- Email: [email protected]
Formulating global perspectives on mental health care: Impressions and experiences from the APNA delegation to China
Journal of the American Psychiatric Nurses Association
Briefings
Formulating Global Perspectives on Mental Health Care: Impressions and Experiences from the APNA Delegation to China Carol D. Campbell, RN, CS, MSN, and Laurie A. Rockelli, RN, CS-P, MS
I
n June 2001, we traveled to the People’s Republic of China with the American Psychiatric Nurses Association (APNA) delegation. The purpose of the trip was to learn firsthand about the evolution of nursing, medicine, psychiatry, and mental health services in China. Professional Exchanges International, along with APNA and Jane Ryan, who served as delegation leader, coordinated our group. The delegation consisted of nine psychiatric nurses, a family medicine physician, a retired superintendent of schools, and a culinary expert. For 2 extraordinary weeks, we traveled throughout China and explored the cities of Beijing, Xi’an, Guilin, and Shanghai.
Carol D. Campbell, RN, CS, MSN, is a doctoral student at the University of North Carolina at Chapel Hill. Laurie A. Rockelli, RN, CS-P, MS, is a therapist at Maple Shade Mental Health Clinic in Mardela Springs, Maryland. Reprint requests: Carol D. Campbell, RN, CS, MSN, 907 N. Columbia St. Chapel Hill, NC 27516. J Am Psychiatr Nurses Assoc (2001). 7, 163-5. Copyright © 2001 by the American Psychiatric Nurses Association. 1078-3903/2001/$35.00 + 0 66/1/118652 doi.10.1067/mpn.2001.118652
October 2001
We attended professional meetings, seminars, and banquets with Chinese counterparts and visited numerous medical, psychiatric, and Traditional Chinese Medicine (TCM) hospitals, along with mental health centers and medical universities. Highlights from the cultural part of the trip included visits to The Great Wall, Tiananmen Square, the Forbidden City in Beijing, and the famous Terra Cotta Warriors in Xi’an; a breathtaking cruise on the Li River in Guilin; and visits to the Shanghai Art Museum, the Old City, and the Jade Buddha Temple in the modern city of Shanghai. Meeting Marlys Bueber, an American psychiatric nurse who lives in Beijing with her psychiatrist husband, was an invaluable experience. Marlys, a master’s-prepared psychiatric–mental health clinical nurse specialist, has been practicing psychiatric nursing in Beijing for more than 10 years. She provided us with an initial overview of psychiatric-mental health nursing in China and shared many of her own personal insights and experiences about mental health care in China. IMPRESSIONS FROM PROFESSIONAL MEETINGS AND SEMINARS During the professional meetings and seminars, with the assistance of outstanding translators, we were able
to exchange information, ideas, problems, and concerns related to mental health care with our Chinese counterparts, who represented hospitals, mental health centers, universities, and professional associations. Dialogue during the meetings and seminars focused on nursing education, practice, and research; exploring similarities and differences in the profession of nursing between China and the United States; the incidence and prevalence of psychiatric disorders in China; intervention strategies used to treat patients with psychiatric disorders; and the mind/body interface from a multicultural perspective. We were eager to learn about the education and practice of psychiatric nurses in China, although it was disappointing to learn that nursing students in China receive very little formal psychiatric training. According to several Chinese nursing faculty present at the professional meetings and seminars, no psychiatric–mental health nursing course is offered as part of the nursing curriculum, and no psychiatric nursing textbooks are available in the Chinese language. Several textbooks have been translated from other languages, including English; however, concepts essential to psychiatric nursing have a tendency to lose their meaning in translation. Some psychiatric–mental health nursing content is incorporat-
APNA Web site: www.apna.org 163
Campbell & Rockelli
Journal of the American Psychiatric Nurses Association
Figure 1. APNA delegates met with members of the Chinese Nurses Association in Beijing.
