Roles of a Mental Health Nurse

This article discusses the roles and responsibilities of a mental health nurse in providing care and support to individuals with mental health issues. It explores the case of a patient named Lisa who is experiencing hallucinations and paranoid delusions. The article emphasizes the importance of trauma-informed care and collaboration in the treatment process. It also highlights the need for risk assessment and management, effective communication, and a person-centered approach to care. The role of the mental health nurse in medication management, counseling, and promoting recovery is discussed. The article concludes with the importance of a collaborative care model and the transition from in-patient to community care.

Running head: ROLES OF A MENTAL HEALTH NURSE
ROLES OF A MENTAL HEALTH NURSE
Name of Student
Name of University
Author note

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Lisa is visited by an alcohol and other drugs community counsellor who finds her in
an agitated and restless state. Having left her parent’s home, Lisa has been staying with her
partner since last two weeks where she had found herself hearing voices and sleeping in the
night on the garden chair with a knife. She also thinks her partner has inserted a transmitter in
her stomach and all of her feelings and thoughts are getting transmitted out. She talks about
cameras in the rooms and terrace that is always watching her. The ‘voice’ that she hears are
referred by ‘Lisa’ as being horrible which alerts her continuously about her partner who
would hurt her bad one day. She is also afraid if she may hurt her partner in order to protect
herself. Throughout the conversation, she had been responding to invisible stimulus in the
room with erratic gazing. She is on cannabis and speed currently and Lisa could not
remember if she has taken her medications in last two weeks which has worsened her
symptoms to great extent. Her parents were angry with her for leaving them and she had not
spoken to them as well. Substance abuse has led to hallucinations in a stage of psychosis
(Clark et al., 2017).Lisa had been hallucinating about the cameras (visual hallucinations) and
hearing voices (auditory hallucinations) along with commands (command hallucinations)
which is a key issue. Memory is another problem for Lisa because it caused a forgetfulness
about medications, presenting her agitation and hallucinatory symptoms due to non-
adherence to prescribed drugs. Risk of self-harm or to others (her partner) is another potential
issue with Lisa for the paranoid delusionary voices has made her conscious about the danger
posed by her partner and in turn, she keeps a knife while sleeping at night.
While Lisa’s case portrays certain covert borderlines of a complex childhood trauma
which she still attempts to cope with through the use of drugs. There had been trauma
survivors who shows exquisite resilience towards their own recovery (Ben-David & Jonson-
Reid, 2017) while others struggles with day to day self and worldly conflict with contrasting
emotions, dubious relationships, and loss of self-identity (Matheson et al., 2015). Any sort of

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complex trauma affects just not its victims who were involved directly but with their near
relations too and future children as well (Woolf et al., 2016). Trauma of any kind – mental or
physical is a big health problem of major concern. But to the horrors of our currently
established medical systems – the etiology or the pathophysiology is not properly identified
or acknowledged and hence the insidious course of these events goes unaddressed. Subjects
who are affected are again somehow re-traumatized within healthcare systems with
practitioners who lack the requisite knowledge about the trauma. These practitioners with the
ad hoc trauma care training can easily trigger the sensations of depression and discomfort
back in the patient. Trauma Informed Care and Practice is an agile strengths-based medical
framework founded on five exclusive core principles – trustworthiness, safety, choice,
empowerment and collaboration along with the respect for population diversity. Trauma
informed services aims at not re-traumatizing or blaming victims for their own traumatic
reactions. The trauma care experts embrace optimism and hope to a point from where
recovery becomes possible (Schiff et al., 2018). Trauma-informed services allow survivors to
be like ‘special’ individuals who had been through extremely unpleasant situations but have
actually managed to drive through. Identifying core principles for each of the issue is
extremely important (Raja et al., 2015). Perceived distress along with lack of self-control
triggers hallucinations in traumatic or developmental schizophrenia (Hugdahl & Sommer,
2017), has common etiological processes that needs a specific treatment. A complete 5 year
follow-up is advised for non-psychotic adults between 40 to 70 with recurrent auditory verbal
hallucinations(Daalman et al., 2016). Ensuring safety and collaboration is important for a
nurse led care of Lisa. In trauma treatment settings, there is a great distinction between: 1)
treating trauma symptoms, 2) treating experience of the trauma. The difference is understood
which doing trauma-processing therapy (Varkovitzky, Gilbert & Chard, 2018). An eclectic
counseling of the trauma experience help stabilize the memory induced agony which treating

