Guest Editorial

Developments in neurosci-ence during the past 3 de-cades have led to a better

understanding of psychiatric illnesses and their treatment (Preskorn, 2010). These advances have contributed to a greater reliance on the use of psycho-tropic medications, sometimes at the expense of other treatment modalities. What does this mean for nurses provid-ing psychiatric care?

Nurses have played an important role in the use of psychotropic medica-tion in the treatment of psychiatric ill-nesses. This involvement has included providing education to patients and their families about pharmaceutical treatments, administering and monitor-ing medications for safety and efficacy, and, in the case of advanced practice nurses (APNs), prescribing therapeutic drugs. Due to the central role that medi-cations have assumed in the treatment of psychiatric illnesses, health care orga-nizations, administrators, educators, and even nurses themselves may overlook other significant therapeutic modalities in the treatment of psychiatric illnesses. There is no question that psychotropic medications have transformed treat-ment for psychiatric patients but, as nurses, we must promote a holistic ap-proach that addresses the psychological and social needs—as well as the biologi-cal needs—of the individual.

Fortunately, mental health clinicians of all disciplines increasingly recognize the importance of balance in treating patients with regard to their psycho-logical, social, and physiological needs (Grant, 2011; Hyun & Alfonso, 2011; Lüllmann, Berendes, Rief, & Lincoln, 2011). In a recent article published in the New York Times, Daniel Carlat (2010), a leading psychiatrist and writer on men-

tal health issues, lamented the fact that the psychiatrist’s role is now primarily to medicate psychiatric patients, while the psychotherapy component is carried out by another nonprescribing clinician, re-ferred to as the split treatment model. He asserts that even if the psychiatrist’s role is primarily pharmacological, it is still important to provide some level of psy-chotherapy within this framework. It is imperative that we, as psychiatric nurses, avoid assuming a similar limited role. We need to be cautious not to overemphasize

the use of pharmacotherapy, while over-looking other therapeutic interventions. Nursing theory is grounded in viewing the patient as a biological, psychologi-cal, and social being and emphasizes the interplay between these three spheres (McFarlane, 1980). Theory guides the practice of nursing, and it is essential that in our practice we do not limit our focus solely to the biological aspects of psychi-atric illness (Colley, 2003).

Many nurse theorists have identified the importance of seeing the patient as

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Guest Editorial

one who interacts with the environment to achieve and maintain psychological, social, and physical health. For example, the nurse theorist Martha Rogers iden-tified the primary purpose of nursing as promoting the overall health and well-ness of the patient. She proposed that nursing practice is an art and a science and should entail noninvasive modali-ties, such as therapeutic touch, humor, guided imagery, and use of color, light, music, and meditation, focusing on the person’s health potential. Rogers (1992) believed pain management, supportive psychotherapy, and motivation for reha-bilitation are areas that nursing prac-tice should emphasize. Sister Callista Roy, founder of the Adaptation Model of Nursing, saw the person holistically as a biopsychosocial being who needs to adapt to the environment to main-tain wellness (Roy & Andrews, 1976). Another major nurse theorist, Virginia Henderson (1966), emphasized the idea of biophysiology, culture, communica-tion, and human needs as central to the care of patients.

Hildegard Peplau (1962), the fore-most theorist and leader of psychiatric nursing and advocate for individuals with mental illness, considered inter-personal techniques as the “crux of psychiatric nursing.” She believed the counseling role was the heart of psychi-atric nursing practice. While she also identified nurses as technical experts, which would seem to apply to the role of psychotropic prescriber, administer, and educator, the roles of resource person, counselor, and surrogate were perceived as the most important.

Bedside nurses, nurse educators, APNs, and nurse administrators have a responsibility to promote and practice holistic care based on nursing theory. Steps to prevent a myopic focus on medi-cation interventions need to be identi-fied. For example, nurse educators should continue to include psychology, ethics, nutrition, wellness, and sociology com-ponents along with core nursing and life sciences curriculum requirements. At the graduate level, educators should preserve the didactic and clinical com-

ponents of psychotherapy of the indi-vidual, family, and group in addition to psychiatric assessment, psychopathol-ogy, and pharmacology. Even if nurses are primarily involved in administering or prescribing medication, this broad education will aid them in more fully understanding the patient and promote therapeutic interactions with patients and families. Postmaster and postdoctor-al training in psychotherapy should be encouraged for nurses who plan to work in private practice, as is customary with other psychiatric professionals.

In practice, APNs should apply psy-chological, social, and family theory in

their work with patients, in addition to pharmacotherapy and biological theory. Certainly, if the APN is in the role of psychotherapist this would be the case. However, even if the APN’s role is pri-marily prescribing medication, a thera-peutic approach based on these theories will improve outcomes. Patients are more likely to benefit from medication if it is incorporated into a holistic treatment plan. For example, APNs need to as-sess and address how the family is react-ing to the patient’s need for medication. The family’s support of pharmacological treatment is often vital in a achieving medication adherence. Without knowl-edge of family system theory, APNs are not prepared to provide optimum treat-ment to support the best outcomes for the

patient. Furthermore, the importance of understanding the cultural identities of patients and their families and how these influence their understanding of medica-tion cannot be overstated. How does the patient feel about taking the medication? What is the family’s and cultural beliefs about medication? These are important questions nurses need to explore with pa-tients and their families.

