Психиатрическая медсестра: история, образование и сфера деятельности.

Health profession
Psychiatric nursing or mental health nursing is the appointed position of a nurse that specialises in mental health, and cares for people of all ages experiencing mental illnesses or distress. These include: neurodevelopmental disorders, schizophrenia, schizoaffective disorder, mood disorders, addiction, anxiety disorders, personality disorders, eating disorders, suicidal thoughts, psychosis, paranoia, and self harm. Mental health nurses receive specific training in psychological therapies, building a therapeutic alliance, dealing with challenging behaviour, and the administration of psychiatric medication. In most countries, after the 1990s, a psychiatric nurse would have to attain a bachelor's degree in nursing to become a Registered Nurse (RN), and specialise in mental health. Degrees vary in different countries, and are governed by country specific regulations. In the United States one can become a RN, and a psychiatric nurse, by completing either a diploma program, an associate (ASN) degree, or a bachelor's (BSN) degree. Mental health nurses can work in a variety of services, including: Child and Adolescent Mental Health Services (CAMHS), Acute Medical Units (AMUs), Psychiatric Intensive Care Units (PICUs), and Community Mental Health Services (CMHS).

The history of psychiatry and psychiatric nursing, although disjointed, can be traced back to ancient philosophical thinkers. Marcus Tullius Cicero, in particular, was the first known person to create a questionnaire for the mentally ill using biographical information to determine the best course of psychological treatment and care. Some of the first known psychiatric care centers were constructed in the Middle East during the 8th century. The medieval Muslim physicians and their attendants relied on clinical observations for diagnosis and treatment. In 13th century medieval Europe, psychiatric hospitals were built to house the mentally ill, but there were not any nurses to care for them and treatment was rarely provided. These facilities functioned more as a housing unit for the insane. In the colonial era of the United States, some settlers adapted community health nursing practices. Individuals with mental defects that were deemed as dangerous were incarcerated or kept in cages, maintained and paid fully by community attendants. Wealthier colonists kept their insane relatives either in their attics or cellars and hired attendants, or nurses, to care for them. In other communities, the mentally ill were sold at auctions as slave labor. Others were forced to leave town. As the population in the colonies expanded, informal care for the community failed and small institutions were established. In 1752 the first "lunatics ward" was opened at the Pennsylvania Hospital which attempted to treat the mentally ill. Attendants used the most modern treatments of the time: purging, bleeding, blistering, and shock techniques. Overall, the attendants caring for the patients believed in treating the institutionalized with respect. They believed if the patients were treated as reasonable people, then they would act as such; if they gave them confidence, then patients would rarely abuse it. The concept of a safe asylum, proposed by Philippe Pinel and William Tuke, offered protection and care at institutions for patients who had been previously abused or enslaved. Moreover, since psychiatric drugs were becoming more available allowing patients to live on their own and the asylums were too expensive, institutions began shutting down. Global health care underwent huge expansions in the 1980s; this was due to the government's reaction from the fast increasing demand on health care services. The expansion was continued until the economic crisis of the 1970s.

Psychiatric medication is a commonly used intervention and many psychiatric mental health nurses are involved in the administration of medicines, both in oral (e. g. tablet or liquid) form or by intramuscular injection. Nurse practitioners can prescribe medication. Nurses will monitor for side effects and response to these medical treatments by using assessments. Nurses will also offer information on medication so that, where possible, the person in care can make an informed choice, using the best medical based evidence available.

Psychiatric mental health nurses are also involved in the administration of the treatment of electroconvulsive therapy and assist with the preparation and recovery from the treatment, which involves anesthesia. This treatment is only used in a tiny proportion of cases and only after all other possible treatments have been exhausted. Nurses may also be involved in gaining consent for this procedure. However, consent arrangements vary depending on the jurisdiction in which the treatment takes place.

Along with other nurses, psychiatric mental health nurses will intervene in areas of physical need to ensure that people have good levels of personal hygiene, nutrition, sleep, etc., as well as tending to any concomitant physical ailments. In mental health patients, obesity is not rare because some medications can have a side effect of gaining weight which can cause the patient to have low confidence and lead to other health issues. To fix this problem, mental health nurses are urged to encourage patients to get more exercise to enhance their physical health, along with their mental health by improving the patients confidence and lowering stress levels, improving their mental health which has been a focus for mental health nurses because many patients do not get enough exercise. that evidence based practice is focused primarily on quantitative research and should reflect also a more qualitative research approach that seeks to understand the meaning of people's experience.

The basis of this approach is to look at mental illness or distress from the perspective of a spiritual crisis. Spiritual interventions focus on developing a sense of meaning, purpose, and hope for the person in their current life experience. Spiritual interventions involve listening to the person's story and facilitating the person to connect to God, a greater power or greater whole, perhaps by using meditation or prayer. This may be a religious or non religious experience depending on the individual's own spirituality. Spiritual interventions, along with psychosocial interventions, emphasize the importance of engagement, however, spiritual interventions focus more on caring and 'being with' the person during their time of crisis, rather than intervening and trying to 'fix' the problem. Spiritual interventions tend to be based on qualitative research and share some similarities with the humanistic approach to psychotherapy.

As with other areas of nursing practice, psychiatric mental health nursing works within nursing models, utilising nursing care plans, and seeks to care for the whole person. However, the emphasis of mental health nursing is on the development of a therapeutic alliance. In practice, this means that the nurse should seek to engage with the person in care in a positive and collaborative way that will empower the patient to draw on his or her inner resources in addition to any other treatment they may be receiving.

