Running head: Nursings Leadership Role in Mental Illness and Suicide

Nursings Leadership Role in Community Mental Illness and Suicide Education and Prevention Melissa B. Scholtens Ferris State University

2 Nursings Leadership Role in Mental Illness and Suicide

Abstract Nursing leadership roles vary within the same care providing setting. A community health nurses role and focus varies based on the core responsibilities of the nurse. Within the community health setting there are clinical nurses who focus care on the patient, and management nurses who direct and create policies and reform. There are various roles for the nurse based on the setting of care and leadership characteristics, this paper explains both as related to community health for individuals with mental illness and a focus on suicide prevention. The roles of clinical nurse and management nurse both have a goal of treating patients and preventing further injury, but differ at which point the care is provided. One role could not function without the other, thus the roles are dependent upon one another while operating independently. Community health nursing offers opportunity to have intimate working relationships with patients or a more distant relationship by creating and improving policy and direct care.

3 Nursings Leadership Role in Mental Illness and Suicide

Mental Illness and Suicide A mental illness is a medical condition that disrupts a person's thinking, feeling, mood, ability to relate to others and daily functioning (National Alliance on Mental Illness, (2013). A mental illness affects your brain in the same manner that an illness like arthritis affects your bones. Mental illnesses can include, but are not limited to depression, bipolar, schizophrenia, obsessive compulsive disorders, post-traumatic stress disorders and panic disorders. Mental illnesses can affect persons of any age, race, religion or income. Mental illnesses are not the result of personal weakness, lack of character or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan (National Alliance on Mental Illness, 2013). According to National Alliance on Mental Illness about 1 in 4 adults experience mental illness within a given year, or approximately 61 million Americans. Suicide is when someone intentionally takes his or her own life. According to the Centers for Disease Control, in 2009, the number of deaths from suicide surpassed the number of deaths from motor vehicle crashes in the United States. The suicide rate for middle age men increased dramatically from 21.5 to 27.3 (CDC, 2013) and this is a rate per 100,000 people. The fact that one quarter of Americans suffers from mental illness within a given year combined with the increasing incidence of suicide suggests a significant population for intervention and assistance. A nursing community outreach and intervention would target men between 35 and 64 to address mental illness and screen for suicide while implementing interventions and education in an effort to decrease suicide rates in this population.

4 Nursings Leadership Role in Mental Illness and Suicide

Nursing Role Nursing care takes place at two different and unique levels. One level of nursing is faceto-face and clinical in nature; one nurse with one patient or small groups of patients at a time, this is a direct contact nurse. The clinical nurse has the biggest impact with one patient at a time. In a clinical role the nurse would complete patient assessments, review medications, evaluate the current state of the individual, provide education and intervention in needed so flexibility is important. The first 3 American Nursing Association (ANA) Standards of Practice can be clearly demonstrated by a clinical nurse and they include assessment, diagnosis and outcome identification (ANA, 2010). Community health nurses are valued for their adaptability and willingness to provide care in many settings (Meadows, 2009). A nursing role that would provide with face to face or direct contact with those diagnosed with mental illness or increased risk of suicide would be clinical nurse. A community health nurse who cares for patients either in a facility, outpatient setting or in their homes would be an example of a clinical nurse. A possible agency for a clinical nurse would be Pine Rest which has a location in Grand Rapids, Michigan, as well as satellite offices throughout West Michigan and Iowa. A leadership role that a clinical nurse could fulfill would be that of educator. A clinical nurse has frequent contact with the patient population and who in real time provides education and intervention if needed, this is a leadership role of a nurse for this proposal. One very important aspect of nursing is education, and to provide quality education you need to have effective communication. According to the American Nursing Association effective communication requires an understanding of the underlying context of the situation, an appreciation for the tone and emotions of the conversation, and the accurate information (American Nurses Association, 2013). To effectively educate patients or peers, a nurse needs to

5 Nursings Leadership Role in Mental Illness and Suicide

have understanding of the topic, ability to concisely present the information and a method by which to assess understanding. Leadership characteristics would include: effective communication, in-depth and detailed assessment capabilities, adaptability and flexibility to respond to changing patient circumstances and strength of character to interact with individuals who may be difficult to communicate. A second level of nursing is a leadership or overseer role that is not only a clinician, but one who would plan and implement new policies or education or program planning. Leader/manager nurses can develop sustainable programs and build community capacity for health promotion (Kulbok, Thatcher, Park & Meszaros, 2012). An agency that this nurse might align with would be Michigan Department of Community Health, mental health services. By working with a state-wide department the nurse would have access to broader and farther reaching resources and a platform to implement programs on a larger scale. Policy and procedure as well as educational offerings and materials can be drawn up and utilized through a group such as Michigan Department of Community Health and have an effect on more people than if implemented on a local level only. A leadership role that the leader/manager nurse might take would be that researching and writing new policy directed toward the education on suicide awareness in middle age men. The leadership characteristics necessary for this nurse include attention to detail, meticulous organization, and knowledge of the topic as well as best method to present information to have the most significant effect. The ANA Standards of Practice clearly demonstrated at the leader/manager level are focused in more detail on planning, implementation and evaluation (ANA, 2010).