ed into other required nursing courses, but the majority of psychiatric nursing education is learned on the job from experienced nurses and psychiatrists. Members of the Psychiatric Nursing Academic Committee of the Chinese Nursing Association shared their hope of eventually adding a psychiatric–mental health nursing course to the required nursing education curriculum. During the past several years, the Chinese government has been focusing on the importance of additional education for all nurses, with an emphasis on continuing education opportunities for nurses, advanced nursing education, and the requirement that nurses educated in nursing and health schools obtain additional nursing education and take college courses such as anatomy and psychology. Most of the nurses practicing in China received their nursing education in nursing and health schools, where students are able to enroll after completing junior high school or high school. The curricula of these schools focus exclusively on technical nursing skills. Recently, nursing education
164 APNA Web site: www.apna.org
programs have begun to add and integrate more courses from the humanities and social sciences into each curriculum. However, most nursing curricula still are focused on the biologic aspects of illness. Nurses in China have little autonomy in their nursing practice; physicians direct the treatment of patients, and nurses carry out the physicians’ orders. The advanced practice nurse in China is a new position that has emerged because of the recent development of graduate nursing programs. The first master’s program in nursing began in China in 1992. To date, China has nine master’s programs in the areas of medical–surgical nursing, maternal and child health nursing, rehabilitation nursing, nursing education, and nursing administration. China does not have a master’s program in psychiatric–mental health nursing; therefore, the advanced practice psychiatric nurse role does not exist. Several psychiatric nurses whom we met expressed their desire for the development of a psychiatric–mental health nursing master’s program in China.
Nurses in China are assigned to the location where they will be employed and an area of specialization after they complete their nursing education. In recent years, nurses have had some choices with regard to specialization; however, some nurses are still assigned on the basis of nursing jobs available and the areas in need of nursing personnel. Because of the low status of psychiatric nursing in China, which is related to the stigma associated with mental illness that is prevalent in the general population, many nurses are not given a choice of specialty and are assigned to practice nursing in the area of psychiatry. Often, when nurses are assigned to a nursing specialty, they remain in that area throughout their career. At some point in our own nursing careers, we may have been assigned to an area or unit with little choice in the matter. Imagine being assigned to an area of nursing you did not choose and staying there throughout your entire nursing career! Insights like this reminded us how fortunate we are in the United States to have freedom to choose.
Vol. 7, No. 5
Journal of the American Psychiatric Nurses Association
The incidence and prevalence of mental disorders in China are increasing. According to estimates from the World Health Organization, mental disorders make up 14.3% of China’s burden of disease. With China’s continued population growth, especially in the aging population, and the large number of persons affected with mental disorders who are not receiving the appropriate treatment, this number is likely to increase. Affective disorders, such as depression and anxiety, have become common mental health problems for the Chinese people, given the drastic changes in the social, political, and economic factors in China. The demand for outpatient and community-based services has increased tremendously during the past few years. However, because of the lack of facilities available, economic factors, and the stigma associated with mental illness in China, only persons who are severely psychotic, suicidal, and socially disruptive are admitted to psychiatric hospitals. Thus, the diagnoses of schizophrenia and bipolar disorder account for the majority of admissions. The evolution of psychiatry and approaches to treatment of psychiatric disorders in China have been heavily influenced by Western medicine. The majority of patients who receive acute care in psychiatric hospitals receive Western-style treatment (e.g., psychotropic medications, psychotherapy, and occupational and recreational therapy). Electroconvulsive therapy is used for patients who are resistant to other treatment modalities. TCM is rarely used alone to treat patients with mental disorders. Sometimes TCM and the Western-style treatments mentioned previously are used in tandem. The Chinese government has been working to raise mental health awareness in China. This past year, the president of China declared mental illness a high priority for the country, and the government developed guidelines for mental health
