Most people who go into nursing feel a call to do so, a longing to be able to help others who are vulnerable. This is often more challenging than imagined, and not everybody makes it through training, but those who do report high levels of job satisfaction. Part of this is due to the opportunity to specialize and pursue niche interests. Of these, one of the least well-understood is psychiatric nursing. It differs from standard practice nursing in several ways, and because it often involves working with difficult or even ungrateful patients, outsiders can’t always see the appeal – but to those who do it, it’s difficult to imagine finding anything else as rewarding.
An understanding of wellness
It’s often said that while doctors are interested in curing diseases, nurses are interested, first and foremost, in patient wellness. In general practice, that’s fairly straightforward – there’s a well-established idea of what it means to be well. In psychiatric nursing, the situation is rather more complex. It’s only relatively recently that we’ve begun to develop a proper understanding of neurodiversity and appreciate that different people have different baselines for normal function. Factoring in other kinds of difference complicates the picture further. Most mental health nurses now focus on trying to help patients reach a point where they can cope with day-to-day life without risk to themselves or others, and be reasonably happy, but there are differing schools of thought, and this remains an active conversation within the profession.
A holistic approach
Where doctors look at specifics, nurses tend to focus on the whole patient in order to understand how health can be improved. For a psychiatric mental health nurse practitioner, that often involves looking at the patient’s environment as well. It might, for instance, include spending time with family members in group counseling sessions, to help them understand the patient’s experience and provide better support. It might also mean helping the patient to develop better communication skills and social behaviors. It often involves liaising with other professionals, especially in outpatient settings where additional support is needed in different areas of life. In this way, mental health nurses decrease the risk of relapses and help to ensure that patients can cope as well as possible in every area of life.
Respecting patients’ dignity
One of the key principles of nursing is that patients should be treated with respect and given as much dignity as possible regardless of their circumstances. In psychiatric nursing, this presents particular challenges as nurses need to find ways to be true to it – even in cases when patients are not competent to make decisions about their own lives. They must also be capable of being persuasive and firm with patients who possess legal competence but persistently make bad decisions, respecting their right to choose for themselves even while seeking to help them make better choices. That can be a difficult balancing act. A good mental health nurse never loses sight of a patient’s humanity no matter that patient’s behavior.
Assessment
One distinctive task carried out by psychiatric nurse practitioners is the ongoing assessment of patients in their care. Although they rarely make diagnoses – unless they are further qualified, with masters’ or doctoral degrees – they contribute to them by identifying key features of a patient’s behavior and tracking them over time. In addition, they carry out the forms of monitoring common in general practice nursing, such as checking vital signs or taking blood and assessing test results. They aim to build up trust with their patients so that they can more easily identify any developing problems. That is particularly important given that patients are often less trusting of psychiatrists than of the doctors who treat their physical health problems.
Counseling
In addition to assessment, mental health nurses often take on the more proactive role of the counselor. This may simply mean listening to patients (which still requires training if it is to be done well) or it may involve the administration of treatments such as cognitive-behavioral therapy (CBT). Often, they will specialize in particular types of therapy. This could be carried out on a one-to-one basis or in a group setting, with patients in the community or in a hospital. In some cases, it can involve being on call, such as when working with addicts who are at risk of relapse.
Managing medication
While it is usually psychiatrists or senior members of the nursing staff who prescribe medication, every psychiatric nurse has to know how to ensure that patients are taking it properly, and this is often considerably more complicated than it is in general practice nursing. Some mental health problems – and some of the drugs used to treat others – make patients forgetful, so that they struggle to keep track of what they have taken. Other patients are distrustful because of their illnesses and need a lot of coaxing before they will take each individual dose of the medication they need. Some common medicines have unpleasant side effects which make patients reluctant to take them. Others have dangerous interactions with other drugs or with foods, which nurses need to be aware of so that they can keep patients safe.
Relationship building
Perhaps the single most important task of the mental health nurse is to provide emotional support. It’s not uncommon for the most severely ill patients to have lost contact with their families and friends, and while nurses can’t replace them – and need to be wary of creating unhealthy dependency – they can help such patients to rebuild their social skills, giving them a better chance of making positive new connections. They can also help them to feel valued and learn to value themselves in the meantime.
This work requires a lot of mental energy and can sometimes be daunting but for many psychiatric nurses, it’s where the real magic happens. Unlike most other types of nurse practitioners, they often work with the same patients over many years and getting to see them make progress and live happier lives is one of the greatest joys that any profession can deliver.
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