Psychological care by nurses, paramedical and medical staff: essential developments for the general hospitals

To date clinical psychologists and psychiatrists have given sparse attention to the development of clinical services within general hospitals, despite a literature demonstrating high levels of need. It is argued that attempts to reverse this situation must resolve long-standing obstacles in attitude and practice within the medical and nursing professions as well as the apparent ambivalence of psychologists and psychiatrists towards the endeavour. If projected developments are to hold credence, planned changes in practice must emphasize a preventive approach towards psychological care and must do this primarily through existing resources; that is, the nursing and paramedical professions. A scheme of psychological care designed to be operated by nurses and other professions is outlined. It depends on teaching and supervision by psychologists and psychiatrists, and it emphasizes the basic skills of monitoring psychological state, caring by informing, emotional care and basic counselling. The absorption of these practices into the daily routine is essential in order that psychological care becomes a standard provision for all seriously ill and injured people. Approaches to training are reviewed and an overview is given of the author's experiences in promoting such a scheme within a renal unit.