October 2001
care and social support services. The country has initiated a plan to educate the general public about mental illness to reduce the stigma and discrimination associated with it. EXPERIENCES OF SMALL TEAM WORKPLACE VISITS Small team workplace visits were one of the most exciting aspects of the trip. These visits to hospitals and mental health centers were organized around the interests of the delegates. We had the opportunity to speak with our Chinese counterparts about individual areas of interest and were exposed to traditional methods of medical practice in China. Several delegates visited the Shaanxi Academy of Traditional Chinese Medicine and Pharmacology in Xi’an and the Guilin Hospital of Traditional Chinese Medicine. During our visits to the TCM hospitals, we were introduced to several TCM treatments, including Chinese massage, acupressure, acupuncture, moxibustion, pharmacology, and TCM diagnosis. We witnessed female patients receiving Chinese massage for weight loss purposes. Acupuncture in combination with moxibustion (the application of heat to specific points on the body to restore the normal flow of chi through the meridians to promote healing) was being used to treat arthritis, neck and back pain, paralysis, and acne. We toured the TCM pharmacy and watched pharmacists measure out prescriptions that included ingredients such as leaves, berries, roots, flowers, and dead insects (scorpions and ants, to mention a few). We learned that TCM is based on the principles of internal harmony among the organs, between mind and body, and between mind-body and the external environment. The purpose of TCM is to maintain a balance of yin and yang, that is, the forces that regulate chi (universal energy) and all living things. Disease and illness are seen as an imbalance of yin and yang. According to TCM, the body is composed of five basic
Campbell & Rockelli
elements (wind, fire, earth, water, and metal), and good health and well–being depend on the balance of these elements. Any one of the elements can be affected by diet, emotions, and the external environment; therefore, all of these factors should be considered by TCM practitioners when diagnosing illnesses and prescribing treatments. After learning about the principles of TCM, several of the delegates were assessed and diagnosed by TCM physicians, who used techniques such as palpation of the radial pulse on both wrists at three different depths (in three different positions) and inspection of the tongue. The physicians used TCM principles to diagnose acute as well as chronic conditions in several delegates. SUMMARY International exchanges like this are a valuable experience for everyone involved and are important to the profession of nursing, as well as to the future of mental health care. It was astonishing to realize how small the world is and how alike we are in so many ways. Our experiences in China have given us a new sense of respect for and unity with our Chinese colleagues. We are presenting a poster presentation of our experience in China at this year’s APNA Annual Conference in Reno, Nevada, October 17-20. Xiexie (thank you). APNA DELEGATES Carol D. Campbell, RN, CS, MSN Gregory Cook, RNC Linda Hoche, RN, CS, MS Miriam Kaplan, CS, NPP, MSN Loren Pool, MD Rebecca Pool, RN, CNHA, MSN Laurie A. Rockelli, RN, CS-P, MS Jane Ryan, RN, CNAA, MN Billie Jo Ross, RNC, MSN Rachel E. Tierney, RN/PC, CS, PhD GUEST DELEGATES Ronald Evans James Tierney
APNA Web site: www.apna.org 165
Briefings
Formulating Global Perspectives on Mental Health Care: Impressions and Experiences from the APNA Delegation to China Carol D. Campbell, RN, CS, MSN, and Laurie A. Rockelli, RN, CS-P, MS
I
n June 2001, we traveled to the People’s Republic of China with the American Psychiatric Nurses Association (APNA) delegation. The purpose of the trip was to learn firsthand about the evolution of nursing, medicine, psychiatry, and mental health services in China. Professional Exchanges International, along with APNA and Jane Ryan, who served as delegation leader, coordinated our group. The delegation consisted of nine psychiatric nurses, a family medicine physician, a retired superintendent of schools, and a culinary expert. For 2 extraordinary weeks, we traveled throughout China and explored the cities of Beijing, Xi’an, Guilin, and Shanghai.
