Self Reflection
We live in a time when mental health has been
increasingly failing for many individuals. Many situations that are reflected in
our societies today re increasingly convincing me, helping me to come to realize
that mental health nurses matter, are essential healthcare providers, and will
continue to be needed in the future. Mental health nurses are in the right
position to grow in the understanding of mental health and to better identify
the constructs and care practices that promote, strengthen, and protect the
mental health of individuals and families.
Mental
health can be a very challenging area to work in and as an experienced student
nurse, I have a great admiration for the skills and commitment registered mental
health nurses give. There are many qualities that a registered mental health
nurse must possess. Personally, I feel that I have already developed some of
these qualities given the time and experience that I have spent in the mental
health field. To illustrate my capabilities, I will outline in the succeeding
paragraphs the qualities that I have developed as well as the situations where I
have applied them. These are experiences that I have encountered 6 months prior
to registration.
A registered mental health nurse must adopt a
quality of mental health practice. The nurse systematically enhances the quality
and effectiveness of nursing practice (Potter & Perry, 2004). As a student
nurse, I have demonstrated quality by documenting the application of mental
health nursing process in a responsible, accountable, and ethical manner. I also
use creativity and innovation in nursing practice in order to improve the
delivery of care. When I feel that the desired outcomes of quality are not
achieved, I start to plan that I should incorporate new knowledge to initiate
the desirable changes that are needed in the mental health area.
However, I have also reflected that
the quality of mental health care or of health care for that matter also rests
on other aspects. Quality of patient care is threatened by the acute shortage of
nursing staff and at times a less than optimum mix of skills and experienced
staff. The consequences are felt by patients or their families as well as nurses
and have implications for clinical responsibilities and vulnerability to
litigation.
Patients with chronic mental
alterations can restore or maintain their health through a variety of strategies
aided by the mental health nurse. Sometimes, mental health patients require
medications to maintain or stabilize their health. A medication is a substance
used in diagnosis, treatment, relief, cure, or prevention of health alterations
(Potter & Perry, 2004).
As a student nurse, I am aware that
medication administration and evaluation are essential to nursing practice. We
need to have knowledge about the actions and effects of the medications we
deliver to the mental health patients. Given the delicate condition of the
patient, the administration of medications to mental health patients is a more
difficult task.
I have also reflected that in order to administer medications, it is
essential for the mental health nurse to have an understanding of basic
arithmetic to calculate medication doses, mix solutions, and perform a variety
of other activities. This skill is important because medications are not always
dispensed in the unit of measure in which they are ordered (Kozier & Erb, 2004).
The registered mental health nurse must therefore be aware of approximate
equivalents in all major measurement systems.
I have used my knowledge learned
from many disciplines when administering medications. It is this knowledge that
helps me understand why a particular medication has been prescribed for a
patient and how this medication will alter the patient’s condition and behavior.
I have to admit that my weakness
lies in the fact that as a nursing student I have limited experience with
medication administration as it applies to professional practice. The clinical
provides me as a student the opportunity to use the nursing process as it
applies to medication administration. As I gain more experience in the field of
medication administration, my psychomotor skills become more refined. I have
learned that the attitudes of patients, knowledge, physical and mental status
and responses can make medication administration a complex experience.
Standards
Standards are those actions that
ensure safe nursing practice. Registered mental health nurses should be aware of
nursing standards called the six rights of medication administration in order to
ensure safe medication administration to mental health patients (Potter & Perry,
2004). All medication administration errors can be linked in some way to any
inconsistency in adhering strictly to the six rights of medication
administration. These six rights are as follows:
- The right medication
- The right dose
- The right patient
- The right route
- The right time
- The right documentation
Maintaining Patient’s Rights
Because of the potential risks
related to medication administration, the patient is also given rights. It is
the patient’s right to be informed of the medication’s name, purpose, action,
and potential undesired effects. The patient can also refuse medication
regardless of consequences. The patient also has the right to be properly
advised of the experimental nature of medication therapy and to give written
consent for its use. The patient has the right to receive appropriate supportive
therapy in relation to medication therapy. However, in the case of the mental
health patient who may have impaired reasoning, the family of the patient can
decide instead and take over the right of the patient.
Ways to Prevent Medication Administration Errors
The table below can help serve as a guide for nurses in avoiding errors
in medication administration.
PRECAUTION
RATIONALE
Read medication labels carefully.
Be aware of medications with similar names.
When new or unfamiliar medication is
ordered, consult resource.
Do not administer medication ordered by a
nickname or unofficial abbreviation.
Do not attempt to decipher illegible
handwriting.
Know patients with same last names. Also
have the patients state their full names, or ask their families if you
cannot talk to the patient.
Many products come in similar containers,
colors, and shapes.
There are many medication names that sound
alike.
If prescriber is also unfamiliar with the
drug, there is greater risk for inaccurate being ordered.
Many prescribers refer to commonly ordered
medications by nicknames or unofficial abbreviations.
When in doubt, ask the prescriber. Unless
nurse questions order that is difficult to read, chance of misinterpretation
is very high.
It is common to have two or more patients in
the hospital with the same or similar last names. Special labels n a
medication book can warn off potential problems.
