ACU Semester 1 NRSG263: Mental Health Nursing Essay

This essay delves into the principles of mental health nursing, focusing on the use of psychotropic medications in treating mental disorders. It examines the shift towards deinstitutionalization and the impact of these drugs on patient care, while acknowledging associated controversies and criticisms. The essay identifies the challenges faced by registered nurses (RNs) in administering these drugs, particularly concerning patient safety and potential for harm. It further explores the role of RNs in promoting recovery-oriented practices, including physical, emotional, social, and psychological care, and the implementation of nursing intervention strategies. The discussion includes the impact of patient aggression on nurses, and the importance of a safe environment for the client. Furthermore, the essay highlights the importance of education for both clients and their families regarding the side effects of psychotropic drugs and the need for more documentation, practice, and understanding, especially in inpatient mental healthcare settings, to mitigate the harmful effects of these drugs on humans.

Running head: PRINCIPLES OF MENTAL HEALTH NURSING
PRINCIPLES OF MENTAL HEALTH NURSING
Name of the Student:
Name of the University:
Author’s Note:

1PRINCIPLES OF MENTAL HEALTH NURSING
Psychiatric medications are licensed psychoactive drugs that are administered in order
to induce an effect on the chemical composition of the brain and the nervous system. These
drugs are usually used for treating the patient with mental disorders and are generally
prescribed in a psychiatric setting. The drugs are made up of synthetic chemical compounds.
From the mid-20th century, these are widely used in treating a wide range of mental diseases
thus, reducing the need to stay in the hospitals for an extended period, lowering the cost of
mental healthcare and hospitalisation (Kronenfeld et al., 2017). The use of psychotropic
medication is stated to control behaviours and manage the signs and symptoms of mental
illness; however, criticisms are associated. The aim of the essay is to understand the
controversies related to the use of psychotropic drugs and the identification of the challenges
that the registered nurses (RNs) face while administering the drug to the client. It can be
noted that a significant amount of risk of harm is posed to the professional as the client have a
tendency of hurting self or other due to the psychological distress. The experts must be aware
of it and adopt strategies to control them. Thus, the way adopted by RNs for promoting
recovery-oriented practice will be assessed in the essay.
The introduction of psychotropic drugs has brought various changes in the treatment
process of mental illness. This lead to the better option of treating the patient without the
need of confining them in a psychiatric setting or using constraints. This was the primary
reason because of which many countries had moved to deinstitutionalisation lead to the
closure of many mental health hospitals allowing patients to be treated at home, general
hospitals, or small care centre. It also results in discontinuation of the use of physical
restraints such as straitjackets. The most prescribed psychiatric drugs as per the record of
2013 are alprazolam, citalopram, sertraline, escitalopram, fluoxetine, bupropion XL,
trazodone and duloxetine. According to the study conducted by Tomba, Guidi and Fava
(2018), during the industrialisation period, when the healthcare facilities supported in

2PRINCIPLES OF MENTAL HEALTH NURSING
improving physical health, the frequency of psychosocial disorder was rising. The causes of
such a drastic increase is a debatable issue. As per the US Surgeon General, it was estimated
that about one in five children and adolescents exhibited signs and symptoms of the
recognised disorder in a period of one year. Among the subjects, 5% of the population
suffered from severe functional impairment. In a more recent study by Cummings and
Wiggins (2016), it was observed that the onset of the mental illness begins as early as 14
years and significant symptoms manifest in preschools. As stated by Goldberg and Ernst
(2018), a psychotropic drug is a classification of psychiatric medications that has an impact
on the mood, a behaviour thought, and perception of the human being. The psychotropic
drugs include both prescribed as well as misused drugs whose use is often misleading and has
a negative impact on the body and the mind. The incidents of violent and aggressive
behaviour are common among adult mental health inpatients settingsthe ues of restrictive
interventions such as seclusion, restraint, sedating drugs are used for managing them.
Houghton, Ong, & Bolognani (2017) opined that coercise and restrictive practice have risks
that may harm the patients physically and psychologically. The interventions are expensive
and legal asoecst are aasociated with them. According to the Substance Abuse and Mental
Health Services Administration (SAMHSA) and data from the National Survey on Drug and
Health, it was noted that there were 47 million adults above the age of 18 that had presented
mental illness in 2018. The use of the psychotropic drug has been recognised to treat a
number of the disorder. They are responsible for altering the level of chemicals present in the
brain or neurotransmitters that include dopamine, gamma-aminobutyric acid (GABA),
serotonin and norepinephrine. Five major classes of legally used psychotropic medications
that include anti-depressants, anti-anxiety, antipsychotics, mood stabiliser, and stimulants
(Vickery, Mathews & Vickery, 2019). Evidence states that some drugs have severe side
effects on the brain as a result; they require specific monitoring processes and requirements