Carol D. Campbell, RN, CS, MSN, is a doctoral student at the University of North Carolina at Chapel Hill. Laurie A. Rockelli, RN, CS-P, MS, is a therapist at Maple Shade Mental Health Clinic in Mardela Springs, Maryland. Reprint requests: Carol D. Campbell, RN, CS, MSN, 907 N. Columbia St. Chapel Hill, NC 27516. J Am Psychiatr Nurses Assoc (2001). 7, 163-5. Copyright © 2001 by the American Psychiatric Nurses Association. 1078-3903/2001/$35.00 + 0 66/1/118652 doi.10.1067/mpn.2001.118652
October 2001
We attended professional meetings, seminars, and banquets with Chinese counterparts and visited numerous medical, psychiatric, and Traditional Chinese Medicine (TCM) hospitals, along with mental health centers and medical universities. Highlights from the cultural part of the trip included visits to The Great Wall, Tiananmen Square, the Forbidden City in Beijing, and the famous Terra Cotta Warriors in Xi’an; a breathtaking cruise on the Li River in Guilin; and visits to the Shanghai Art Museum, the Old City, and the Jade Buddha Temple in the modern city of Shanghai. Meeting Marlys Bueber, an American psychiatric nurse who lives in Beijing with her psychiatrist husband, was an invaluable experience. Marlys, a master’s-prepared psychiatric–mental health clinical nurse specialist, has been practicing psychiatric nursing in Beijing for more than 10 years. She provided us with an initial overview of psychiatric-mental health nursing in China and shared many of her own personal insights and experiences about mental health care in China. IMPRESSIONS FROM PROFESSIONAL MEETINGS AND SEMINARS During the professional meetings and seminars, with the assistance of outstanding translators, we were able
to exchange information, ideas, problems, and concerns related to mental health care with our Chinese counterparts, who represented hospitals, mental health centers, universities, and professional associations. Dialogue during the meetings and seminars focused on nursing education, practice, and research; exploring similarities and differences in the profession of nursing between China and the United States; the incidence and prevalence of psychiatric disorders in China; intervention strategies used to treat patients with psychiatric disorders; and the mind/body interface from a multicultural perspective. We were eager to learn about the education and practice of psychiatric nurses in China, although it was disappointing to learn that nursing students in China receive very little formal psychiatric training. According to several Chinese nursing faculty present at the professional meetings and seminars, no psychiatric–mental health nursing course is offered as part of the nursing curriculum, and no psychiatric nursing textbooks are available in the Chinese language. Several textbooks have been translated from other languages, including English; however, concepts essential to psychiatric nursing have a tendency to lose their meaning in translation. Some psychiatric–mental health nursing content is incorporat-
APNA Web site: www.apna.org 163
Campbell & Rockelli
Journal of the American Psychiatric Nurses Association
Figure 1. APNA delegates met with members of the Chinese Nurses Association in Beijing.
ed into other required nursing courses, but the majority of psychiatric nursing education is learned on the job from experienced nurses and psychiatrists. Members of the Psychiatric Nursing Academic Committee of the Chinese Nursing Association shared their hope of eventually adding a psychiatric–mental health nursing course to the required nursing education curriculum. During the past several years, the Chinese government has been focusing on the importance of additional education for all nurses, with an emphasis on continuing education opportunities for nurses, advanced nursing education, and the requirement that nurses educated in nursing and health schools obtain additional nursing education and take college courses such as anatomy and psychology. Most of the nurses practicing in China received their nursing education in nursing and health schools, where students are able to enroll after completing junior high school or high school. The curricula of these schools focus exclusively on technical nursing skills. Recently, nursing education
164 APNA Web site: www.apna.org
programs have begun to add and integrate more courses from the humanities and social sciences into each curriculum. However, most nursing curricula still are focused on the biologic aspects of illness. Nurses in China have little autonomy in their nursing practice; physicians direct the treatment of patients, and nurses carry out the physicians’ orders. The advanced practice nurse in China is a new position that has emerged because of the recent development of graduate nursing programs. The first master’s program in nursing began in China in 1992. To date, China has nine master’s programs in the areas of medical–surgical nursing, maternal and child health nursing, rehabilitation nursing, nursing education, and nursing administration. China does not have a master’s program in psychiatric–mental health nursing; therefore, the advanced practice psychiatric nurse role does not exist. Several psychiatric nurses whom we met expressed their desire for the development of a psychiatric–mental health nursing master’s program in China.
Nurses in China are assigned to the location where they will be employed and an area of specialization after they complete their nursing education. In recent years, nurses have had some choices with regard to specialization; however, some nurses are still assigned on the basis of nursing jobs available and the areas in need of nursing personnel. Because of the low status of psychiatric nursing in China, which is related to the stigma associated with mental illness that is prevalent in the general population, many nurses are not given a choice of specialty and are assigned to practice nursing in the area of psychiatry. Often, when nurses are assigned to a nursing specialty, they remain in that area throughout their career. At some point in our own nursing careers, we may have been assigned to an area or unit with little choice in the matter. Imagine being assigned to an area of nursing you did not choose and staying there throughout your entire nursing career! Insights like this reminded us how fortunate we are in the United States to have freedom to choose.