While economic changes and man-aged care organizations are influenc-ing patient care, nurse leaders need to make sure that the care nurses provide represents the full caliber of nursing ca-pabilities, as recommended in the Future of Nursing report from the Institute of Medicine (2011). Nurse managers should provide a dynamic, therapeutic environ-ment on inpatient and partial hospital-ization units, despite staffing cuts. Since an integral part of the nurse’s role is to interact therapeutically with patients and their families, nurses should continue to be involved in running patient and fam-ily groups on the unit as part of an inter-disciplinary team. Additionally, nurses need to continue to educate patients and families about medications. The ability to do so needs to be supported with ongoing education related to social, psychologi-cal, and biological theory.

Nurse administrators need to remem-ber that the nurse’s most powerful tool is the use of self. When critical deci-sions are made regarding staffing levels and educational preparation and expe-rience in the planning for patient care, the value of the nurse as a therapeutic tool should not be underestimated. Nurses are much more than medication administrators and prescribers. In this day of cost-consciousness, nurses’ capa-bilities should be used to the fullest. We should be asking, in addition to prescrib-ing medication, what else can nurses do to improve patients’ health? Nurses are well prepared to educate patients about the benefits of exercise, healthy eating, and stress management; nurse adminis-trators and managers should capitalize on this for the benefit of patients. These significant factors influence health and should not be overlooked, particularly

Nurses are well prepared to educate patients about the benefits of exercise, healthy eating, and stress management; nurse administrators and managers should capitalize on this for the benefit of patients.

5Journal of Psychosocial nursing • Vol. 49, no. 12, 2011

Guest Editorial

in those with chronic mental illness, as they have significantly greater morbidity and mortality than the general popula-tion.

As nurses, we are well equipped to provide integrated holistic care to psy-chiatric patients. Because of our core be-liefs and education, we view the person as a biopsychosocial being. Although we incorporate psychotropic medications in the care of our patients, it doesn’t re-flect the essence of what we do. Despite external forces that may contribute to a limited perspective on how psychiatric care is provided to individuals and their families, we need to maintain our own vision of what constitutes excellence in psychiatric nursing care.

REFERENCESCarlat, D. (2010, April 23). Mind over meds. New

York Times. Retrieved from http://www.nytimes.com/2010/04/25/magazine/25Memoir-t.html

Colley, S. (2003). Nursing theory: Its importance to practice. Nursing Standard, 17(46), 33-37.

Grant, A. (2011). A critique of the representation of human suffering in the cognitive behavioural

therapy literature with implications for mental health nursing practice. Journal of Psychiatric and Mental Health Nursing, 18, 35-40.

Henderson, V. (1966). The nature of nursing: A defi-nition and its implications for practice, research, and education. New York: MacMillan.

Hyun, A., & Alfonso, C.A. (2011). Epilogue: Con-versations between a psychoanalyst and a psy-chiatry resident. Journal of the American Acad-emy of Psychoanalysis and Dynamic Psychiatry, 39, 221-227.

Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Retrieved from the National Academies Press website: http://www.nap.edu/catalog.php?record_id=12956

Lüllmann, E., Berendes, S., Rief, W., & Lincoln, T.M. (2011). Benefits and harms of providing biological causal models in the treatment of psychosis–An experimental study. Journal of Behavioral Therapy and Experimental Psychiatry, 42, 447-453.

McFarlane, E.A. (1980). Nursing theory: The com-parison of four theoretical proposals. Journal of Advanced Nursing, 5, 3-19.

Peplau, H.E. (1962). Interpersonal techniques: The crux of psychiatric nursing. American Journal of Nursing, 62(6), 50-54.

Preskorn, S.H. (2010). CNS drug development: Part II: Advances from the 1960s to the 1990s. Journal of Psychiatric Practice, 16, 413-415.

Rogers, M.E. (1992). Nursing science and the space age. Nursing Science Quarterly, 5(1) 27-34.

Roy, C., & Andrews, H.A. (1976). The Roy Adap-tation Model. Upper Saddle River, NJ: Prentice Hall.

Mary Cullen-Drill, DNP, APN-BC, DCCAssistant Professor of Clinical NursingColumbia University School of NursingNew York

Private Psychotherapy and Psychopharmacology PracticeMontclair, New JerseyKathleen M. Prendergast, MSN, PMH-NP, BCClinical Adjunct FacultyRutgers UniversitySchool of NursingNewark, New JerseyAdvanced Practice NurseCare Plus NJParamus, New Jersey

Private Psychotherapy and Psychopharmacology PracticeCaldwell, New Jersey

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.

doi:10.3928/02793695-20111108-01