Community Mental Health and Community Psychiatric Nursing Pierre Galea
Community Mental Health A Historical Perspective Institutional neurosis Role of medication Closing down of psychiatric hospitals
Community Mental Health What are the benefits of providing mental health care in the community? De-institutionalization De-stigmatization Normalization (least disruptive) Taking the service to those who need it the most! (revolving door syndrome) Promotion of good mental health in the population
What is the role of the Psychiatric nurse in Psycho-social support the Community? Link between patient, family and MH services Monitoring / observation Medication Management (education, administration, monitoring) Assessment (risk, mental state, social support/situation) Psycho-education Making the service adaptable to the patient Home visits
The research study: The Role of the Community Psychiatric Nurse in Malta How is the role of the Community Psychiatric Nurse evolving in Malta? What are the challenges and difficulties experienced by the CPNs in their role? How are psychiatric nurses coping with the new challenges and changes to their role from hospital based nurses to community nurses?
Method Single Case Study Method - the study of the particular (Simons, 2009) Sample (n=5) Single, face-to-face, semi-structured, qualitative interviews Thematic Analysis Ethical issues
Main Themes CPNs are working effectively as independent and dedicated practitioners The therapeutic relationship Activities with patients Being flexible and working independently Working as part of a team Knowledge and experience to perform the role Qualities to perform the role CPNs are struggling in the role Uncertainties about the role Difficulties in performing the role A struggle to be recognized
Activities of the CPNs What activities do psychiatric nurses engage in the community? The role is vague and difficult to describe, but flexible (Kudless & White, 2007 and McKenna et al., 2000) o The development of a therapeutic relationship o Medication Management o Monitoring of effects and side-effects o Monitoring of mental state o Education o Family work o Therapeutic individual sessions / homevisits
The therapeutic relationship Guided the participants in their work Helped in the transition from hospital based work to community (Barlow, 2006) (Ryan et al., 2006) (Shattell, et al., 2006) Beyond the illness towards recovery Focus on the person Walking the journey with the patient The Tidal Model (Barker, 2001) therapeutic friendliness (Gardner, 2010)
Challenges and difficulties Uncertainties about the role Difficulties in performing the role Struggle to be recognized
Recommendations Clinical supervision Involvement in decision making Role recognition
MHNs have consistently identified the therapeutic relationship and the therapeutic use of self as the hallmarks of their practice, while simultaneously recognizing the difficulty of describing these in nursing documentation in any way that does not reduce the complexity of these phenomena to something approaching the banal. (Hurley, Mears & Ramsay; 2009) Thank you pierregla@yahoo.co.uk
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