PROMOTING RECOVERY IN MENTAL HEALTH NURSING
Introduction
Mental health services refer to specialized care for people with mental distress or illness, such as depression, bipolar disorder, dementia, schizophrenia, and psychosis (Fontaine and Fletcher, 2003). Mental health nursing involves the application of psychological interventions and therapies to manage the challenging behaviors of people with mental illness (Grace, 2013). It also entails the formation of therapeutic alliances and providing psychiatric medication with the goal of promoting the mental well-being of patients. Mental health services have changed significantly over time. These changes are associated with the development of biological and psychological views of mental illness and treatment interventions. In this paper, I present discuss developments in mental health services and present a personal philosophy on recovery and treatment of people with mental illness, on the basis of ethical, political, and organizational perspectives.
Personal Recovery Philosophy
Historical Context
Mental health services can be traced back to medieval Europe. In the 13th Century, special housing units were built to confine mentally ill people (Shorter, 2008). During this period, no treatments were provided. Therefore, the ethical and moral aspects of mental health services were not emphasized during this time. Moral treatment of people with mental distress began in the 1790s (Micale and Lerner, 2001). The concept of safe asylums for people with mental illness was popularized by Dorothea Dix (Shorter, 2008). The rights of mentally ill people started to be appreciated. In addition, less coercive approaches to managing the behavior of the mentally ill were used. However, it was in 1808 that psychiatry was recognized as a formal profession. The need for educating professionals to treat people with mental illness was appreciated due to the increase in the prevalence of psychosis within society. Mental health nursing education began in 1913 in John Hopkins University (Shorter and Marshall, 1997). In the 1980s, hospitals were structured to include psychiatric units. The goal of mental health services shifted from managing behavior to the provision of reasonable treatments (Alexander and Selesnick, 1966). Additional developments in mental health nursing education were experienced in the 2000s. Special schools for mental health nurses increased in number during this period (Shorter, 2008). Since then, nurses are able to specialize in specific disciplines of mental health, such as care for mentally ill adults and children.
Traditional Biological Views of Mental Illness
Views on mental illness have changed significantly over time. In the 19th Century, people with mental illness were mostly institutionalized. Coercive interventions were used to manage the mentally ill. Early in the 20th Century, mental illness was purely attributed to biological influences (Micale and Lerner, 2001). For example, Sigmund Freud accepted the use of drugs, such as cocaine to manage mental distress (Shorter and Marshall, 1997). Access to drugs led to a high prevalence of substance abuse and psychiatric comorbidities. During the mid-20th Century, the field of biological psychiatry was established. The antidepressant and antipsychotic medications of the time had many adverse effects. Non-adherence was common because patients found psychotic medications to be unpleasant. Biological hypotheses in the 21st Century agreed with the traditional biological views of mental illness (Micale and Lerner, 2001). For example, mental illnesses were considered to be neurodegenerative disorders that disrupt the function and structure of cells in the brain (Shorter, 2008). However, the biological view of mental illness has been criticized due to limitations in empirical evidence. For example, scholars argue that psychiatric conditions are not associated with any known biomarkers. New research findings indicate that both biological and social influences contribute to an individual’s risk of developing mental illness (Shorter, 2008).
Political and Personal Power of Lived Experience
Stigma and discrimination are the main challenges facing persons with mental illnesses. Mann and Cowburn (2005) assert that stigma and discrimination are barriers to the overall well-being of people with mental illness because they limit access to opportunities, such as proper housing, education, and employment. The challenges people with mental illness face are associated with societal misconceptions of psychosis. For instance, mentally ill people are often assumed to be violent or likely to engage in violent crimes (Shives, 2008). Videbeck (2013) recommends that stigma and discrimination can be mitigated through a change in attitudes, equitable treatment, and respect for people with mental illness. Public education programs can be used to eliminate misconceptions and to change the attitudes of society toward people with mental disorders (Videbeck, 2013). Furthermore, legal and policy frameworks that provide for equity in access to essential social and economic opportunities, such as education and employment, can be used to promote the social well-being of individuals with mental illnesses (Fry, Veatch and Taylor, 2010).
