Mental Health Nursing in the 21st Century

Abstract

Mental health nursing in the 21st century will expand to include a neuropsychiatric focus that encompasses the science, knowledge, and skills of both neurology and psychiatry. The shift to neuropsychiatric nursing is directed by the explosion of knowledge in the neurobiologic basis of mental illness, tremendous advances in diagnostic technology, and the discovery of new and more effective psychopharmacologic treatments. Neuropsychiatric disorders are common, disabling, costly, and stigmatizing. A neuropsychiatric paradigm allows treatment to reach more people who are affected and is less stigmatizing than a psychosocial view alone. Neuropsychiatric advanced practice nurses will need both primary care and specialty knowledge and skills. The challenge to nursing education is to determine how best to incorporate this knowledge and skills into curricula. Neuropsychiatric research must focus on both biologic and behavioral measures and interventions. The philosophical and ethical challenge to nursing is to integrate biologic and behavioral concepts into the nursing care of mentally ill people while remaining centered in the nursing domain and maintaining our focus on caring and our sensitivity to the human condition.

Promoting critical perspectives in mental health nursing education

“…The ‘identity crisis’ of mental health nursing is demonstrated in the profession's dependence upon other professional knowledge, principally that of psychiatry. Adherence to the ‘epistemological certainty’ (Lakeman & Cutcliffe ) inherent within the medical (disease) model of mental disorder is seen in attention given to such features as aetiology (Flaskerund & Wuerker ), classificatory diagnosis (Barker ), pharmacological treatment (Jones & Gray ), physical treatments such as electro‐convulsive therapy (Dawson , Gass ), legal detention (Griffith & Tengnah ), assessment of risk (Barker & Buchanan‐Barker ) and to the use of specific therapeutic interventions such as special observations (Addo et al . ).…”

Nurture: The Fundamental Significance of Relationship as a Paradigm for Mental Health Nursing

“…Biochemistry and genetics, although important, do not explain or encompass all mental health problems or treatment approaches. As Flaskerud and Wuerker (1999) stressed, biophysiology does not provide a comprehensive conceptual model for practice. Mental health nursing needs an inclusive philosophy that honors the relational nature of the nursepatient relationship, the critical nature of the environment, the importance of biochemical factors, and the way that narrative understanding shapes human behavior.…”

Health Care Reform and Meeting the Needs for Primary Care

“…Our school is situated in an ethnically, racially, and economically diverse community and had a history of serving vulnerable populations. It wasn't long before we realized that these populations sought treatment for mental health problems from their primary care givers (Flaskerud & Wuerker, 1999). Although there was a minimal amount of content on mental health problems in the NP curriculum, it did not provide practitioners with the skills and expertise necessary to make assessments, diagnoses, treatment, and referrals for the large numbers of patients seeking care for depressive and anxiety disorders, psychotic disorders, and addictive disorders.…”

“…In response we created an elective subspecialty in neuropsychiatric nursing for primary care NPs, attended principally by family and geriatric NP students. This program was patientcentered and focused on the areas of neuropsychiatric disorders noted above, on psychopharmacology, and on coordination, referrals, and community care (Flaskerud & Wuerker, 1999). The program was heavily subscribed and funded by the Division of Nursing from 1995-2004.…”