destined to be dependent on hospitalization and/or medications forever. In addition, mental illnesses often do not display physical signs or symptoms, and so some may discount mental illness as not being significant. Patients who try to reach out for help are brushed off with, "it's all in your head; suck it up and get over it" or other useless tidbits of advice. The stigma crosses over to psychiatric nursing as well. Psychiatric nurses are not seen as the life-savers that nurses in other specialties may be viewed as. Instead, psych nurses are seen as pill pushers who are quick to restrain a patient or give an injection for any real or imagined infraction. They may be seen as being "as crazy as their patients are." Psych nursing is seen as the specialty for nurses who couldn't hack it in other specialties. Or it's the specialty for nurses who want to "take it easy", yet psychiatric nursing is seen as being very violent. And of course, the rumor is that once you're in psychiatric nursing, you will lose all of your nursing skills and be stuck there forever. Inaccurate Portrayals It does not help that the media tends to portray psych and its patients in a negative (and often not quite accurate) light. The term "psych nurse" conjures up Nurse Ratched as its poster child. Movies frequently show psychiatric hospitals as part prison, part torture-chamber; its staff is portrayed as barbaric, if not sadistic individuals. In fact, psychiatric hospitals are a frequent setting for many horror movies. Television shows use mental illness as the catalyst for a character's violent behavior, such as the veteran going on a homicidal rampage due to his PTSD. We see and read news reports about a suspect who recently admitted to depression, insinuating that this was the trigger for the criminal actions. And, very often, movies and television may use mental illnesses for a comic effect instead. The Reality The reality of mental illness and psychiatric nursing is very different. The best way to describe psychiatric patients is like this: whenever nursing students come to do clinicals on my unit, one of the first things they will say to me is that most of the patients look so "normal". And to that I reply, "they ARE normal. Most are just regular people experiencing a psychiatric crisis and need help." It is true that there are very acute and unstable patient populations out there, but the reality is that many psychiatric patients are not that much different than you or I. Psychiatric facilities are not that much different than other hospital facilities, though there are extra precautions taken to ensure the safety of patients and staff. As far as psychiatric nursing practice goes, while medications are one major nursing intervention, they are not the only nursing intervention. Psychiatric nurses do perform physical assessments and interventions. Psychiatric nurses may not use skills such as Foleys and IV placements as often as their non-psychiatric nursing counterparts. Instead, psychiatric nurses develop a different skill set where therapeutic communication and relationship building are key, and a nurse who fails to develop this skillset will struggle. While the tight job market may make this more difficult to do, nurses have been able to transition out of psych into other specialties. Psychiatric nursing does have a higher risk of violence than you would find on a regular hospital unit. However, nursing and clinical staff are trained in de-escalation and crisis intervention, with the end result of heading off many situations before they get out of control. Measures such as seclusion (chemical or physical restraint) are not used with abandon, but only as a last resort. In addition, many patients in non-psych units/settings often have concurrent psychiatric disorders so essentially, you will find psych patients anywhere and everywhere. Mental illness does not discriminate based on age, race, gender or income level; psychiatric patients can be anyone. Duties (not all-inclusive) Utilize therapeutic communication Conduct comprehensive initial clinical assessment Rapid on-going assessment; recognize deviations from initial presentation Provide safe environment Develop nursing diagnoses and plans of care Administer medication Provide patient education Advanced practice psychiatric nurses provide primary care mental health services such as diagnosis and psychotherapy treatment including prescription of medication. Psychiatric patients frequently have medical comorbidities such as diabetes, hypertension, or hepatitis. While the focus is on the psychiatric