Psychotherapeutic management: a model for nursing practice

Role clarification that will increase recognition and decrease the role confusion of psychiatric nurses who practice in the inpatient setting is the central thrust of this discussion. Indeed, the author suggests that more, not less, energies and resources be directed toward emphasizing and preparing nurses to become more effective inpatient psychiatric nurses. It is quite obvious that the recent overvaluation of outpatient nursing with the subsequent devaluation of inpatient nursing has had an overall negative effect on psychiatric nursing. The net result is role confusion and loss of professional momentum. More specifically, the role of nurses who control the therapeutic milieu and provide 24-hour patient management within the inpatient setting has become devalued, while the newer role of the nurse in the outpatient settings is not only overvalued but is, in many instances, in conflict with the outpatient psychiatric services offered by other professions. In a phrase, psychiatric nursing is divesting its energies by moving away from its historical power base, inpatient care, to compete at a disadvantage with other professions in outpatient care. Psychotherapeutic management is "real world" nursing. Mastery of the components--psychopharmacology, therapeutic nurse-patient communication, and milieu management--grounded in psychopathological concepts, is a challenging but achievable undertaking; one that will provide a model for productive psychiatric nursing, and a distinct sense of professional achievement and role clarity for inpatient psychiatric nurses.