Understanding and empathy from psychiatric nurses reinforces a positive psychological balance for patients. Conveying an understanding is important because it provides patients with a sense of importance. The expression of thoughts and feelings should be encouraged without blaming, judging, or belittling. Feeling important is significant to the lives of people who live in a structured society, who often stigmatise the mentally ill because of their disorder. Empowering patients with feelings of importance will bring them closer to the normality they had before the onset of their disorder. When subjected to fierce personal attacks, the psychiatric nurse retained the desire and ability to understand the patient. The ability to quickly empathise with unfortunate situations proves essential. Involvedness is also required when patients expect nursing staff to understand even when they are unable to express their needs verbally. In order to accept the patient as an individual, the psychiatric nurse must not be controlled by his or her own values, or by ideas, and pre understanding of mental health patients. Individual needs of patients are met by bending the rules of standard interventions and assessment. Psychiatric nurses spoke of the potential to 'bend the rules', which required an interpretation of the unit rules, and the ability to evaluate the risks associated with bending them.

Successful therapeutic relationships between nurses and patients need to have positive support. Different methods of providing patients with support include many active responses. Physical support may also be used and is manifested through the use of touch. In his article about pivotal moments in therapeutic relationships, Welch found that nurses must be in accordance with their values and beliefs. Along with the previous concept, O'Brien concluded that being consistent and reliable in both punctuality and character makes for genuinity. Schafer and Peternelj Taylor found that genuineness was expressed by fulfilling intended tasks. Self disclosure proves to be the key to being open and honest. It involves the nurse sharing life experiences and is essential to the development of the therapeutic relationship, because as the relationship grows patients are reluctant to give any more information if they feel the relationship is too one sided. Psychiatric nurses convey themselves as team members or facilitators of the relationship, rather than the leaders.

To develop a quality therapeutic relationship, nurses need to make patients feel respected and important. and instills the patient with feelings of safety and containment. Different personalities affect the way psychiatric nurses respond to their patients. The more self aware, the more knowledge on how to approach interactions with patients nurses have. to improve clinical skills, The reflections

The registered psychiatric nurse is a distinct nursing profession in all of the four western provinces. Such nurses carry the designation "RPN". In Eastern Canada, an Americanized system of psychiatric nursing is followed. Registered Psychiatric Nurses can also work in all three of the territories in Canada; although, the registration process to work in the territories varies as the psychiatric nurses must be licensed by one of the four provinces.

In Ireland, mental health nurses undergo a 4 year honors degree training programme. Nurses that trained under the diploma course in Ireland can do a post graduation course to bring their status from diploma to degree.

Mental Health Nurses in New Zealand require a diploma or degree in nursing. All nurses are now trained in both general and mental health, as part of their three year degree training programme. Mental health nurses are often requested to complete a graduate diploma or a post graduate certificate in mental health, if they are employed by a District Health Board. This gives additional training that is specific to working with people with mental health issues.

In Sweden, to become a registered psychiatric nurse one must first become a registered nurse which requires a BSc. (Bachelor of Science) in Nursing (three years of full time study, 180 higher education credits). Then, one must complete one year of graduate studies in psychiatric/mental health nursing (60 higher education credits), which also includes writing a MSc. (Master of Science) thesis. The registered psychiatric nurse is an evolving profession in Sweden. However, unlike in countries such as the US, there is no psychiatric mental health nurse practitioner, so in Sweden, the profession cannot for example prescribe pharmacological treatment.

In the UK and Ireland the term psychiatric nurse has now largely been replaced with mental health nurse. Mental health nurses undergo a 3–4 year training programme at bachelor's degree level, or a 2 year training programme at master's degree level, in common with other nurses. However, most of their training is specific to caring for clients with mental health issues. RMNs can continue into further training as Advanced Nurse Practitioners (ANPs): this requires completion of a 9 month Master's programme. The role includes prescribing medications, being on call for hospital wards and delivering psychosocial interventions to clients.

In North America, there are three levels of psychiatric nursing. The licensed vocational nurse (licensed practical nurse in some states) and the licensed psychiatric technician may dispense medication and assist with data collection regarding psychiatric and mental health clients. The registered nurse or registered psychiatric nurse has the additional scope of performing assessments and may provide other therapies such as counseling and milieu therapy. The advanced practice registered nurse (APRN) either practices as a clinical nurse specialist or a nurse practitioner after obtaining a master's degree in psychiatric mental health nursing. Psychiatric mental health nursing (PMHN) is a nursing specialty. The course work in a master's degree program includes specialty practice. APRNs assess, diagnose, and treat individuals or families with psychiatric problems/disorders or the potential for such disorders, as well as performing the functions associated with the basic level. 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, APRNs have the authority to prescribe medications. Qualified to practice independently, psychiatric mental health APRNs offer direct care services in a variety of settings: mental health centers, community mental health programs, homes, offices, HMOs, etc. Psychiatric nurses who earn doctoral degrees (PhD, DNSc, EdD) often are found in practice settings, teaching, doing research, or as administrators in hospitals, agencies or schools of nursing.

In Australia, to be a psychiatric nurse a bachelor's degree of nursing need to be obtained in order to become a registered nurse (RN) and this degree takes three years full time. Then a diploma in mental health or something similar will need to also be obtained, this is an additional year of study. An Australian psychiatric nurse has duties that may include assessing patients who are mentally ill, observation, helping patients take part in activities, giving medication, observing if the medication is working, assisting in behaviour change programs or visiting patients who are at home. Australian nurses can work in public or private hospitals, institutes, correctional institutes, mental care facilities and homes of the patients.