illness presentation, psychiatric nurses cannot neglect the patient's medical conditions and must provide nursing care for them as well. Practice Settings Freestanding psychiatric hospitals Psychiatric units within medical hospitals Partial hospitalization/outpatient facilities Community settings Clinics Private practices Home health Correctional facilities Out-patient education Research facilities Subspecialties (not all-inclusive) Geropsych Child and adolescent psych Chemical dependency and rehab Addictions Emergency psych Electroconvulsive therapy (ECT) Forensic psychiatric nursing Professional Organizations The American Psychiatric Nurses Association (APNA) is the, "largest professional membership organization committed to the practice of psychiatric-mental health (PMH) nursing and wellness promotion, prevention of mental health problems, and the care and treatment of persons with psychiatric disorders". The mission of the International Society of Psychiatric-Mental Health Nurses (ISPN) is, "to support advanced-practice psychiatric-mental health nurses in promoting mental health care, literacy, and policy worldwide". There are also professional organizations for several subspecialties in psychiatric nursing such as advanced practice psych nursing, child and adolescent psych nursing and addictions nursing as well as individual U.S. state organizations. Education Graduate from an accredited RN (Registered Nurse) nursing program (Diploma, ADN, BSN, MSN) or LPN/LVN (Licensed Practical/Vocational Nurse) nursing program (Diploma, Certificate, Degree) Successfully pass the NCLEX-RN or NCLEX-PN examination Current, unencumbered U.S. license as an RN or LPN/LVN To become an Advanced Practice Psychiatric Nurse, the individual will need to graduate from an accredited master's or doctoral program with an emphasis in psychiatric-mental health nursing. Licensed Psychiatric/Mental Health Nurse Practitioners sit for the certification examination and are certified by the American Nurses Credentialing Center (ANCC) as required by their individual Boards of Nursing (BON) in the U.S. state of practice. Certifications (ANCC) 1 - Registered Nurse (RN): Psychiatric-Mental Health Nursing Certification (RN-BC) The Accreditation Board for Specialty Nursing Certification (ABSNC) accredits this ANCC certification for the RN. This examination is offered to the RN who meets eligibility requirements. Eligibility (not all-inclusive) Current, unencumbered RN* license in state or territory of the U.S. Practiced the equivalent of 2 years full-time as an RN Minimum 2,000 hours clinical practice in psychiatric–mental health nursing within last 3 years Completed 30 hours continuing education in psychiatric–mental health nursing within last 3 years *Note: Certification is not offered to the LPN/LVN 2 - Nurse Practitioner (NP): Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC) The ABSNC also accredits this ANCC certification for the NP. This examination is offered to the NP who meets eligibility requirements. Eligibility* (not all-inclusive) Current, unencumbered RN license in state or territory of the U.S. or hold the professional, legally recognized equivalent in another country Hold a master's, post-graduate, or doctoral degree from accredited psychiatric-mental health NP Program (minimum 500 faculty-supervised clinical hours must be included in the program) *see ANCC's eligibility requirements for complete information Other Certifications Pediatric Nursing Certification Board (PNCB): Pediatric Primary Care Mental Health Specialist (PMHS) certification for the Advanced Practice Registered Nurse (APRN)* Eligibility** (not all-inclusive) Current, unencumbered APRN license in U.S. state of practice Current Certification (one of the following): Primary Care Pediatric Nurse Practitioner Family Nurse Practitioner Child/Adolescent Psychiatric & Mental Health CNS Psychiatric-Mental Health NP Clinical practice hours completed within past 5 years Minimum 2,000 hours pediatric developmental, behavioral, and mental health clinical practice experience while holding APRN license Education or CE completed within the past 5 years Either 30 hours of DBMH CE or 1 graduate level DBMH course of at least 2 credits *Note: The PMHS certification does not replace primary APRN certification required for licensure **see PNCB's eligibility requirements for complete information Salary (2020) RN - According to salary.com, the salary is $76,277 and falls between $69,754 and $86,111. NP - According to salary.com, the salary is $107,390 and falls between $95,990 and $117,800.
