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This paper presents an integrative review of articles regarding the aspects of psychiatric nursing in Canada. It studies the issues new registered nurses should consider before starting their practice and discusses the challenges associated with working in mental health units. The paper also addresses specialty training for psychiatric nurses in Canada and suggests the communication strategies and capacities caregivers should develop to provide high-quality care and reduce the risk of acute psychotic episodes in patients.
Issues New Registered Nurses Should Consider
New registered nurses should be aware of challenging working conditions they may encounter in acute inpatient psychiatry units. The research by Stevenson, Jack, O’Mara, and LeGris (2015) that involved twelve Canadian registered nurses proves that working in psychiatric care units can include exposure to violent behaviors. The study suggests that almost one-third of registered nurses report a physician-directed assault and around a half of them experiences emotional abuse (Stevenson et al., 2015).
It can cause high levels of staff turnover, a hostile working environment for caregivers, increased frequency of malpractice, and reduced quality of care. Novice registered nurses should consider these aspects and improve their communication skills to develop the practitioner-patient relationships based on collaboration, sensitivity, and respect (Gudde, Olsø, Whittington, & Vatne, 2015). Moreover, new caregivers should be aware of possible emotional effects of working in mental health care units, which can involve anxiety, anger, fear, depression, and sleep disturbance (Iozzino, Ferrari, Large, Nielssen, & De Girolamo, 2015). It is crucial for nurses to develop risk-management techniques before they start working with patients having acute psychotic episodes (Slemon, Jenkins, & Bungay, 2017).
Berring, Pedersen, & Buus (2016) point out that it is necessary for nurses to eliminate the stereotypical perception of patients as unpredictable, divergent, and dangerous. The study that involved 41 participants from five psychiatric mental health units shows that patients aspire to achieve non-confrontational social relationships while being engaged in threatening situations (Berring et al., 2016). The study by Lamothe, Rondeau, Malboeuf-Hurtubise, Duval, & Sultan (2016) suggests that new registered nurses can avoid adverse issues of care by developing emotional competencies, including acceptance, nonjudgmental attitude, and empathy to the patients.
Working in a psychiatric unit may be challenging, so it is necessary for new caregivers to consider the difficulties associated with their work before starting their practice. Novice care providers should develop stress-management strategies and study the risk factors that can contribute to the violent behavior of patients. For example, the investigation by Van Wijk, Traut, and Julie (2014) underlines the significance of a positive hospital environment for individuals, as the rigid attitude of medical professionals can result in patients’ aggressive behavior.
Canadian researchers suggest that the use of residency programs can improve the clinical skills of new practitioners and improve their confidence in working in psychiatric units (Pizzingrilli & Christensen, 2014). Moreover, exposure to mental health placements can enhance novice nurses’ knowledge of the issues they may encounter during their practice.
Nurses’ Specialty Training
In Canada, registered nurses can be employed in the field of mental health or psychiatric care along with licensed practical nurses, registered psychiatric nurses, and nurse practitioners. Smith and Khanlou (2013) note that there are no legislated provisions or educational programs for care providers wanting to specialize in mental health issues. In some provinces, they can obtain a Master’s degree in mental health, but there are no programs concentrating on patient diagnosis and medication prescription particular to psychiatric care. Halter, Pollard, Ray, and Haase (2013) also report that Canadian registered nurses are not obliged to have specific certification but may have specialty training.
The authors underline that in Alberta, British Columbia, Manitoba, and Saskatchewan registered psychiatric nurses represent a separate profession, while in other provinces registered nurses provide care in all medical units. It means that in Canada caregivers do not have to be specifically trained to work in the area of psychiatric care. Moreover, the opportunities for receiving education in the field are limited in Canada.
Nurses’ Communication Competencies and Strategies
Communication with patients can be challenging for novice registered nurses. Mani and Abutaleb (2017) reveal that new caregivers are hesitant to approach psychiatric patients showing aggressive behavior, avoid discussing sensitive topics, and feel uncomfortable in emotionally charged situations. It can be a result of the stigma associated with mental health illnesses, a lack of working experience, as well as wrong perceptions of the nurses’ role in psychiatric care.
Therapeutic communication is an essential clinical competency for novice nurses. Abdolrahimi, Ghiyasvandian, Zakerimoghadam, and Ebadi (2017) view it as a primary method of building interpersonal relationships and a significant tool for providing patient-centered care. Amoah, Anokye, Boakye, and Gyamfi (2018) report that the lack of therapeutic communication knowledge and skills is a challenging issue for almost 35% of new nurses.
The study by Aguiar et al. (2018) underlines that communication competencies should be taught to nursing students at universities to reduce their lack of confidence. Moreover, other researchers note that communication is essential to patient safety as incorrect treatment is often a result of communication failure (Furnes, Kvaal, & Høye, 2018). Nurses with no prior psychiatric experiences should acknowledge their possible emotional responses to challenges associated with mental health nursing and develop the behavior that will meet patients’ needs. For example, they can use the method of communication simulation to prepare for practice and increase their confidence before encountering real patients.
New registered nurses should consider learning de-escalation techniques as they can reduce the risks of patients’ acute psychiatric episodes as well. For example, caregivers can listen to the patients’ concerns to reduce their stress levels, follow their choice of language (slang or jargon), or involve them into a distracting activity, such as taking a shower (Berring et al., 2016). The research by Moss (2015) proves that such a method can enhance nurses’ communication capacities, and reports that the ability to interact with patients effectively often depends on the length of time caregivers work in the hospitals.
Another communication capacity that nurses should master to manage and prevent violent behavior in acute psychiatric care include the ability to adapt to patients’ conditions, such as speaking slowly or loudly. It is crucial for caregivers to address every individual’s needs to develop positive relationships with them. Moreover, care providers should be able to use the body language carefully and pay attention to their posture, the position of their hands, and their facial expression.
Positive nonverbal messages can reduce the risk of physician assault or other forms of abuse. It is essential for nurses to note which communication techniques are most useful for in care and apply their experience to eliminate adverse issues associated with psychiatric nursing.
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In Canada, caregivers do not need specialized training to work with individuals that have mental health disparities; the opportunities for education in the field are limited as well. However, it is crucial for new registered nurses to be aware of the challenges associated with psychiatric care. Residency programs, stress-management strategies, and elimination of stereotypes associated with mental illnesses can improve care providers’ experiences in care. To work in psychiatric units, registered nurses should also develop communication competencies, including de-escalation techniques and the ability to adapt to patients’ needs and use the positive nonverbal language.
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