Page 111 - Encyclopedia of Nursing Research

78 n CoMMUnITY MEnTAL HEALTH

the national Institute of Mental Health in and expand their practices to include a var-
the 1980s, psychiatric nurses grew more ied clientele base.
C sophisticated and diversified. They began to In the United States, psychiatric nurses
function as psychotherapists for individu- continued to develop pivotal roles in a vari-
als, families, and groups and to serve as ety of community treatment modalities. In
case managers and coordinators of commu- one national survey of assertive outreach
nity services. Psychiatric home care nursing programs, findings show that 88% had a
also began to flourish during this period as psychiatric nurse as an integral member
reimbursement for these services became of the treatment team (Deci, Santos, Hiott,
available (Fagin, 2001). Although nurs- Schoenwald, & Dias, 1995). over time, psy-
ing research related to community mental chiatric clinical nurse specialists became
health was still scarce, an early intervention recognized as independent practitioners,
study (Slavinsky & Krauss, 1982), funded eligible for third-party reimbursement, and
by the national Institute of Mental Health, active in caring for seriously mentally ill
characterized nurses’ commitment to the patients (Iglesias, 1998; White, 2000); how-
care of psychiatric patients in the commu- ever, research addressing specific psychiat-
nity and their skill in developing innovative ric nursing interventions for this population
programs for this population. was still quite limited (Beebe, 2001; Rabbins
The drive for autonomy for community et al., 2000). The “Decade of the Brain” in the
psychiatric nurses in the United Kingdom 1990s brought the medicalization of psychi-
was away from psychiatry and “general nurs- atric practice. In response to the challenge
ing.” Their “professionalization” and expan- of integrating biologic knowledge into clin-
sion was largely achieved through their ical practice, psychiatric nurses working in
successful incursion into primary health care community mental health centers and in pri-
and distancing from mental health teams. vate practice in the United States sought pre-
Government initially supported community scriptive authority. Current nursing research
psychiatric nurses’ efforts in building new reflects efforts to understand prescribing
relationships with general practitioners and practices of advanced practice psychiatric
even funded their training (Godin, 2000). nurses (Talley & Richens, 2001) and identify
Community psychiatric nurses expanded in barriers to prescriptive practice (Kaas, Dahl,
number and also in the range of therapeutic Dehn, & Frank, 1998).
approaches used in their practices. As their By the 1990s, community psychiatric
self-image as professionals and their rela- nurses in the United Kingdom were numeri-
tionships with general practitioners grew, cally the most dominant occupational group
however, their caseloads became composed within community mental health care; how-
of patients with less severe problems (Godin, ever, this also meant that they were per-
1996). The findings of one U.K. study (Barratt, ceived as responsible for many of its failures.
1989) show community psychiatric nurses’ Criticism was primarily directed toward
self-perceived roles becoming more differen- their decision to shift focus away from the
tiated, emphasizing prevention, counseling, care of patients with severe mental illnesses
and a variety of therapies for certain patient in favor of work in primary health care. Many
populations. Another study (Wetherill, Kelly, also questioned the effectiveness of their
& Hore, 1987), investigating the effectiveness work in primary care, contending that coun-
of a structured home intervention to improve seling-based interventions were of unproven
patient compliance in alcohol treatment and worth with people experiencing minor, self-
recovery, demonstrates the growing ability of limiting problems, and were not cost effective
community psychiatric nurses in the United (Hannigan, 1997). not only were community
Kingdom to develop innovative interventions psychiatric nurses directed to reappraise the