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Psychiatric Mental Health Nursing

By Carolyn Kirkup, Registered Nurse, Psychiatric Mental Health Nurse, Ambulatory Services Program, Ontario Regional Treatment Centre

Photos: Philip Gordanier

Carolyn Kirkup

Dr. Hildegard E. Peplau, who died in 1999 at age 89, is considered by nurses worldwide to be the founder of psychiatric nursing. For her, the key question was: “What do nurses know and how do they use that knowledge to benefit people?”

Dr. Peplau's scope of influence goes far beyond the field of psychiatric mental health nursing. She advanced nursing professional, educational, and practice standards and stressed the importance of professional self-regulation through credentialing. Peplau challenged psychiatric nursing to thrive in the new millennium in four central areas:

• the nurse-patient relationship;
• engagement in evidence-based practice;
• competence in information technology; and
• leadership in shifting the health care paradigm to community-based delivery.

Today, psychiatric mental health content is part of all diploma and baccalaureate nursing programs on an international scale. Specialization can occur at the graduate level. Sub-specialties include child, adolescent, adult, geriatric, consultation/liaison, addictions/substance abuse, eating disorders and forensic psychiatry. Psychiatric mental health nursing in the area of corrections is also a sub-specialty.

What do nurses know?

We know the number of offenders with mental disorders is increasing in Canadian federal prisons. Many offenders have serious and chronic physical and mental illnesses requiring substantial health care efforts. Institutional factors, inmate vulnerabilities, poor coping skills and conditions of confinement, such as segregation, all make caring for these offenders extremely challenging for nurses who work in a correctional setting.

According to the Canadian Nurses Association, psychiatric nurses must be knowledgeable in the areas of biological and psychological theories of mental health and mental illness, psychotherapy, substance abuse, care of populations at risk, the community as a therapeutic milieu, cultural and spiritual implications of nursing care, psychopharmacology and documentation specific to the care of the mentally ill. Skill competency stresses comprehensive bio-psychosocial assessment, interdisciplinary collaboration, identification and coordination of resources for offenders and families, the use of psychiatric diagnostic classification systems, therapeutic communication, establishing therapeutic relationships, therapeutic use of self, psycho-education with clients and administering and monitoring psychopharmacologic agents.

Both registered nurses and registered practical nurses provide psychiatric mental health nursing care at the Ontario Regional Treatment Centre. Nurse coordinators are responsible for management, leadership, education and training. Nurses work with offenders to meet their goals for recovery. Nurses with specialty certification in psychiatric mental health nursing with the Canadian Nurses Association work with offenders as part of the Ambulatory Services Program.

How do nurses use their knowledge to benefit offenders?

The Registered Nurses Association of Ontario (RNAO) has evidence-based nursing best practice guidelines such as client-centered care, establishing therapeutic relationships and crisis intervention that assist psychiatric nurses working in correctional institutions, where self-knowledge and boundary setting is imperative when responding to offenders in crisis.

This year, RNAO is holding the first International Conference on Evidence-based Practice Guidelines. New partnerships are being formed to evaluate clinical practice guidelines in Canada and worldwide. Collaboration, sharing, working with researchers, academic institutions and health care providers will translate evidence into practice. Networks where psychiatric nurses and health care organizations come together to share dramatic improvements result in positive clinical outcomes for our patients and our offenders.

Pat Onysko, Louise Kennedy and Carolyn Kirkup, Ambulatory Services Nurses

The following Canadian Nurses Association domains of practice for psychiatric mental health nursing are applied to the correctional setting:

• the helping role;
• the diagnostic and monitoring function;
• the teaching-coaching function;
• administering and monitoring therapeutic interventions;
• effective management of rapidly changing situations;
• organizational and work-role competencies;
• monitoring and ensuring the quality of health care practices. ♦