Vol. 7, No. 5
Journal of the American Psychiatric Nurses Association
The incidence and prevalence of mental disorders in China are increasing. According to estimates from the World Health Organization, mental disorders make up 14.3% of China’s burden of disease. With China’s continued population growth, especially in the aging population, and the large number of persons affected with mental disorders who are not receiving the appropriate treatment, this number is likely to increase. Affective disorders, such as depression and anxiety, have become common mental health problems for the Chinese people, given the drastic changes in the social, political, and economic factors in China. The demand for outpatient and community-based services has increased tremendously during the past few years. However, because of the lack of facilities available, economic factors, and the stigma associated with mental illness in China, only persons who are severely psychotic, suicidal, and socially disruptive are admitted to psychiatric hospitals. Thus, the diagnoses of schizophrenia and bipolar disorder account for the majority of admissions. The evolution of psychiatry and approaches to treatment of psychiatric disorders in China have been heavily influenced by Western medicine. The majority of patients who receive acute care in psychiatric hospitals receive Western-style treatment (e.g., psychotropic medications, psychotherapy, and occupational and recreational therapy). Electroconvulsive therapy is used for patients who are resistant to other treatment modalities. TCM is rarely used alone to treat patients with mental disorders. Sometimes TCM and the Western-style treatments mentioned previously are used in tandem. The Chinese government has been working to raise mental health awareness in China. This past year, the president of China declared mental illness a high priority for the country, and the government developed guidelines for mental health
October 2001
care and social support services. The country has initiated a plan to educate the general public about mental illness to reduce the stigma and discrimination associated with it. EXPERIENCES OF SMALL TEAM WORKPLACE VISITS Small team workplace visits were one of the most exciting aspects of the trip. These visits to hospitals and mental health centers were organized around the interests of the delegates. We had the opportunity to speak with our Chinese counterparts about individual areas of interest and were exposed to traditional methods of medical practice in China. Several delegates visited the Shaanxi Academy of Traditional Chinese Medicine and Pharmacology in Xi’an and the Guilin Hospital of Traditional Chinese Medicine. During our visits to the TCM hospitals, we were introduced to several TCM treatments, including Chinese massage, acupressure, acupuncture, moxibustion, pharmacology, and TCM diagnosis. We witnessed female patients receiving Chinese massage for weight loss purposes. Acupuncture in combination with moxibustion (the application of heat to specific points on the body to restore the normal flow of chi through the meridians to promote healing) was being used to treat arthritis, neck and back pain, paralysis, and acne. We toured the TCM pharmacy and watched pharmacists measure out prescriptions that included ingredients such as leaves, berries, roots, flowers, and dead insects (scorpions and ants, to mention a few). We learned that TCM is based on the principles of internal harmony among the organs, between mind and body, and between mind-body and the external environment. The purpose of TCM is to maintain a balance of yin and yang, that is, the forces that regulate chi (universal energy) and all living things. Disease and illness are seen as an imbalance of yin and yang. According to TCM, the body is composed of five basic
Campbell & Rockelli
elements (wind, fire, earth, water, and metal), and good health and well–being depend on the balance of these elements. Any one of the elements can be affected by diet, emotions, and the external environment; therefore, all of these factors should be considered by TCM practitioners when diagnosing illnesses and prescribing treatments. After learning about the principles of TCM, several of the delegates were assessed and diagnosed by TCM physicians, who used techniques such as palpation of the radial pulse on both wrists at three different depths (in three different positions) and inspection of the tongue. The physicians used TCM principles to diagnose acute as well as chronic conditions in several delegates. SUMMARY International exchanges like this are a valuable experience for everyone involved and are important to the profession of nursing, as well as to the future of mental health care. It was astonishing to realize how small the world is and how alike we are in so many ways. Our experiences in China have given us a new sense of respect for and unity with our Chinese colleagues. We are presenting a poster presentation of our experience in China at this year’s APNA Annual Conference in Reno, Nevada, October 17-20. Xiexie (thank you). APNA DELEGATES Carol D. Campbell, RN, CS, MSN Gregory Cook, RNC Linda Hoche, RN, CS, MS Miriam Kaplan, CS, NPP, MSN Loren Pool, MD Rebecca Pool, RN, CNHA, MSN Laurie A. Rockelli, RN, CS-P, MS Jane Ryan, RN, CNAA, MN Billie Jo Ross, RNC, MSN Rachel E. Tierney, RN/PC, CS, PhD GUEST DELEGATES Ronald Evans James Tierney
APNA Web site: www.apna.org 165