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Beyond the walls
ARCHIVES OF
PSYCHIATRIC NURSING October 1991
Vol. V. No. 5
EDITORIAL
Beyond the Walls
Y
ES, WE DO NEED TO “Put the Community Back in Mental Health” (Krauss, 1991), and even more importantly, we need to put psychiatric nurses back into the community. How is this to be done when most psychiatric nurses work within the walls of hospitals and clinics? What role can the psychiatric nurse have in community nursing? The American Nurses’ Association (ANA) is taking a bold step toward a comprehensive health policy plan to remedy the failures of our current health care nonsystem in which, “far too many health care dollars are spent unnecessarily and ineffectively, while at the same time many essential health care needs go unmet” (ANA, 1991). The goal of the ANA proposal, Nursing’s Agenda for Health Care Reform, is to ensure necessary and effective health services for all people. To achieve this goal, the proposed agenda calls for the most cost-effective providers in the most accessible and appropriate setting. Under this plan, there would be an emphasis on having a full range of qualified providers of primary care services in community settings such as schools, work sites, homes, children’s day care, and senior citizens’ centers. The health care agenda “calls for a renewed commitment to programs devoted to public health, active participation in self care, and personal responsibility for health and wellness” (ANA, 1991). This proposal clearly calls for health care professionals to reach beyond the traditional walls of the hospital and clinic to meet the needs of people where they live, work, and learn. What the proposal doesn’t address are some of
the realities of providing health care beyond the walls. Zerwekh (1991) poignantly relates the stories of community health nurses who are on the front lines providing primary health care in the community. Although the initial goal of her qualitative study of community health nurses was to assess their perceptions of making a difference in their practice, she also experienced some unexpected findings related to the hardships that restrict their practice. The community health nurses are finding that their work is almost exclusively with the most disturbed people and families in our society; they find that their clients are so impoverished that they question if they can make an enduring difference. With these extreme problems, there is a limit on what the nurse can do to help. These nurses not only struggle with the lifethreatening experiences of their clients, but must also face the threat of violence to themselves. She notes that community health nurses even work with the police to protect themselves and to evaluate whether some families are too dangerous for them to visit. These circumstances leave nurses who deliver primary care in the community feeling overburdened, vulnerable, and isolated. Zerwekh concludes that nurses working beyond the walls need social support mechanisms, policies to preserve physical safety, and individual and group counseling opportunities. So, what does all this have to do with psychiatric nursing? It appears obvious that as more nurses focus their care outside the walls of hospitals and clinics, they will increasingly encounter some of
Archiues of Psychiatric Nursing, Vol. V, No. 5 (October), 1991: pp. 253-254
253
254
PATRICIA C. POTHIER
the same issues that the community health nurses are currently reporting. Psychiatric nurses are experts in caring for disturbed people and families: We have learned strategies for dealing with violent patients and we have expertise in both group and individual counseling. We belong there, providing either direct services or consultation and support to our nursing colleagues; we need to be involved in the process of planned community change and at the policy-making table. Together, with a full array of health care professionals and the strength of organized nursing behind us, we just might make some difference in the lives of the desperate and neglected. And, we just might experience satisfac-
tion and fulfillment as professional community psychiatric nurses. Patricia C. Pothier Associate Editor
REFERENCES American Nurses’ Association (1991, April). Nursing’s agenda for health care reform, Public Policy Supplement. The American Nurse, pp. 1-4. Krauss, J.B. (1991). Editorial: Put the community back in mental health. Archives of PsychiatricNursing, 5(l), l-2. Zerwekh, J.V. (1991). At the expense of their souls. Nursing Ourlook, 39(2), 58-61.
Editor’s Note This will be Pat Pothier’s last editorial as Associate Editor of the Archives ofpsychiatric Nursing. Pat has retired from her position at the University of California, San Francisco, and will be retiring from her post as Associate Editor of the Archives of Psychiatric Nursing effective December 3 1, 1991, in order to take more time for writing, thinking, and travel. Fortunately for us, she will remain on the Editorial Board. I want to express my deepest gratitude to Pat for her service to the Archives of Psychiatric Nursing. She has single-handedly recruited the many fine manuscripts that deal with child psychiatric nursing practice. I know she will continue to hold a special interest in child and adolescent psychiatric nursing and we will benefit from her continued counsel through the Editorial Board. -J.B.K.
