Reflection upon my practice as an experienced student nurse undergoing the transition of registered mental health nurse
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 (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.
When it comes to education, I know that as a student nurse I still have a lot to learn. This is one area where I feel that I am weak. I still need more education to be able to carry out my role as a mental health nurse. I personally believe that even when I become a registered mental health nurse, I still need to continually study and learn. It is a must that a registered nurse must attain knowledge and competency that would reflect the best current mental health nursing practice.
A registered mental health nurse interacts with and contributes to the professional development of peers and colleagues (Potter & Perry, 2004). As a student nurse, I have shared my knowledge and skills with my fellow classmates and even with some registered mental health nurses when I was practicing as a student. I have also maintained a compassionate and caring relationship with the other student nurses and registered mental health nurses. This way, I am able to enhance my own professional nursing practice and role performance. However, as a student nurse I feel that my weakness in this area about collegiality is that when I notice that the other registered nurses and student nurses have not performed the right procedure, I hesitate to give feedback regarding the practice or issue. I feel that I need to improve my voicing out of opinions or giving feedbacks to my colleagues.
When it comes to the care of the mental health patient, the registered mental health nurse collaborates with the patient, family, and others in the conduct of nursing practice. In my own reflection, I am aware that I have done this during my student practice. I communicate with the mental health patient, family, and other health care professionals regarding the care of the patient and my role in the provision of that care. I know that I really needed to ask and collaborate with other people because handling a mental health patient is very difficult. Especially when it comes to creating a documented plan for the mental health patient, my role becomes more difficult. Thus I collaborate with the patient, the family, or other health care professionals in creating a documented plan focused on outcomes and decisions related to care and delivery of services appropriate for the mental health patient.
The registered nurse also considers factors in the utilization of resources that are related to safety, effectiveness, cost, and impact on the planning and delivery of mental health nursing services ( 2004). As a student nurse, I was able to evaluate factors such as safety, effectiveness, costs and benefits, efficiencies, and impact on practice when I choose practice options that would result in the expected outcome. I was also able to assign and delegate tasks which I base on the needs and condition of the mental patient, potential for harm, stability of the mental patient’s condition, complexity of the task, and the predictability of the outcome. As a student nurse, I was also able to assist the patients and their families in becoming informed consumers about the options, costs, risks, and benefits of treatment and care with regards to mental health and illness.
Action Plan
(1963 described a number of tensions that help us understand developmental processes during the stages of identity formation. The same goes true in finding a perception for explaining, defining, and guiding mental health nursing. The development of an action plan that can guide not only me but other mental health nurses is definitely not an easy task given the fact that there is still an ongoing debate on the paradigm about mental health.
Mental health nursing is a profession in which “genuine human to human connection should be of particular interest and priority” ( 1995). 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 (2003).
There is a debate regarding the cause of mental illness, whether by nature or nature and this has posed implications for which mental health nurses face a problem on which aspect should be used for reference. The selected paradigm or aspect must feed and nourish the mentally ill patients as well as the nursing profession. There are many authors that have argued that nurses should avoid adopting a perception that is overly individualistic or reductionistic because this could be in contradiction to the nursing profession’s efforts to seek scientific and professional legitimacy (2002;1992).
Mental health nurses are taking a significant and leading role in the innovation that is driving up the quality of mental health services. I still have to improve myself to be able to proudly contribute to the quality of mental health services and staff. To be able to strengthen my strengths and overcome my weaknesses, I have developed a plan of action based on what is the standard and required of registered mental health nurses.
First of all, when I become a registered mental health nurse, there is a need for me to obtain and maintain a professional certification in the area of expertise. To further improve myself, I also need to evaluate the practice environment or the health care environment and the quality of nursing care rendered in relation to existing research and evidence.
When it comes to education, I should participate in ongoing educational activities related to mental health nursing and other professional issues. I must demonstrate a commitment to lifelong learning through self-reflection and inquiry to identify if there are any learning needs that I should fulfill. Additionally, I have the responsibility to maintain my professional records that will provide evidence of competency and lifelong learning.
When it comes to collegiality or relationship with colleagues and peers, I must develop the courage to be able to give out feedback because this can be constructive and can help them. Participation with interdisciplinary teams that contribute to role development and advance nursing practice and health services must also be practiced. I must collaborate not only with other health care professionals but also with the patient and the family when it comes to care and delivery of health services. (1996) indicated that mental health nurses who work in inpatient facilities have minimal interaction with other health care professionals and patients; thus has a reported high level of burnout.
Aside from collaboration with health care professionals in the hospital or other health care setting, the registered mental health nurse also has to collaborate with other people outside of the health care field. Collaboration among psychiatric mental health nurses, school nurses, school administrators, and counselors is also advised and can result in establishment of multi-focused violence and suicide prevention programs with evaluation criteria and the ability to be replicated. These programs should include staff training in violence and suicide awareness and crisis intervention as well as group leadership instruction. The nurse can also join or establish support groups to decrease isolation and increase coping skills among patients that are at risk for depression and suicide (1990).
Collegiality and collaboration both emphasize the need for communication the area of mental health nursing. This could be discussed in relation to the general systems theory. General systems theory refers to a set of interdependent parts that are goal-oriented, require resources, and exist within an environment (1972). A basic assumption of systems theory is that the whole is greater than the sum of its parts. Concepts such as independence, interdependence, boundaries, organization, equilibrium, and goals are integral to systems theory. Communication also is an important dimension of general systems theory because all human systems are open insomuch as they admit information from and exchange information with the larger environment. Change in any one part affects all other parts of the system.
In relating systems theory to nursing, (1989) defines nursing “as a process that functions to convert the knowledge and skills of the nurse, patient, and patient’s family into supportive and therapeutic interventions against illness, disability, and loss” (). This same nursing process can be applied in a nontraditional practice setting.
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 (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.
In the aspect of resource utilization, the registered mental health nurse must utilize organizational and community resources to formulate multidisciplinary or interdisciplinary plans of care for the mental health patient. Additionally, the mental health nurse must develop innovative solutions for the mental health care patient’s problems that would address effective utilization of resources and the maintenance of quality.
As a registered mental health nurse, the nurse must also act as a leader. The registered nurse provides leadership in the professional practice setting and the profession (2004). The nurse must provide direction to other colleagues to enhance the effectiveness of the health care team taking care of the mental health patient. The registered mental health nurse must additionally work to influence decision-making bodies to improve the quality of mental patient care, health services and policies for the mental health patient.
Nursing roles appropriately include the development of reports to document needs, the preparation of grants to secure funding for selected aspects of service, leadership in grassroots community organizations, and networking to build action coalitions among various providers and service agencies. Individual clinical skills also can be utilized within existing provider organizations on a voluntary basis ( 1996).
There has been much less consideration, however, of the ways in which professional values are to be applied by individual nurses in acting to address broad social and health policy issues, such as that of adequate and appropriate mental health services for the patients and their families. A few visionary nurses have written about values and resultant action for the larger social good (1994; 1991), and there have been numerous calls for nurses to become more responsible for and involved in shaping health and social policy.
Still, the translation of such conceptual mandates into clear strategies to be utilized by individual nurses in addressing specific health policy issues has been less common. It is Important to consider how professional nursing values can be used to derive and direct the actions required of individual nurses in acting to preserve and enhance mental health services for children and families (1996).
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