3PRINCIPLES OF MENTAL HEALTH NURSING
by healthcare practitioners before prescribing or administering them. The benefits of
psychiatric drugs are stated to be exaggerated; however, the harms are underplayed because
of poor trial design. As per the report of the British Medical Journal (BMJ), more than half a
million people who are above the age of 65 years have a high mortality rate due to the use of
psychiatric drugs in the western world on an annual basis. The benefits of using such drugs
are minimal and thus, the treatment needs to be exclusively used in case of acute scenarios
(Modern Healthcare, 2015).
As per the new guidelines, the change needs to be an acknowledgment and the
withdrawal of clinics in order to help patients to discontinue the use of such medications that
need to be promoted. As per another study conducted by Cummings and Wiggins (2016), the
benefits of using psychotropic drugs are overemphasised; however, the harms are not
highlighted. The reason for this is because of biasness in randomised controlled trials (RCTs),
not blinded in an appropriate manner, and not fully assessed about the effects of the drugs on
brain functioning. For example, it can be seen that in most of the studies, the patients have
undergone usage of the drugs and, thus, exhibit symptoms such as abstinence and withdrawal
symptoms. Thus, in the result section, the benefits of the treatment were exaggerated and
increased the harm in the placebo group (Roitto et al., 2019). Before coercision, the patiuents
are subjected to professional control and the interaction of staffs and patient is found to act as
a trigger. The trigger include power, controlling action by staffs and loss of autonomy. This
led to protest behaviour in the form of aggression or violence. Various controversies are
associated with the use of these drugs that need to understand for gaining insight about its
effect on the human body. As per the report of 27 February 2010, patients who had to seek
psychiatric help for mood disorders have a high chance of being diagnosed with a disease that
does not exist or treated with a drug that effective than a placebo (Psychiatric Times, 2020).
As per the author, American psychiatry is moving to a direction where a large number of the

4PRINCIPLES OF MENTAL HEALTH NURSING
population is a mental illness with an improper diagnosis process and is treated with powerful
drugs. The controversy has paved the way for a way of measuring the clinical
psychopathology that is whether the psychiatrists should depend on the use of the definite
diagnostic system such as DSM-IV or V, use of the dimensional approach that is used in the
UCLA Family Study of Schizophrenia or other personality disease or use both. According to
the study of Epel and Prather (2018), a stress variable is made up of various environmental
factors. It spans the lifetime of an individual as well as variables related to family
psychopathology. Thus, it can be seen that the complex need of the patients is difficult to
identify and assess and the use of drugs is commonly referred. The impact of coercision are
pain, physical discomfort, seclusion and overpowering behaviours of the staffs. The report of
such behaviours are found to have a positive impact among some patients for example, it
preventing such behaviour and resulted in intervention focused on patient safety.
Community mental health nurses are responsible for assessing the symptoms,
functional level, ability of support to themselves, whether the patient is taking medication on
time, a physical issue, understanding the issue faced by the client by interacting with family
and others to gain evidence and offer person-centered care. As per the study of Milich and
Roberts (2018), there is a high risk of an injury to the central nervous system, impaired
physical activity, impaired urinary elimination and risk associated with the intolerance of
sedation and weakness; all are the side effects of the psychotropic drugs. Thus, the nursing
professionals come into play by offering them physical, emotional, social and psychological
care to improve. The nursing intervention strategies that are offered to mentally ill patients
include offering comfort measures such as proper positioning of the body, safety measures
that help in minimising the risks related to raised side rails, inadequate lighting, and
continuous monitoring of the client’s status after the administration of the drug (Inventor et
al., 2018). The nurses are also responsible for educating both the client and family about the