PSYCHIATRIC NURSING October 1991
Vol. V. No. 5
EDITORIAL
Beyond the Walls
Y
ES, WE DO NEED TO “Put the Community Back in Mental Health” (Krauss, 1991), and even more importantly, we need to put psychiatric nurses back into the community. How is this to be done when most psychiatric nurses work within the walls of hospitals and clinics? What role can the psychiatric nurse have in community nursing? The American Nurses’ Association (ANA) is taking a bold step toward a comprehensive health policy plan to remedy the failures of our current health care nonsystem in which, “far too many health care dollars are spent unnecessarily and ineffectively, while at the same time many essential health care needs go unmet” (ANA, 1991). The goal of the ANA proposal, Nursing’s Agenda for Health Care Reform, is to ensure necessary and effective health services for all people. To achieve this goal, the proposed agenda calls for the most cost-effective providers in the most accessible and appropriate setting. Under this plan, there would be an emphasis on having a full range of qualified providers of primary care services in community settings such as schools, work sites, homes, children’s day care, and senior citizens’ centers. The health care agenda “calls for a renewed commitment to programs devoted to public health, active participation in self care, and personal responsibility for health and wellness” (ANA, 1991). This proposal clearly calls for health care professionals to reach beyond the traditional walls of the hospital and clinic to meet the needs of people where they live, work, and learn. What the proposal doesn’t address are some of
the realities of providing health care beyond the walls. Zerwekh (1991) poignantly relates the stories of community health nurses who are on the front lines providing primary health care in the community. Although the initial goal of her qualitative study of community health nurses was to assess their perceptions of making a difference in their practice, she also experienced some unexpected findings related to the hardships that restrict their practice. The community health nurses are finding that their work is almost exclusively with the most disturbed people and families in our society; they find that their clients are so impoverished that they question if they can make an enduring difference. With these extreme problems, there is a limit on what the nurse can do to help. These nurses not only struggle with the lifethreatening experiences of their clients, but must also face the threat of violence to themselves. She notes that community health nurses even work with the police to protect themselves and to evaluate whether some families are too dangerous for them to visit. These circumstances leave nurses who deliver primary care in the community feeling overburdened, vulnerable, and isolated. Zerwekh concludes that nurses working beyond the walls need social support mechanisms, policies to preserve physical safety, and individual and group counseling opportunities. So, what does all this have to do with psychiatric nursing? It appears obvious that as more nurses focus their care outside the walls of hospitals and clinics, they will increasingly encounter some of
Archiues of Psychiatric Nursing, Vol. V, No. 5 (October), 1991: pp. 253-254
253
254
PATRICIA C. POTHIER
the same issues that the community health nurses are currently reporting. Psychiatric nurses are experts in caring for disturbed people and families: We have learned strategies for dealing with violent patients and we have expertise in both group and individual counseling. We belong there, providing either direct services or consultation and support to our nursing colleagues; we need to be involved in the process of planned community change and at the policy-making table. Together, with a full array of health care professionals and the strength of organized nursing behind us, we just might make some difference in the lives of the desperate and neglected. And, we just might experience satisfac-
tion and fulfillment as professional community psychiatric nurses. Patricia C. Pothier Associate Editor
REFERENCES American Nurses’ Association (1991, April). Nursing’s agenda for health care reform, Public Policy Supplement. The American Nurse, pp. 1-4. Krauss, J.B. (1991). Editorial: Put the community back in mental health. Archives of PsychiatricNursing, 5(l), l-2. Zerwekh, J.V. (1991). At the expense of their souls. Nursing Ourlook, 39(2), 58-61.
Editor’s Note This will be Pat Pothier’s last editorial as Associate Editor of the Archives ofpsychiatric Nursing. Pat has retired from her position at the University of California, San Francisco, and will be retiring from her post as Associate Editor of the Archives of Psychiatric Nursing effective December 3 1, 1991, in order to take more time for writing, thinking, and travel. Fortunately for us, she will remain on the Editorial Board. I want to express my deepest gratitude to Pat for her service to the Archives of Psychiatric Nursing. She has single-handedly recruited the many fine manuscripts that deal with child psychiatric nursing practice. I know she will continue to hold a special interest in child and adolescent psychiatric nursing and we will benefit from her continued counsel through the Editorial Board. -J.B.K.