Personal versus Clinical Recovery
Clinical recovery in mental health refers to the view that effective care for the mentally ill should involve the restoration of social functioning through the minimization of symptoms. The concept is based on the views of mental health professionals (Townsend, 2014). On the other hand, personal recovery suggests that mental illness is effectively managed through unique personal experiences, such as changes in values, attitudes, goals, feelings, skills, and roles. The concept of personal recovery is based on the views of people with lived experiences and challenges related to mental health problems (Frisch and Frisch, 2006). I believe that clinical recovery and personal recovery should be integrated to allow for the delivery of personalized mental health care services. The integration of the two concepts will also allow people with mental illness to participate actively in treatment programs or in the implementation of personalized recovery interventions (Shives, 2008).
Ethical Considerations
Mental health services should focus on protecting the rights of patients, such as the right to treatment. In addition, mental health practitioners should ensure that they treat patients with the goal of alleviating or minimizing suffering (Nolan, 2000). Respect and protection of human dignity are the other important considerations in the delivery of mental health services (Australia and Australia, 2017). Furthermore, practitioners should never allow personal prejudices, beliefs, feelings, or views to interfere with the delivery of high-quality mental health care services to their patients (Pavlish, Brown?Saltzman, Hersh, Shirk and Rounkle, 2011). Mental health institutions should also provide adequate resources to support high-quality care, such as enough space and reasonable living environments. Fontaine and Fletcher (2003) assert that coercive treatment of mentally ill patients should be avoided. More importantly, providers should collaborate with family members with the goal of ensuring that all needs of patients with mental illness are met (Videbeck, 2013).
Application to Practice
Adults of Working Age
I would like to work with adults of working age in my mental health practice. I am motivated by the need to promote the philosophy of moral treatment of patients with mental illnesses. I support the moral treatment of patients as it provides for the protection of their rights. The philosophy of moral treatment allows me to ensure my patients enjoy their right to informed consent. I specifically advocate for patients with mental illnesses by meeting their information needs, which enables them to make appropriate decisions on their psychological or psychiatric treatments. I also safeguard the rights of my patients to confidentiality. More importantly, I ensure that all service users are treated with dignity and respect. Notably, I am able to develop trusting relationships with my patients, which motivates them to talk about their concerns and fears. Trusting relationships with patients allows me to promote personalized mental health care. Nonetheless, the philosophy of moral treatment of mentally ill patients does not consider the fact that least seclusion and restraint measures may become inadequate, such as when a patient endangers others.
Acute Patient Ward
Acute care is characterized by specific ethical challenges. For example, disagreement between providers and family members may delay acute care (Mark, Jones, Lindley & Ozcan, 2009). Therefore, providers face the challenge of making ethical decisions related to the conflict between the need to protect the right to autonomy and adhering to the ethical principle of beneficence in acute care. The philosophy of moral treatment of patients is applicable in medical research within acute care settings. Casida & Pinto-Zipp (2008) assert that the rights of patients to high-quality acute and the protection of their dignity and privacy should be prioritized over the objectives of research within acute care settings. Ethical dilemmas related to waiting for acute care settings also face practitioners. Notably, the goal of providers should be to facilitate access to the needed acute care services and resources, especially among patients with mental illness and chronic conditions.
Review of Literature
Empirical literature reveals that high-quality care in mental health is related to the willingness of providers to work with families and to provide personalized care (Boyd, 2008). From my experience, working with families allows nurses to have adequate information on the needs of patients with mental illness, which is applicable in meeting their unique needs. According to Hanks (2008), nurse practitioners should participate in the process of developing policies and guidelines for promoting a safe environment in mental health settings. Barker (2008) explains that the participation of nurses in the formulation of policies on safety minimizes malpractice and negligence. However, in my practice, I have not had a chance of participating in the formulation of policies related to practices or procedures in health care. Literature review on mental health care demonstrates that effective communication and the protection of the rights of patients should be considered a top priority in the implementation of all care interventions (Lutzen, Blom, Ewalds-Kvist and Winch, 2010). Therefore, the research literature is aligned with the provisions of the NMC Code of Conduct on effective communication among providers and the need to uphold the dignity of patients.
