What is the role of a nurse in your mental health care? I’ve never really considered this until today. When I think about it, nurses were key in improving my quality of life when I was an in-patient in a psychiatric ward. In another case, after I received surgery (appendicitis), I spent much more time with nurses than doctors. They really took care of my physical needs, which ensured my mental health wasn’t impacted.
Today is International Nurses Day, a day meant to honour and celebrate the contributions of nurses worldwide. To show my appreciation for nurses, I wanted to share stories and opinions directly from nurses themselves.
I interviewed Shanna, a psychiatric nurse from Montreal who has direct experience working with mental health patients. I also interviewed Jayne, who works in Toronto as a nurse in a cancer unit, with elderly patients who have their own unique mental health needs. These patients are suffering from a variety of cancers, such as breast, lung, prostate, colon, etc. They can range from quite healthy and receiving chemotherapy, to actively dying and breathing their last breaths.
I’ll get right into it with the questions and answers:
What is the role of a nurse in caring for a patient with mental health?
Shanna: It depends on what sector of mental health care the nurse works in. I work in in-patient care, which is when a patient is hospitalized as a result of their mental health issue. My role is to work with the health care team, which is made up of (but not limited to) psychiatrists, social workers, psychologists and occupational therapists. Together, we develop individualized treatment plans for each patient under my care. Throughout a patient’s treatment in-hospital, I will offer support, advice, communicate with families and advocate for those who are not in the condition to advocate for themselves. I also assess and monitor their medical issues.
Jayne: The role of nursing is very much the same across all specialties of healthcare. We are the front-line. We are the advocates for our patients. A nurse who actually works in mental health would have more training and experience in the unique needs of mental health patients. But that doesn’t mean nurses in other settings can’t provide quality care to these patients too. Personally, I think the most important role is patient advocacy. It is out of our scope to diagnose or prescribe treatments to these patients. However, it is well within our scope to recognize signs of depression, suicide ideation, obsessive behaviors etc. and bring it to the attention of the rest of the health care team. After that, we need to ensure that these issues are being treated just like we do with any physical symptoms or medical diagnoses. I believe that is the first step to helping patients get the best care for their mental health (especially when they’re not in a mental health setting).
What is the most rewarding part of your job?
Shanna: The most rewarding part of my job is seeing patients gain insight into their condition. Once that happens, they will most likely collaborate in their treatment, get well and be discharged from the hospital. I feel like a proud momma!
Do you have an idea on how mental healthcare could be improved?
Shanna: There are so many ways in which mental healthcare can be improved. We need more resources, in particular a bigger focus on prevention. We need more teaching and education around mental illness. There also needs to be a focus on hiring more nurses and funding more research. Finally, we need to work on debunking the taboo that surrounds mental illness.
Jayne: There needs to be more awareness of the importance of mental health in in-patient settings. Cancer has become like any other chronic illness, as survival rates are increasing. All these patients are living with an illness that needs consistent monitoring and treatment. How can we not think about their mental well-being? That is because our health care system is based on the biomedical model that solely focuses on physical well-being. I think one solution would be to re-focus our education system. Education for health care professionals need a bigger emphasis on mental health. And naturally, slowly, hospitals will evolve to be less biomedical, and more holistic. Hopefully we can get to a point where signs and symptoms of mental illness are assessed and screened in all health care settings just like how physical illnesses are now. I also think this helps answer your second question: if we, as health care professionals and the health care system as a whole, put more emphasis on mental health, then patients may be more inclined to advocate for their mental health instead of feeling embarrassed about their depression or that it’s not important to bring attention to.
Just to quickly summarize: I think our health care system is seriously lacking in education, and awareness of mental health. Although my answers are very specific to medical in-patient units, I think it strikes an alarming parallel to the real world where people in general are uninformed about mental health, and therefore ignorant to its importance and prevalence.
What did you learn about mental health in school versus on the job?
Jayne: Very little – in both those settings. There is a major gap in education on mental health, at least in my nursing program. We learned the basics of the major disorders such as depression, bipolar, schizophrenia, but it was such a small part of the curriculum that I hardly remember any of it. We had a larger focus on Alzheimer’s and dementia due to the demographics of our patients. But really we didn’t learn much at all about mental health.
At work, due to the setting, I have very little exposure to mental health patients. In fact, I admitted a patient that was labeled as “a psych patient”, meaning her major issues were not exactly “medical” and she was followed by psychiatry (also, an example of how mental health patients are quickly stereotyped even in a hospital setting). I remember having no idea how to care for this patient and feeling unprepared. So I just stuck with what I knew and cared for her as I would for any other patient. She was soon discharged with not many changes to her care plan. Although I understand psychiatry is not the expertise of our unit, I still felt I would have liked to be able to cater my care for her needs, instead of giving her a “one-size-fits-all” kind of care. So in a typical medical in-patient floor, there is very little education or training on mental health.
Shanna: In school, (CEGEP Registered Nurse program) mental health took up half of a semester. I learned about the main illnesses and disorders in a lot of detail, as well as the main medications. I completed a few weeks of clinical hours on a psychiatric unit, which did help prepare me to work in psychiatry. However, working full- time on a psychiatric unit, or any hospital unit in our public health care system, is eye-opening to the resources we lack.
How can patients advocate for themselves in their own mental health care?
Shanna: By understanding their illness/disorder, their triggers and seeking help when their condition changes. Additionally, they can better advocate for themselves by understanding the medications they’re prescribed, how they work for them and why they need them. If they have concerns, they should also address them with their psychiatrist. They could also better advocate for themselves by knowing what resources are available to them and making use of them. Finally, they can help themselves by creating a support system, whether it be friends, family, or resources (crisis centres, group homes, community health centres, etc).
Jayne: This is a difficult question to answer because the first thing that comes into my head is the concept of health literacy. Health literacy is basically a person’s ability to understand their health and illness to an extent that allows them to make informed decisions. (Many things like level of education, socio-economic status, literacy and more, all affect health literacy.) All of our patients on my floor are diagnosed with at least one type of cancer, and because they are in the hospital, it means they’re not doing so well. You can imagine that every single patient probably has some kind of mental health need. The issue here is that they may not realize it – they do not have the health literacy to realize they have mental health needs. And without that basic knowledge or understanding of their own needs, how can they advocate for themselves? Building on top of that, even the patients who are already diagnosed with mental illnesses hardly get much support on that aspect of their health, as most of the focus is on oncology and medical treatments.
So that’s it for my interviews with Jayne and Shanna! Do you have a good experience with a nurse that you want to share in honour of International Nurses Day? Comment below!