Psychiatric nursing faces many challenges. These include challenges in effective care delivery due to issues like frequent patient relapse and complex symptoms, challenges associated with psychiatric nursing education like lack of clinical infrastructure and opportunities for knowledge application, and challenges to psychiatric nursing research such as ethical issues and lack of ground-level data. Stigma is also a significant social challenge to effective mental healthcare delivery. Addressing these challenges will help improve psychiatric nursing practice and the recovery of those with mental illness.

1. Challenges in
Psychiatric Nursing
Bivin B. Jose. MSN.
Psychiatric Nurse, Male Forensic Unit,
Govt. Mental Health Center, Thiruvananthapuram

2. 1. What does challenge mean?
2. Psychiatric nursing; meaning and concept?
3. Changing trends in mental health care; will it be a challenge?
4. Future of psychiatric nursing practice; is there a challenge?
5. Stigma as a social challenge in effective care delivery
 Continues…
Overview

3. 6. Challenges in effective care delivery in clinical
settings
7. Challenges associated to psychiatric nursing
education & Research
8. Challenges in psychiatric nursing education
9. Challenges associated to psychiatric nursing
research
Overview

4. What does challenge mean?
 Noun
 A call to someone to
participate in a
competitive situation or
fight to decide who is
superior in terms of
ability or strength
 Verb
 Invite someone to engage
in a contest

5. Psychiatric/ MH Nursing;
Meaning and concept
 Wellness promotion:
 Stress management
 Social support enhancement
 “Psychological First aid”
 Illness treatment:
 Early recognition
 Early intervention
 Symptom management
 Preventing relapse
Not just symptom reduction (Remission) but recovery to be
focused

6.  Recognition & treatment of FEP have increased chance of
recovery.
 Half of all lifetime causes of diagnosable mental illness starts
under the age of 14 years
 Kesler et al, 2007
 Three quarters by mid-20s
 Meltzer et al, 2003
 Sixty to seventy percent of children with clinically significant
difficulties have not received appropriate MH interventions
 Friedy & Parsonage, 2007
Why recovery-focused MH care?

7.  Provides an insight into patients’ needs
 Patient-centered approach. (case method)
 Treatment based on measurement metrics
 Challenges
 Lack of quality time
 Public perception/stigma
 Lack of clinical guidelines
Challenges in recovery-focused care

8.  Caring concept from “Mental Illness to mental health”
 Deinstitutionalized care- Deduction in the duration of
IP stay
 Community based mental health care
 Time-consuming psychotherapeutic regimen
 Advancement in psychopharmacology
 Emerging branches of advanced psychiatry
Trends in Psychiatric Care

9.  Changing concepts related to diagnoses and
nomenclature (ICD/DSM?)
 Decentralized service delivery
 Emerging psychiatric care through allied health
disciplines
 Increased mental health literacy among public
Trends in Psychiatric Care
Continues…

10. Future Psychiatric Nursing
 Translational Nursing
Practice
 Concept of “Bench to
bedside”
 Transformational Nursing
leadership
 Inspirational leaders
 Collaborative roles
 Multi-level Nursing
 Through the different
stages of patient progress
 Multidisciplinary Nursing
 Team management

11.  Stigma is a global challenge in mental health care
 Associated with human right violation in many
societies
 Social and cultural context as loci of control
Stigma as a social challenge in
effective care delivery
Stigma
(Disgrace)
Prejudice
(Negative
opinion without
experience)
Discrimination
(Act of ill
treatment)

12. Stigma in Mental illness
What people see
 Cutting people out or giving up
friendships
 Laziness or not trying enough
 Staying in bed all the day
 Not listening/ paying attention
 Being rude/bad attitude
 Purposely distant
 Not caring/being selfish
What actually happening
 Self isolating due to severity of illness
& many other reasons
 Fighting so hard but silently
 Exhausted, fatigue or no energy
 Severe symptoms that freezes him into
the bed
 Intrusive thought/voices often louder
than people who talk
 Constant worrying, ruminations
 Unable to express emotions

13.  Self stigma
 Therapeutic intervention
 Peer support programs
 Public stigma
 Community awareness programs
 Motivational stories
 Structural stigma
 Policy changes
 Educational programs
Anti-stigma strategies

14. Physical layout
Patient characteristics
Therapeutic Roles
Staffing
Challenges in effective care delivery in
clinical settings

15.  Should psychiatric
hospital need a special
design?
 Why a behavior
monitoring system
needed?
 Continues..
Challenges related to physical design

16.  Seclusions; is it really a need?
 Chemical Vs. Physical restraints
 How would a psychiatric ward
be safe?
 Where to place nurses’ station in
a psychiatric hospital?
Challenges related to physical design

17.  Frequent relapse
 Poor compliance
 Accessibility &
affordability issues
with Treatment
 Adverse drug reactions
 Co-morbidities
 Expressed emotions
Challenges related to patient
characteristics- Relapse

18.  Poor insight
 Socio-demographics/
Cultural sensitivity
 Co-morbid illnesses
 Variety/ complexity of
symptoms
 Trust/confidentiality
issues
Challenges related to patient
characteristics

19.  Overlapping therapeutic roles
 Wellness initiatives
 Consultation- Liaison functions
 Mentorship vs partnership roles
Challenging therapeutic roles

20.  Legal liabilities- National Mental Health care act
(7th July 2018)
 Human rights issues with involuntary
admissions
 Rehabilitation challenges
 Community based
 Vocational
Challenging therapeutic roles

21.  Staff shortage & Non-nursing roles
 Absence of a specific guidelines on MH nurses’
assignment
 Lack of Unified guidelines on staff recruitment
Challenges with staffing

22.  Operational manuals
based on evidence is
lacking
 Active professional
bodies specific to
psychiatric nurses
 Low opportunities for
learning while doing
Challenges with staffing

23.  Lack of clinical infrastructure
 Accessibility of the training institution
 Lack of guidelines for student appraisal
Challenges associated to psychiatric
nursing education

24.  Negligence from other
disciplines in nursing
 Confidentiality issues
 Lack of opportunities in
application of knowledge
in terms of assessment,
planning and interventions
Challenges associated to psychiatric
nursing education

25.  Based on acknowledging &
respecting human values
 Helpful in recognition of self &
others potential
 Class-room based training
modules are available
 Peer mentorship models are
tested using group assignments
Value-based education; anything
related?

26.  Ethical issues & informed consent
 Discipline specific interventions with its efficacy tested
 Cultural sensitive measurements
 Lack of ground level data
 Insisting on higher form of evidence without an
adequate ground-level work
 Poorly developed strategies adopted from other
disciplines
Challenges associated to psychiatric
nursing research

27.  Stigma/ misconceptions are greater challenge to MH
care
 Changing global trends in MH care is indeed a
challenge to nurses
 Development of MH specific clinical guidelines,
measurement modes and policy changes are vital
 Recovery focused care and value based education
could better be adopted with it’s best evidences
Conclusion

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References

29. Discussion & Queries