Risk Management Process and Action Plan
Mental
health nursing is a profession in which “genuine human to human connection
should be of particular interest and priority” (Mohr, 1995, p. 365). The
identity of mental health nurses should be continually sought and defined in the
relationship. However, it has been argued that mental health nursing is in
danger of losing its identity if mental health nurses become puppets and just
simply imitate psychiatry’s footsteps, particularly after the field of
psychiatry has debated the wisdom of an exclusive focus on explanations and
treatments in the realm of biology (Raingruber, 2003).
The action plan should also include how as a
registered mental health nurse I was able to educate my patients and their
families. First it is important that as a registered mental health nurse I am
aware of nursing theories that are applicable to the mental health patient. One
such theory that is important is the preventive theory. Preventive theory as
developed by Caplan (1964) has three dimensions: primary, secondary, and
tertiary. Primary prevention emphasizes health promotion and prevention of
disability or disease. Education is the principal vehicle for this kind of
prevention. Early case detection and prompt treatment if disease occurs
constitute secondary prevention. Tertiary prevention refers to minimizing the
severity and residual effects of the disability or disease. Rehabilitation is
the principal method for this kind of prevention.
Certain social, political, and
economic actions on behalf of a patient’s mental health are inherently
compatible with professional values, and should be considered by all mental
health nurses. Nurses can be excellent participants and leaders on community
action boards, bringing to them special healthcare system knowledge.
Corporate Level
Various health groups in different
countries have set up policy and health program developments, and strategic
goals in relation to minimizing risk for errors when it comes to medication
administration. Various health services and agencies have come up with a
clinical guideline for medication administration risk assessment and prevention
of errors.
The answer
to reducing the prevalence of medication administration errors lies not in
implementing any one strategy, but in providing an institution-wide prevention
program. Assessments need to be repeated regularly throughout a patient’s
hospital stay and when there is a significant change in health status. A number
of risk-assessment tools can be used (Potter & Perry, 2004).
Organization Level
A major challenge in many areas of medical
practice is to successfully implement guidelines for clinical practice. A recent
review of effective strategies for implementing guidelines against medication
administration errors concluded that active strategies were more successful in
reducing the rates. The most effective strategies used targeted educational
sessions and, in particular, multiple approaches.
To formulate the action plan on this
level, hospitals and other health care organizations can develop reporting and
feedback processes for tracking medication administration to mental health
patients and the occurrence of errors. Health care organizations can also
develop and implement a comprehensive education program for nursing staff on
assessment, identification of risk and management of medication administration.
Project Level
Healthcare professionals must work together in
groups or teams in the care of a mental patient especially when it comes to
administering medications.
Nursing director:
The nursing director has the role of getting
reports from the head nurse. These reports would include statistics of how many
incidents of errors in administration of medication to mental health patients
are occurring in the hospital and how it is prevented according to new research.
In addition, the nursing director also has the responsibility of providing
qualified nurses and offers them new courses for continuing education.
Head nurse:
The head nurse plays an important role to
prevent the incidence of medication administration errors. The head nurse has
the responsibility of providing the policy and procedure in the unit for all
staff; as well as making the staff understand the need and importance of such
policies and procedures. The head nurse must also distribute enough staff nurses
to cover all shifts in the hospital unit because a shortage of nurses may cause
bad care for the patients that could lead to an increase in the incidence of
medication administration errors in the unit.
Clinical instruction:
Education and clinical instruction of mental
patients and their caregivers is an important function of health care
professionals, especially of the nurses (Potter & Perry, 2004). Also, the
caregivers of the mental patients should be the ones that should be more
educated about the situation since mental health patients could have deficits in
their understanding level. There are times that the caregiver should be the one
to administer medications to the mental health patient. There are a variety of
educational tools, including videotapes and written materials that can be used
by the nurse when mental health teaching patients and their caregivers or family
to prevent the errors in medication administration. Patient instruction should
be individualized for each patient, depending on the degree of mental health
impairment of the patients.
Nurse:
The nurses are responsible for regularly
monitoring patients and giving them the correct medication.
However, the nurse does not have the sole responsibility for medication
administration. The prescriber and pharmacist also help ensure the right
medication gets to the right patient. But still, the registered mental health
nurse administering medications is accountable for knowing which medications are
prescribed, their therapeutic and nontherapeutic effects, and the medications
associated to nursing implications. The registered mental health nurse is also
responsible for knowing why the patient needs the medication and determining if
the patient and their family require supervision with administration and
education about the medication and its effects.
Individual Level
All health care professionals should
receive relevant training or education in medication administration and the
prevention of errors in the field. Health care professionals with recognized
training the administration of medications should cascade their knowledge and
skills to their local health care teams. An inter-disciplinary approach to the
training and education of health care professionals should be adopted.
References
Caplan, G. (1964). Principles of preventive
psychiatry. New York: Basic books.
Kozier, B. and Erb, G. (2004). Fundamentals
of Nursing: Concepts, Process, and
Practice 7th Edition.
Pearson Education Inc.
Potter, P. and Perry, A. (2004). Fundamentals
of Nursing. Mosby.
Raingruber, B. (2003). Nurture: the Fundamental
Significance of Relationship as
a Paradigm for Mental Health Nursing.
Perspectives of Psychiatric Care.
Credit:ivythesis.typepad.com
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