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the responsive symptoms can better the present recovery (Spiers, 2018). There exists a
potential treatment gap between trained trauma care practitioners and number of patients with
severe trauma histories. Though every practitioner or health care provider is not trained on
trauma care but it is recommended for every health care setup to train their practitioners on
trauma care and practice. A structured approach must be followed by institutions for
providing Trauma Informed Care (Isobel & Edwards, 2017) .Hallucination is a de-realization
disorder which can be have an extreme complex origin and sometimes, the underlying causes
can be extremely diffused. Although securing safety at home (Cockerham, 2016), change of
environment and behavioral therapies (Goldbeck et al., 2016), can be intervened by a nurse
along with help of a multi-disciplinary team including psychiatrists, community health
workers, occupational and physical therapists. Memory loss and registration problems leads
to loss of identity, detachment with the reality and many cognitive distortions (Bortolotti &
Sullivan‐Bissett, 2018) – collaboration with the patient, developing trust worthiness with the
subject are the main principles of informed trauma care to be practiced by a mental health
nurse. Risk assessment and risk management is crucial to informed trauma care and practice
which involves assessing the life risks of the subject by a nurse. An effective communication
with the patient while cutting down her fears and paranoid behaviors through counselling is
important and a mental health care nurse should be able to ‘empower’ Lisa to charge of her
own life for the nurse must many roles of many practitioners in Lisa’s recovery. As a
practitioner of informed trauma care, a mental health nurse must be able to ‘choose’ what is
right for the patient and situational with reflective judgment becomes an important trait in this
vital decision making process. With further qualitative conversations, the nurse must be able
to decipher any past traumas associated with current present substance abuse issue and the
nurse must also be able to analyze any such findings in development of her paranoid and

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anxiety disorders. Any such findings must be immediately reported to the concerned
psychiatrist or the other specialist who can take therapeutic actions on the same.
Collaborative care which is an important healthcare model, aims at improving patient
outcomes with an inter-professional assistance and cooperation. Commonly, the treatment
includes a diverse tertiary and primary care team who are working with allied medical
professionals – such as physiotherapists, occupational therapists, psychologists and other
specialists. An effective collaborative medical management always encourages families of
patients, patients and practitioners to be active participants of treatment process that in turn
enhances improvement in quality outcomes, patient experience and safety along with an
effective usage of medical and social resources. The hallmarks of collaborative care involve
prioritizing patients and true commitments from medical management to ensure a good inter-
professional collaboration along with an effective bonding between multidisciplinary team.
Effective communication is always a critical tool for a collaborative nurse care plan to
properly work while mental health nurses are actually trained to practice empathy,
adaptability and communication skills (Ignatavicius & Workman, 2015). A nurse’s ability to
assess a patient’s mental, clinical, covert behavioral, emotional, social needs that empower
them to form a patient centered plan. As nurses are offering direct patient care around the
clock, they have a unique and focused view of how that care should be provided. Nurses has
to be a patient’s companion and model for best practice in person-centered care added with
shared form of decision-making and an effort from multi-disciplinary teamwork (Newton,
Taylor & Crighton, 2017). Medical care is based on the core principles - requiring an
extensive collaboration with and between the professionals, patients and their relatives; with
each of the member practicing autonomy with each other. A collaborative care is to be at
practice along with the core of person-centered care so that there can exist a fine patient-
professional ethical relationship made of trust, recognition and mutual respect (Bachnick et