5PRINCIPLES OF MENTAL HEALTH NURSING
die effects of such drugs in order to gain better cooperation and understanding. One of the
critical roles of the psychiatric nurses is to provide a better and safe environment for the
client; this not only includes the physical environment but a supportive atmosphere that will
help in a recovery-oriented approach. The assistance to the client in performing activities that
help in developing confidence and self-esteem among them. As per the opinion of DeFehr
(2017), the administration of the medication is stated to be an autonomous role of the nursing
professionals; however, fewer studies have been conducted that explored the area of nursing
practice; therefore, the use of any intervention strategies used by the mental health nurses are
not known. A study was conducted upon in order to explore the factors involved in the
administration of psychotropic drugs, where lack of lucidity related to such medication and
the practice related aspect, confusion related to decision-making associated with the use of
intervention, and ineffective process of documentation (ScienceDaily, 2015). These were
found to be the reason because of which, the incidence of administering such drugs is higher.
In another similar study by Westbury et al. (2018), it was found that there was an increase in
dependence on the use of antipsychotics over benzodiazepines, which is not supported by
relevant literature. Therefore, the complexities in nursing intervention limit the understanding
of the harmful effect of these drugs on humans, which require more documentation, practice,
particularly in the inpatient mental healthcare settings.
As stated by Alves et al. (2016), people with a mental health condition tend to have
aggressive or violent behaviour that may be harmful to the self or the nurses. Therefore, it is
important to identify various challenges posed by the patients who are given antipsychotics to
mitigate the mental issue. As per the opinion of Silva et al. (2015), these drugs may be
responsible for exhibiting unnatural behaviours that may be harmful, especially while giving
the medication. The wellbeing of mental health nurses is associated with the aggressive of
mentally ill patients however, it can be on opposite side also. Pekurinen et al. (2017) opined

6PRINCIPLES OF MENTAL HEALTH NURSING
that patient aggression, specifically among psychiatric patients, is a global concern. The
nurses are taking care of people with mental distress are found to exposed to harm and violent
behaviour. Aggression is referred to as different practices or actions that have the potentiality
of causing harm, injury, or hurt to oneself or others either physically or verbally; however,
the intention is not known. The nurses are the target of these patients are linked with various
factors such as anxiety, guilt, feat, burnout, poor health status, dissatisfaction, and others at
work. The most common incident when they are exposed to such behaviour or action is
administering the drugs prescribed to them. It is noted that due to various uncontrollable
factors, the use of physical constraint is used. An empirical study conducted by Souza et al.
(2015) stated that patient aggression toward nurses and other healthcare professionals in the
mental health setting is increasing at a higher level in terms of assault by patients. This is
especially true among inpatients, patients with substance abuse disease and people with
severe mental distress. Psychiatric nurses adopt various strategies to address these issues and
manage patients. The strategies range from mild to severe and depend on the mental status of
the patient. In some cases, the patient can be communicated in order make them understand
the importance of having the drugs; however, some patient may be harmful toward self and
the professional; as a result, the use of various technologies such as strap belt chairs are used
for making them have the medicine on time and routinely.
From the essay, it can be inferred that the use of psychotropic drugs has benefits as
well as the harmful effect on the brain and may not always be used. It can be seen that there
are drugs, which are misused by people and, thus, cause disease related to substance abuse.
Thus, the drug is a treatment as well as a source of the disease because the continuous use of
psychotropic drugs leads to addiction. In many reputed journals and websites, the
controversies related to these medications have been highlighted; however, the widespread
use of medicine did not affect. It can be seen there are numerous challenges posed to the

7PRINCIPLES OF MENTAL HEALTH NURSING
nurse while administering the drug to mentally ill patients. This is because they demonstrated
aggressive action that can be harmful to both the client and the professionals. The challenges
include anxiety and fear of bearing the patients, lack of appropriate training, the guilt of using
harsh strategies and sleep deprivation as well as mental distress in case of coersion. These
factors lead to a high turnover of the nurses leading to a shortage of nursing professionals in
the psychiatry department. Therefore, it can be recommended that strategies need to be taken
by the mental healthcare committee to address the challenges and promote the health and
wellbeing of the nurses in an effective manner.

8PRINCIPLES OF MENTAL HEALTH NURSING
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