Re: Last week's column on psychiatric nursingIn last week's Health Supplement Pat O'Brien indicated that psychiatric nurses were trapped in the mentality of asylum- keepers and they possessed few skills which could not be easily replicated with minimal training.
We accept that Mr O'Brien may have had a negative experience with a psychiatric nursing service, but we feel that this in no way represents the status of psychiatric nursing.
The majority of mental health services utilises their psychiatric nurses to the optimum level and most of these professionals operate with a high level of autonomy and practise their skills in a dynamic and efficient fashion, keeping pace with all other members of the multidiscipliary team.
At the Cluain Mhuire Service in Blackrock, Co Dublin, nurses are involved in all areas of delivery of care and service planning.
Many nurses are appointed to service committees and service review boards, and the director of nursing sits on the management committee.
The psychiatric nurses in this service do not follow an exclusive medical model and go way beyond the traditional roles of dispensing medication and escorting patients to appointments.
While these duties are carried out, a lot more skill and assessment is required than Mr O'Brien gives credit for.
Nurses are involved in the planning phases of treatment and advocate for patients in the prescription of care.
Nurses also provide compliance therapies and are involved in intensive patient education and carer education programmes. Most nurses are involved in internal audits, while the services have psychiatric nurses dedicated to research and professional development ensuring that all areas of practice follow empirical findings.
This service encourages the use of internationally used psychiatric assessment tools which require a high level of knowledge of psychiatric conditions and could only be facilitated by those with specific training in psychiatry.
The community psychiatric nurses are involved in crisis prevention and early intervention approaches and use specific risk assessments to provide a triage system similar to that used in accident and emergency departments.
Psychiatric nurses manage the clinical aspects of acute day hospitals, rehabilitation day programmes, and residential rehabilitation services .
Mr O'Brien indicates that nurses possess few interpersonal skills. However, in the aforementioned services, nurses are trained in solution-focused therapies, cognitive behavioural therapy and dialectical behavioural therapy and addiction counselling, providing a client- centred approach as opposed to the task-centred approach of former times.
This is an example of one psychiatric service and Mr O'Brien really needs to take a closer look at psychiatric nursing literature and have a broader look at services before condemning a profession that has worked hard to reach a highly regarded status.
It is recognised that some organisations may have poor structures in place for reflective practice and career development for nurses which, in keeping with the literature, leads to decreased motivation and reduction in capacity to practice.
Perhaps then it is the responsibility of healthcare organisations to ensure these structures are in place and the responsibility of Bord Altranais to ensure that nurses are meeting the requirements of their code of conduct, as opposed to restructuring a whole training programme.
Kevin Madigan
Kevin Madigan is a clinical nurse specialist in community psychiatry at the Cluain Mhuire Service in Blackrock, Co Dublin.
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