PREVENTION IN PSCHIATRIC NURSING

      

In 1960s, psychiatrist Gerald Caplan described levels of prevention specific to psychiatry. He described primary prevention as an effort directed towards reducing the incidence of mental   disorders in a community. Secondary prefer refers to decreasing the duration of disorder while tertiary prevention refer to reducing the level of impairment. PRIMARY PREVENTION Primary prevention seeks to prevent the occurrence of mental disorders by strengthening individual, family and group coping abilities. ROLE OF NURSE IN PRIMARY PREVENTION  Community mental health nurses are in a key position to identify individual, family group needs, conflicts and stressors. Thus they play a major role in identifying high risk groups and preventing the occurrence of mental illness in them. Some interventions include: 1. Individual centred intervention ·         Antenatal care to the mother and educating her regarding the adverse effects of irradiation, certain drugs and prematurity. ·         Ensuring timely and efficient obstetrical assistance to guard against the ill effects of anoxia and injury to the newborn at birth. ·         Dietary corrections to those infants suffering from metabolic disorders. ·         Correction of endocrine disorders. ·         Liberalization of laws regarding termination of pregnancy, when it is unwanted. ·         Training programs for physically, and mentally handicapped children like blind, deaf , mute , and mentally subnormal, etc. ·         Counselling the parents of physically and mentally handicapped children, with particular reference to the nature of defects. The parents of emotionally support the child and be satisfied with limited goals in the field of achievement. ·         Fostering bonding behaviour. Explaining importance of warm, accepting, intimate relationship and avoiding the prolonged separation of mother and child are essential. 2. Interventions oriented to the child in the school ·         Teaching growth and development to parents and teachers. ·         Identifying the problems of scholastic performance and emotional disturbances among school children and giving timely intervention. School teachers can taught to recognize the beginning symptoms of problems and referring to appropriate agencies. 3. Family centred interventions to ensure harmonious relationship ·         Consulting with parents about appropriate disciplinary measure. ·         Promoting open health communication in families. ·         Rendering crisis counselling to the parents of physically and mentally handicapped children. ·         Ensuring harmonious relationship among members of the family and teaching healthy adaptive techniques at the time of stress producing events. 4. Intervention oriented to keep families intact ·         Extending mental health education services at Children Guidance Clinics about child rearing practices; at parent-teacher association regarding the triad relationship between teacher, child and parent; and various extramural health agencies regarding integration of mental health into general practice. ·         Strengthening social support for the frustrated aged and helping them to retain their usefulness. ·         Promoting educational services in the field of mental health and mental hygiene. ·         Developing parent-teacher associations. ·         Rendering home-maker services- when there is absence of the mother from home due to illness or other reasons for prolonged periods, the public health nurse can arrange for the service. ·         Providing marital counselling for those having marital problems. 5. Intervention for families in crisis. §  In development crisis situations such as the child passing through adolescence, birth of a new baby, retirement or menopause, death of a wage earner in family, desertion by the spouse, etc. crisis intervention can be given at §  Mental hygiene clinics §  Psychiatric first-aids centres §  Walk-in clinics   6. Mental health education ·         Conduct mass health education programs through film shows, flash cards and appropriate audio-visual aids regarding prevention of mental illnesses and promotion of mental health in the community. ·         Educate health workers regarding prevention of mental illness so that they can function effectively in all the areas of prevention. 7. Society-centred preventive measures ·         Community development-Culturally deprived families need biological and psychosocial supplies. They need better hygienic living condition, proper food, education, health facilities, and recreational facilities. Otherwise psychopathy, alcoholism, drug addiction, crime and mental illness, will result in such situation. ·         Collection and evaluation of epidemiological, biostatistical data. SECONDARY PREVENTION Secondary prevention targets people who show early symptoms of mental health disruption but regain premorbid level of functioning through aggressive treatment. ROLE OF NURSE IN SECONDARY PREVENTION ·         Early diagnosis and case finding:  this can be achieved by educating the public, community leaders, industrialists, Mahila mandals, Balwadis, etc. in how