Trend in Psychiatric Mental Nursing Services
1. History at a Glance
Psychiatric mental nursing as a profession emerged in the early 19th century. Nursing interventions in the early days was still focused on the disease model rather than looking at the client wholly. Then, since 1940, mental psychiatric nursing began to develop rapidly, but the service is still concentrated in the hospital (Otong Antai, 1994). It was not until around the 1960s, the role of psychiatric nurses went to community. This happened in line with deinstitutionalization program. Deinstitutionalization was a chronic-mental-disorder patient acquisition program from hospital institutions and returned them to the environmental rehabilitation in the community (Lefley, 1996). These programs launched for being proven that the client care centered in a hospital was not effective.
Primary, secondary, and tertiary preventions could only be performed whether the patient returned to the community environment. The incidence of mental disorders can be minimized by using preventative methods such as finding the cases early, early diagnosis and intervention of crisis (Gerald Kaplan cited by Otong Antai, 1994).
To date, deinstitutionalization program runs still in several countries, mainly European countries and the United States. With the development of this program, many forms of mental health services available in the community. For example in Melbourne, Australia, there are several the community mental health service programs such as Crisis Assessment and Care Services, Continuing Care, Residential Rehabilitation Services, Aged Persons Mental Health Services and Community Mental Health Center (H & CS, 1996). Even today there are psychosis Early Prevention and Intervention Center provides specialized services in cases of psychosis (Lambert, M., 2001).
2. Trend of Psychiatric Mental Nursing Services in the Globalization Era
Along with the development of deinstitutionalization programs supported by the discovery of psychotropic drugs which proved well able to control the behavior of the client's mental, mental psychiatric nurse role is no longer confined to the provision of care at the hospital, but nurses are required to be more sensitive to social environment and nursing service focuses on preventive and promotive. Leininger (1973) suggests that changes in hospital-based care to community-based care are the most significant trends in the care of mental disorders.
How do mental psychiatric nurses can integrate themselves into the mental health community? Leininger (1973) suggested 3 main key in this process: the experience and education of nurses, role and functions of nurses, and nurse relationships with other professions in the community. Reforms in health care nurses have been demanding for role redefinition. It is the time for nursing interventions that focus on aspects of prevention and health promotion to develop “Community-based Care” (Lefley, 1996).
Lack of available personnel, costs, and facilities support challenges the mental psychiatric nurses and other professions to maximize the available resources and to develop new innovations to meet the needs of the community (Otong Antai, 1994). In this connection, it is important to develop nursing education (Suhaemi, 1997), especially psychiatric mental nursing both in quantity and quality. It is time for education for psychiatric mental nurse who worked in a community psychiatric hospital at least is college level (Jintana, 2002).
Issues around Mental Psychiatric Nursing Services
1. Existed Mental Psychiatric Nursing Service cannot be scientifically justified because of lack of research results in nursing of the Mental Clinic Nursing. Stuart Sudeen (1998) suggested that the Mental Nursing research was still very low.
2. Psychiatry Nursing is less ready to face free market because of low education and lack of practice license recognized internationally.
3. Mental nurse role differentiation based on education and experience is often not clear in the job description, job responsibility, and reward system in the nursing service where they work (Stuart Sudeen, 1998).
4. Become psychiatric nurse is not an option for students (nursing students). They tend to avoid the profession. Based on the author's experience in interacting with students, it is very few among those who are interested to be psychiatric nurse. Other countries have the same tendency. The results of research in Ireland showed that students have the wrong perception about the role of psychiatric nurses (Wells, 2000).
How Mental Psychiatric Nursing Profession in Indonesia deals with?
In the face of evolving trends and issue, mental psychiatric nursing profession in Indonesia has taken measures such as establishing the standard of nursing practice in the mental hospital, a professional nursing practice model in a mental asylum, and conducted various training such as training in mental nursing care and “clinical instructor” training for mental psychiatric nurse. However, perhaps there are many thing need to tidy up and to improve so that able to face all challenges in the future.
Here are mental psychiatric nursing profession should concern in the face of trends and issue of psychiatric nursing service in the era of globalization:
a) Related with the trend of global major health problems and global mental health services, it’s the time for mental nursing service focus based on the community (community-based care) which gives emphasis on preventive and promotive.
b) Related with the rapid improvement of science and, it is a need to improve nursing science by developing existed educational institutions and specializing mental nursing program. Equally important is to increase research on mental psychiatric nursing, particularly mental nursing clinic.
c) In order to maintain quality of provided services and to protect consumers, it's time to make “license” for nurses who work in this service.
d) Due to differences between our cultural backgrounds and the keynote speaker, which in this case we still refer to the Western countries especially the United State, it is necessary to refine the concepts of psychiatric mental nursing obtained from outside. Estin (1999) emphasized that to build trust and therapeutic relationships with clients and to prevent delays in diagnosing client needs, nurses need to understand the patients’ culture, values, beliefs, and attitudes toward their mental disorder.
yosep,iyus.2009.keperawatan jiwa.Bandung:PT Refika Aditama.
Kozier, Barbara. 1979. Fundamental of Nursing. Philadelphia:WB Saunders Company.
Roshdahl, Caroline Bunker. 1999. Text Book of Basic Nursing. Philadelphia, New York, Baltimore: Lippincott.
Varcolis, Elizabeth M. 1994. Foundation of psychiatric-Mental Health Nursing.Philadelphia:WB Saunders Company
Stuart & Sundeen. 1995. Principles & Practice Of Psychiatric Nursing Fifth Edition. St. Louis Missouri: Mosby