6 Nursings Leadership Role in Mental Illness and Suicide

How the Nursing Roles Relate The clinical nurse and the education/policy development leader nurse roles are closely intertwined. There must be a constant flow of communication between the nurse at the bedside and the nurse who is establishing what is going to be taught or developed to help the patient. Both roles are filled by an individual who has a goal of helping the individual, the ability to provide help and the assessment skills to intervene. The two nursing roles are distinctly different by virtue of the population that each nurse is encountering. The clinical nurse focuses on the assessment, intervention and treatment of a small population of individuals. The immediate encounter with the individual and in the moment intervention, education and healing occurs with the nurse at the bedside. The leader nurse works more behind the scenes to develop and implement the education or the policy that is utilized by the clinical nurse. The implications for different skills needed by the clinical nurse and the leader nurse are many. There is a significant difference in the skill set of the nurse who in in the trenches so to say and the nurse who is creating and implementing the policy or procedures that those on the battlefield are utilizing. A clinical nurse needs to acute assessment skills, be confident with treatment planning, conducting individual or group therapy and completion of risk assessments. A manager nurse needs to be able to look at the broader picture and how programs or policies developed are going to affect the majority of the patient population, not just the one patient that you are encountering at any given time. The perspective is different between the two roles even though the anticipated outcome is essentially the same; high quality and accurate care for the

7 Nursings Leadership Role in Mental Illness and Suicide

patient while assessing and educating on his or her mental illness and evaluating the risk of suicide and implementing measures to decrease risk. Reflection My nursing skills are a fairly equal mixture of the clinical nurse and the nurse leader/manager. In my current work environment I function not only as a bedside nurse, but frequently as the charge nurse as well. Working in both roles gives me an opportunity to see both sides of the fence and adjust my practice as well as my expectations in various situations as I have the unique perspective of intimately understanding both perspectives. I thrive on working closely with patients and providing education. The role requirements that would prove challenging for me would be any portion of the job that requires confrontation. The longer that I am a nurse, the easier this area becomes, but I am doubtful that I will ever be easily adept at eloquently dealing with confrontation. Confrontation can occur with either role, the clinical nurse with patients or family members in a stressful situation or as the manager meeting resistance to new methods of care delivery or education implementation. The thing that I might do to increase my competence in either role is to job shadow or attend advanced practice classes pertaining to community health. There are various universities that offer degree programs or course offerings in community nursing or subscribe to the Journal of Community Health Nursing. Crisis management is another area that would be a challenge for me. In my current role I am used to dealing with the crisis of critically ill patients and educating and comforting their family members, however dealing with a patient in crisis that is medically stable and emotionally/psychologically unstable might prove to be challenging. I would attend a crisis management class and volunteer to spend some time within a psychiatric unit shadowing and witnessing first-hand the best practice for handling fragile situations.

8 Nursings Leadership Role in Mental Illness and Suicide

Nursing is a dynamic and fantastic career field that offers many opportunities and experiences, and equally as many educational offerings to be more confident and competent in many areas of nursing. There are many leadership roles in community or population based nursing and numerous characteristics that individuals possess that make them uniquely qualified for either a clinical nursing role or management nursing role and overall I feel am capable and competent to complete both.

9 Nursings Leadership Role in Mental Illness and Suicide

References American Nurses Association. 2010. Scope and Standards of Nursing Practice. American Nurses Association. 2013. Nursing World. Retrieved from http://www.nursingworld.org/nursingstandards Centers for Disease Control. (2013). Suicide Among Adults Aged 3564 Years United States, 19992010. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6217a1.htm Kulbok, P., Thatcher, E., Park, E., & Meszaros, P. (2012). Evolving Public Health Nursing Roles: Focus on Community Health Participatory Health Promotion and Prevention. The Online Journal of Nursing Issues, 17. doi: 10.3912/OJIN.Vol19No02Man01 Meadows, P. (2009). Community Health Nursing. American Journal of Nursing, 109, 19. doi: 10.1097/01.NAJ.000343102.62178.80 National Alliance on Mental Illness. (2013). Mental Illnesses. Retrieved from http://www.nami.org/Template.cfm?Section=By_Illness