Impact on Mental Health Nurses
Mental health nurses are professionally, morally, and ethically mandated to adhere to the NMC Code of Conduct (Sutcliffe, 2011). Therefore, nurses should treat mentally ill patients in a humane manner. Mental health nurses should specifically prioritize service users by treating them with compassion, respect, and kindness as provided by the NMC Code of Conduct. More importantly, nurses should collaborate with families and members of multidisciplinary teams to ensure that the specific needs of patients with mental illness are identified and addressed in the most appropriate manner (Hewitt, 2009). The role of mental health nurses in preserving the safety and health of service users is effectively played when they adhere to the moral, ethical, and legal frameworks on the care of people with mental illness. Additionally, nurses within mental health care settings should promote trust, professionalism, and accountability (Schluter, Winch, Holzhauser and Henderson, 2008).
Personal Considerations
My professional practice experiences are related to placements in a rehab ward, crisis team, functional later life ward, liaison service, primary care, and acute inpatient ward. In the domain of professional values, my experiences in the aforementioned placements have allowed me to gain confidence in nursing care. I am assured that I will advocate for my patients to ensure that their rights are protected. I am also able to recognize the legal and ethical challenges related to mental health care. I seek to provide moral treatment to my patients by promoting their safety and upholding their dignity. I have also learned to provide holistic care to the patient and ensure that I am always objective and professional in the delivery of care. More importantly, I have learned to collaborate with families and my colleagues in ensuring that the needs of patients are appropriately and efficiently dressed.
I am encouraged by the fact that my interpersonal and communication skills have improved. Notably, I am able to form professional and trusting relationships with patients, family members, and colleagues, which is the prerequisite to patient-centered care and effective teamwork in nursing practice (Dobrowolska, Wronska, Fidecki and Wysokinski, 2007). In addition, I respect diversity and understand that people can have divergent views and perceptions. However, I understand that I need to enhance my understanding of the impact of family dynamics on the overall well-being of service users. I also need to improve on the use of informatics to promote personalized care. I plan to improve my skills in the use of health software, applications and data formats order to guarantee that I will be able to protect the confidentiality of information on patients.
I have generally improved my decision-making skills because I am now able to apply reliable or up-to-date evidence to assess situations and design effective care interventions. Nonetheless, I face some challenges in decision-making, especially when I experience ethical dilemmas. Therefore, I must improve the skill of applying a collaborative philosophy that includes moral, ethical, and legal frameworks to make the most appropriate decisions when in dilemma. I also plan to improve my holistic care approach. For instance, I understand that I should be able to assess the psychological, social, spiritual, and physical factors that influence the health of patients to make effective decisions related to the delivery of patient-centered care (Butts and Rich, 2012). I have learned the importance of continuous learning in promoting decision-making skills and the ability to engage effectively with families within mental health settings. Therefore, my plan is to become a life-long learner. I intend to gain new competencies at every change during my nursing career.
The NMC Code provides that nurses should be competent in working with teams and playing leadership roles within healthcare settings. From my professional experiences, I have learned that I am an effective team player. I am able to engage actively and professionally with members of healthcare teams to facilitate the care of service users. However, I have a few weaknesses regarding my leadership skills and style. For example, I have learned that I am not adequately proficient in influencing positive change in nursing care environments. I plan to improve my skills in leading change during my preceptorship. I specifically intend to promote positive change in the working culture of nursing units with the goal of promoting the philosophy of moral treatment of patients. The specific leadership skills I need to improve include coordinating and delegating professional responsibilities. In addition, I need to improve my management skills, including the design and implementation of strategic plans meant to promote the health of individuals, groups, families, and communities. In general, I am confident that I am on the right track to improving my competencies in nursing care. I am committed to acting as a moral agent and ensuring that service users are treated with fairness, dignity, and respect at all times.
Conclusion
I historical view of mental health nursing reveals that there have been notable developments in the care of individuals with mental illness. My collaborative philosophy is based on the ethical mandate of nurses to provide moral treatments to people with mental health conditions. I maintain that nurses are ethically obliged to provide humane and dignified treatment to all service users. Additionally, personal views and beliefs should not interfere with the professional obligations of nurses. The NMC Code of Conduct provides the ethical framework that allows nurses to provide moral treatments to service users. My professional values are inspired by NMC’s ethical framework. I have generally improved my interpersonal and communication skills during my nursing practice. However, I understand that I must engage in continuous learning so that I can become better, especially in leadership, management, and decision-making.
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