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Foreword
Consumers, Practice, Interventions and Education in Mental Health Nursing
Sandra Talley
President, American Psychiatric Nurses Association 2004-2005; Associate Professor; Director, Psychiatric Mental Health Nursing Specialty, Yale University School of Nursing, New Haven CT, United States of America
Article Text
This Special Issue contains articles devoted to some of the most important topics faced by psychiatric mental health nurses: violence, 'difficult to treat' disorders, cultural sensitivity, safety of psychotropic medications, and application of mental health services in non-mental health settings. Each of these topics presents a significant challenge within the profession requiring efforts to find evidence based studies and practices that will help care providers deliver state of the art (or science) interventions.
We know that violence takes a toll on both the perpetrator as well as the victim in psychiatric settings according to a report by authors from Sweden, Carlsson, Dahlberg, Lützen and Nystrom (2004). In this issue, two articles further describe these concerns through a focus on promotion of mental health in the workplace (Barkway) and research on violence against psychiatric nurses (Lanza, Zeiss, and Rierdan). These types of works are essential in order to inform the field on how to protect staff working in the specialty to understand the nature of violence in our work environments, and to promote mentally healthy environments for staff. A related topic on 'recruitment and retention of overseas nurses' (Omeri) is instructive for what obligations we face when we bring nurses to our country during shortages. And lastly, the civil commitment process has always brought many different views to the process of determining who should be involuntarily treated, and what should the treatment unit do in preparation for individuals being sent for legal proceedings. McKenna et al offer their ideas of a best practices model for mental health nurses involved in these delicate proceedings.
A focus on treatment of borderline personality disorder (BPD) further informs the literature regarding this very difficult disorder. The management of clients with BPD remains a challenge for staff who must prevent clients from self-injury, while assisting them to gain emotional and cognitive control. Hazelton, Rossiter, and Milner provide a model (Dialectical Behavioral Therapy - DBT) for teaching staff how to learn and apply new techniques which have proven to have some efficacy with this disorder. One of the most studied aspects of DBT has been on self-harm with some early results that it may be useful in reducing the number of attempts (Hawton, Townsend, Arensman, Gunnell, Hazell, House and van Heeringen 2005).
Another focus on this Issue has to do with psychopharmacology. Usher and Foster review the available literature and research on psychotropic medications with mother's who are breastfeeding. This is an ongoing problem for mental health providers who wish to do no harm to the newborn, but must weigh the evidence about what are the safest medications, and how to achieve positive outcomes for new mothers.
Not all new mothers may even be aware of how to assess their changing mood states which accompany birth and delivery, and their transition to the post partum period. Horowitz provides a model for a community based screening of new mothers during the first month after delivery. With the all too often news reports of infanticide and postpartum depression and/or psychosis we are reminded that there must be more accessible efforts to screen all new mothers rather than hope they seek help on their own.
The delivery of mental health services in the Emergency Department can range from supportive care to specialty mental health care. What is unique about the article by Wand and Schaecken is that they approached the consumers of services in order to generate data for a best practices model. This moves the delivery of care model away from the exclusive domain of the professional and involves recipients of care as partners in the quality outcome process. This is much like the focus on cultural sensitivity which always remains in the eye of the beholder (O'Brien).
I hope you enjoy this issue as an opportunity to round out some new areas of investigation and prepare you a bit more for the complicated environment in which we all practice today. Nothing is either sacred or static anymore, and our efforts to keep up with the knowledge generated within our specialty are assisted by Issues such as this one that brings forth a rich menu of topics.
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