NURSING ROLE TO PSYCHIATRIC NURSING

The American association of colleges of nursing (1986) issued a document on the essentials of professional nursing education and identified the three role of the professional nurse as :
1. provider of care
2. coordinator of care
3. member of a profession

1. Psychiatric nurse as a provider of care
The psychiatric nurse as a provider of care is expected to be more involved in primary care and preventive services in community-based settings. Care of clients with chronic mental illness, dual diagnosis with substance abuse as one of the classification, and violent and abusive behaviors will occur in hospital, community, and correctional facilities. The psychiatric nurse must be prepared to work more independently than in the past as a result of the change in settings for mental health care. It is also anticipated that increased skills in observation of the effects of biological treatments will be needed.

2. Psychiatric nurse as a coordinator of care
As the coordinator of care, the psychiatric nurse will work in conjunction with other disciplines on the mental health team. Role changes include a return to more active involvement in milieu management, case management, managed care systems, rehabilitation services, and other approaches. Because of the various innovative models of care delivery, more attention must be given to teaching nurses skills in critical thinking and self-learning strategies rather than those needed in traditional and perhaps outmoded system of client care.

3. Psychiatric nurse as a member of a profession
One characteristic of a profession is reliance on a body of knowledge that is distinct from other disciplines. However, research is not the only source of knowledge. Knowledge comes from personal experience, an ethical system, and the artistic aspect of caring (Watson, 1988). Psychiatric nurse must allow time for reflection and the development of knowledge.
Nursing students should also develop the characteristics of a professional by the end of their educational program. As a member of professional group, nurse must invest time and energy in activities that promote the preservation of psychiatric nursing as well as resources for clients and their families. Membership in appropriate professional organization is essential for meeting the goals of the specialty. Providing input into the political process, thus ensuring adequate resources not only for the nursing profession but also for underserved and stigmatized mental health consumer groups, is a professional responsibility. The Americans with Disabilities Act will help diminish some of the result of institutionalized stigma. Intensive education at all levels of society must be developed and implemented to address the stigma that the American culture associates with mental illness. Once this is eliminate, mental illness can be treated as any other illness.

The nurse also have some roles to a group of psychiatric nursing, include :
1. The nurse as a group educator
Nurse can teach groups of patients about managing chronic illness or specific rehabilitation or about preventive health care. Some examples of group teaching of a community setting are conducting seminar or nutrition for senior citizens or stress management seminars, or organizing an exercise program. Many wellness programs directed and coordinated by nurses are an opportunity for increased nursing visibility in the community. Many facilities welcome new speakers and opportunities for new knowledge for their participants. With the increasing cost of health care, groups can be seen as an economical solution to health care, as well as an opportunity to decrease social isolation.

2. The nurse as a group therapist
Nurses began to develop a role as leaders of group therapy in the 1960s (Armstrong and Rouslin 1963). Peplau believe that as group therapists, nurses should function along with other health professionals, such as psychiatric social workers, psychologists, and psychiatrics, in the role of group psychotherapists.
Individuals conducting group psychotherapy need specific education and experience. For nursing, the American Nurse’s Association (ANA) sets the standard of graduate study, which includes the necessary theory, supervision, and clinical practice. On the bachelor’s and associate’s levels, nurse need to have an understanding of group therapy and process and may be actively involved in leading therapeutic groups.
Training through college courses, workshop, and ongoing clinical supervision in essential. Psychiatric clinical specialists can serve as role models and mentors for nurses desiring o learn about many types of groups. Group therapy always uses a theoretical base, this base is one that the leader believes in and its educated in.
Nurse group therapists need to have individual or peer-group supervision. In supervision, he nurse reviews the process of therapy with a more experienced therapist on with peers. Group work provide a rich learning environment. All psychotherapeutic work with patients, whether it is individual, couple, family, child, group, or any other type of psychotherapy, requires interpersonal learning with a senior clinician trained in that particular therapy (Critchley and Maurin, 1985). Supervision is a relationship between supervisor and supervisee that helps the supervisee become more therapeutic. The ANA’s Standards of Psychiatric and Mental Health Nursing Practice states that “the nurse participates in peer review and other means of evaluation to assure quality of nursing care provided by nurses for clients.”. Clinical supervision should be ongoing throughout the nurse’s experience as a group leader.

3. The nurse as cotherapist
The use of a cotherapist can benefit the beginning group therapist. For example, a cotherapist may be helpful for handling escalating anger, when a patient decides to leave the group, or when the patient threatens to commit suicide. It is advantageous for he therapist and cotherapist to discuss their theoretical frameworks beforehand to establish if the frameworks are the same or compatible.
The cotherapists need to communicate about the group process and content as often as the group meets, both before and after each group session. Both therapists need to be aware of their reactions o each other. Feelings of competition or disagreement concerning interventions often emerge.


Weiss (1947) quoted from Stuart Sundeen the principles and practice of Psychiatric nursing care (1995), the role of the nurse is as attitude therapy, namely:
1. Observe the change, little or stay change was happened to the client.
2. Demonstrate acceptance.
3. Respect
4. Understand to client
5. Promote client’s interest and participate in the interaction

Meanwhile, according to Peplau, the nurse's role includes :
1. As educators
2. As a leader in the situation that is local, national, and international
3. As a "surrogate parent"
4. As counselor

And in addition, to the nurse's role is to:
1. In collaboration with mental health institution
2. Consultation with welfare foundation
3. provide services to clients outside the clinic
4. Active research
5. Public education helped




reference :
Otong, Antai. 1995. Psychiatric Nursing : Biological and behavioral Concepts. Philadelphia : W.B. Saunders Company

Varcarolis, Elizabeth M. 1994. Foundations of Psychiatric Mental Health Nursing 2nd edition. Philadelphia, Pensylvania : W.B. Saunders Company

Yosep, Iyus. 2007. Keperawatan Jiwa. Bandung : Refika Adiama