  2. xwill327

    Interview with the Psych Nurse

    It’s great when a psych nurse can be empathetic to their patients from the education they received in nursing school combined with previous patients they have cared for. I believe they can give even better care when they had experienced it first hand. Countless times patients have yelled at me, “you have no idea what I am going through.” My one colleague has experienced being admitted to an inpatient psychiatric unit. I wanted to understand her experiences and how it impacted her career as a Registered Nurse in Psychiatry. We worked together and I was immediately drawn to her passion for the field of psych nursing and just her as a person. We became close and were able to share stories about work and eventually our life struggles. We disclosed personal experiences with each other. Not only was she a runway model (super cool), but she also struggled with an eating disorder and mental illness. To my surprise, she had been admitted to an inpatient psych unit. I had always wondered what it would be like to be the patient. Here are some views of the psych nurse as the patient: Has anything on the job ever triggered you from personal experiences? My first week on the floor, I was called to a behavioral health crisis on the medical floor: essentially meaning a medical admission lost their mind… I was called in to help restrain an anorexic patient who was refusing treatment. She was not a danger to herself or others and restraining her would go against my ethics, as well as, and more importantly, it was against the law. I did nothing though! I just stood there, watching her be tied down so they could enforce the treatment that she had refused. All I could think of was, “what if I had been restrained for my anorexia turning my hospital stays.” It would have been nothing less than scarring. That thought repeated in my mind as I remembered back to a time when I still denied my emotional disturbances, just as that girl was as she screamed she was fine. Since then I have learned to be an ally to ED (emotionally disturbed) patients, as I know the world of medicine as a whole for the most part avoids them like the plague! How do you feel when you know you helped someone who had a similar issue as you? I will always think back to this one patient in particular who I will refer to as K. If I can think back to someone I feel I helped, it would be her. I was placed on a one-to-one with her following her attempt to hurl herself through the glass window in her room. She was placed on a suicide watch one-to-one which meant one person watching K. Usually this job is given to a PCA (patient care assistant) or a Behavioral Health Tech. However, we were short staffed that evening so as charge nurse I took the role. I had to be within arm distance of her at all times. To say the least, K. was not having me when I entered the room. My close proximity only bothered her more. Despite her attempts to avoid even eye contact I continued my attempts to make conversation. After my relentless conversation prompts, she began to engage with me. We began to joke and she laughed with me. I stayed with her for nearly three hours that evening. The next day K. approached me and said, “I think I get what you were talking about with good things still having a bad side and bad things having a good, like last night, bad-I tried to jump out a window, good- we got to talk and have fun.” My heart sunk and it remains the largest thank you of my career. I am not out to save the world; that would only be a disappointing pursuit. But, if I can help a suicidal patient laugh for a couple hours, I cannot go home with my head hanging down. What is your take on the inpatient experience? Is it beneficial? How would you change it? I don't know if you meant my personal stay in the psych ward or my time working in them. Seeing that I have now experienced both I can say that after my 4th stay I stopped attempting to make light and accepted I would do anything for them never to have happened. Despite this speaking in terms of my work they each had enormous importance. My first stay at 18yrs I learned how to relate to the fear that comes with admission and of its great unknown. My second, I learned the shame that comes along with it and the anger when you have to be admitted against your will. My third stay was due to a head trauma, not psych symptoms, I was placed in the ward purely because of my history. There, as I came back to reality from the two cracks in my skull, I found out what is was like to lose your voice to your overshadowing past. My fourth stay I went in attempting to get ECT, which I was denied. Already a psych nurse at the time, I had far more insight into the world of outpatient but not inpatient. I learned about the frustration in delaying the discharge process. Only because of my further protest did my 72 hour letter not continue to stretch in time. Most patients don't know their rights: such as a 72hr letter to demand discharge. Are you open with your coworkers on your background or remain private? I remain more than private. I was having vicious side effects causing me to shake and tremor constantly. I looked like a wreck as well. To explain this I would blame my other and more acceptable meds treating for my epilepsy. At times, I went as far as to claim having other disorders to explain my symptoms away. My anorexic appearance I denoted to marathon training despite not having worked out in a year for fear of increased hunger. I wish I could be more honest with my coworkers but the way they talk about these disorders and how they talk about the patients afflicted… I just cannot imagine them thinking of me that way. How do you strive to break the stigma of mental illness? How can others in your opinion? I strive by simply getting up everyday. I have a fortune I carry in my wallet that has the quote, “Heroism is the endurance for one more moment more,” which is far easier said than done. It was only recently that I have admitted to myself I am in fact disabled by my disorders. Despite being crippled by them my unwillingness to let them win as well as at times pure denial of them… has allowed me to achieve both personal and professional success even when it seemed everyone else assumed I would fail. How others can break the stigma is to talk about it. If there were simply more numbers of people talking about their disorders, I truly believe even more would come forward and the rest of the world might not be so uncomfortable. Thank you to my colleague and cheers all!
  3. I'm in my psych clinical and each of the students need to lead a group activity for the patients. One student did stress bingo, meditation, drawing, talking about fears, exercise. it's my time to lead soon and I have a few ideas but I'm worried they won't like it. I thought about doing collages with magazines (but not sure if we can have scissors), decorating picture frames. What are some good ideas?