to recognised early symptoms of mental illness. Case finding through screening and periodic examination of population at risk, monitoring of patients, etc. Thus in clinics, schools, home health care and the work place, community mental health nurse detect early signs of increased levels of anxiety, decreased ability to cope with stress and failure to perceive self, the  environment and/ or reality accurately, and provide direct services as appropriate. ·         Early reference: The public should be educated to refer these cases to proper hospitals as soon as they recognize early symptoms of mental illness. ·         Screening programs: Simple questionnaires should be developed to identify the symptoms of mental illness, and administration of the same in the community for early identification of cases. These questionnaires can be simplified in local languages, and used widely in the colleges, schools, industries, etc. ·         Early and effective treatment for patient, and if necessary, to family members as relevant; providing counselling services to caregivers of mentally ill patients. ·         Training of health personnel: orientation courses should be provided to health workers to detect cases in the course of their routine work. ·         Consultation services: Nurses working in general hospitals may come across various conditions such as puerperial psychosis, anxiety states, peptic ulcer, ulcerative colitis, bronchial asthma, etc. These basic care providers need guidance and consultation to deal with these conditions in an effective manner. ·         Crisis intervention: If crisis is not tackled in time it may lead to mental disorders or even suicide. Sometimes anticipating the crisis situation and guiding the individual in time can help them to cope with the crisis situation in a better way. TERTIARY PREVENTION Tertiary prevention targets those with mental illness and helps to reduce the severity, discomfort and disability associated with their illness. In these terms community mental health nurses play a vital role in monitoring the progress of discharged patients in halfway homes, houses, etc., especially with regard to their medication regimen, co-ordination of care, etc. ROLES OF NURSE IN TERTIARY PREVENTION ·         Family members should be involved actively in the treatment program so that effective follow-up can be ensured. ·         Occupational and recreational activities should be organised in the hospital so that idling is prevented. ·         Community based programs can be launched through meeting with the family members when the need of discharged from the hospitals, night hospitals, after care  clinics, half-way homes, etc. Follow up care can be handed over to community health nurses. ·         There should be constant communication between the community health nurses and the mental health institution regarding the follow up of the discharged patient. The ultimate aim of the hospital and community based programs is to re-socialize and re-motivate the patient for the functional role in the community, consistent with his resources. ·         There is a wide range of services that need to be provided to patients as part of the tertiary prevention program. Nurses need to be familiar with the agencies in the community that provide these services. Collaborative relationships between mental health care providers and community agencies are absolutely essential if rehabilitation is to succeed. ·         An important intervention in the maintenance of patients in their own homes in the community is the Training in Community Living (TCL) program, designed by ‘Stein and Test’. In this model when a person is referred for hospital admission the staff goes to the community with him rather than his going to the hospital to be with the staff. This real world experience with the patient enables the nurse to assess accurately the skills that the persons need to learn and to mutually agree on realistic goals. ·         Another aspect of community life that is more difficult to assess accurately and deal with effectively, is the stigma attached to mental illness. Many patients and their families try to avoid stigma by keeping the nature of the person illness a secret. The need for secrecy places additional stress family system because there is always the fear that the truth will be revealed. Nurses in the community are in a key position to monitor community attitude towards the mentally ill. ·         For some patients, the emotional climate of the family to which they return can have a significant effect on their adjustment, and eventually recovery from the debilitating effect of chronic mental illness. Families sometimes view mental illness as a weakness of a character that can be overcome by exertion of moral effort. This type of familial attitude may result in guilt on the part of the patient who believes that he has disappointed his significant others. Guilt leads to increased anxiety and decreased self-esteem. These are the conditions that interfere with a high level of functioning. Therefore nurses working with families need to foster healthy attitudes towards the mentally ill member.