Page 110 - Encyclopedia of Nursing Research

CoMMUnITY MEnTAL HEALTH n 77

and patients who are nonverbal or uncon- increase in resources was initiated (Bonner,
scious, comfort management competency 2000; Wright, Bartlett, & Callaghan, 2008).
tests, instruments for research, and so forth. The shift from hospital to community C
posed challenges for psychiatric nursing
Katharine Kolcaba in both countries. Most psychiatric nurses
in the United States were educated through
hospital-based programs, making them
ill equipped to take on the demands of an
CoMMunity Mental expanded community role. Although the
findings of several early descriptive studies
health (Hess, 1969; Hicks, Deloughery, & Gebbie,
1971) show psychiatric nurses functioning in
diverse roles, nursing leaders (Mereness, 1983)
over the past 50 years, the community mental during this period expressed concern that
health movement has had a tremendous too often nurses in community mental health
impact on psychiatric nursing, taking psy- adopt “residual roles,” resulting from their
chiatric nurses into communities and freeing lack of education in psychiatric theory and
them from their almost exclusive practices in unequal status among fellow professionals.
large state hospitals. nursing research in the In the United Kingdom, social workers
area of community mental health has steadily were the primary professionals delivering
increased, the United Kingdom having con- care to mentally ill patients in the commu-
tributed most to this body of literature, espe- nity. nursing was represented by the part-
cially in recent years. Historic influences in time activity of hospital-based psychiatric
the United States and United Kingdom cre- nurses who were seen merely as a mech-
ated different climates from which nursing anism through which psychiatrists could
research in each of these countries emerged. extend their authority beyond the confines
From the early nineteenth century until of the hospital (Bonner, 2000; Wright et al.,
the 1960s, mental hospitals, or “asylums,” 2008). In both countries, the main role for
constituted the major treatment resource community psychiatric nurses during these
for the mentally ill in both the United States early years was the task of administering
and United Kingdom. Advances in the use of depot injections to patients with severe men-
psychotropic medications and government tal disorders.
policy directives in each country spurred The 1970s and 1980s were character-
movement of mentally ill patients into the ized by role differentiation and expansion
community. The historic report, Action for for community psychiatric nurses in both
Mental Health, presented to the U.S. Congress countries. In the United States, there was
in 1961, recommended a shift to community- recognition of the need for advanced edu-
based care. This was followed in 1963 by the cational preparation of psychiatric nurses
enactment of the Community Mental Health to meet the challenges of this evolving role
Centers Act, which authorized $150 million (DeYoung & Tower, 1971). The findings of
in federal funds to develop comprehensive one descriptive study (Davis & Underwood,
community mental health centers (Miller, 1976) show that although half of the nurses
1981). The United Kingdom followed suit in employed in four community mental health
1962 when British politician Enoch Powell centers earned a bachelor’s degree and pro-
presented his Hospital Plan for England to vided some consultation and counseling,
Parliament; however, it was not until the most of their time was spent performing
publication of the 1975 White Paper, Better traditional functions. With increased edu-
Services for the Mentally Ill, that any real cational opportunities, funded largely by