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al., 2018). The medical professional’s focus must on the entire multidimensional,
multidisciplinary comprehensive care. While shared decision making skills highlights an
active involvement of the patients in clinical decision making with their equal contribution in
health recovery. A definite patient-nurse collaboration as well as an inter-professional is as
necessary for Lisa to recover in an efficient way without any conception towards relapse.
Although healthcare providers acknowledge a good blend of an inter-professional medical
collaboration(Lancaster et al., 2015), there are certain barriers which come in context of the
shared decision-making (O’Reilly et al., 2017). When a good collaborative network is finally
established between the in-patient staff and community health providers along with
discharged patients, the latter shows a diminished rate of readmission along with an improved
health and quality of life (Zhang et al., 2017). It is vital to achieve a seamless and safe
transition of mental health patients from the in-patient psychiatric units to the final discharge.
A transitional discharge intervention is necessary for an overlap between in-patient with
community health providers, whereas the former continues to treat the discharged patient till
an efficient working relationship is actually established with the community care worker. A
mental health nurse must be able to work towards a shared goal of recovery with Lisa by
putting her back on medication, by counseling her fears and rooting the source of her
anxieties while being able to remove these anxious thoughts from Lisa’s mind. Building a
good rapport and great communication skills incorporated with principles of patient integrity,
totality is to be practiced along with the skilled practice of active listening which becomes
extremely important in mental health profession. The most vital task in hand for a mental
health working with Lisa is to attach her back with ‘reality’ and surrounding while keeping
her away from strange hallucinations with pharmacological interventions. Memory tracking
exercises needs to be practiced with Lisa and the nurse must teach the same to Lisa so that
she can do it by herself. With collaborative work, the nurse should able to develop self-

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confidence and judgment back in Lisa to keep her adhered on medication until she is fully
recovered. For the risk management purpose, the nurse should make Lisa realize the delusion
and paranoia which has made hive inside her head and how she needs to cope with it, finally
eliminating the discourse for her life. This risk management would take extensive behavioral
training, cognitive straightening and patient empowerment which the mental health nurse
needs to provide professionally with complete sincerity, obedience and total truth worthiness.
The mental health nurse should be working collaboratively with Lisa to deliver her
the much necessary medical interventions. Safety is the utmost prime priority to be practiced
by the trauma informed care nurse. Modification of environment with removal of sharp
threatening objects like knife, blade, scissors should kept away from patients reach should be
done initially (Lundgren & McMakin, 2018). Risk management of self-harm behaviors
should be first assessed by the mental health nurse and then managed by the same, in order to
prevent further risks to Lisa’s recovery. Directive, eclectic or patient centered counseling of
Lisa should be done by the attending mental health nurse along with the assistance of a
psychiatrist or clinical psychologist who would be able to analyze and scrutinize the
underlying psychopathologies of Lisa’s trauma responsive behavior. A mutual goal setting
between the nurse and Lisa along with development of a shared decision making is important
to the recovery process. Promoting the right judgment and letting Lisa decide what is correct
for her well-being is an important empowerment process in trauma informed care and best
clinical practice. Hallucinations can be treated with sedatives and neuro-modulatory drugs
treating the pathophysiology induced by substance abuse such as cannabis on the human
nervous and cognitive defense systems. Sleep and relaxation along with application of
anxiolytic drugs can prevent Lisa from a breakdown with de-realization – should be practiced
by a mental health nurse in treatment of the paranoid symptoms. Sleep, relaxation and
recreation activities can also promote better moods, positive behavior towards one’s own

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well-being which must be enhanced with a positive decision making by the nurse in
consensus with other multidisciplinary healthcare members. Choice of treatment is as
important as safety, collaboration and empowerment principle of traumatic informed care and
practice – which is to be done correctly and rightly by the mental health nurse in consensus
with the doctors and the patient.

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