Nursing Sample
UK English
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Used with permission of author.
Nurses as Therapists
A Policy SolutionAnswer
Introduction
This The purpose of this essay is to advocate on behalf of an evolving for role change of psychiatricfor mental health nurses in Australia. Australia is currently experiencing an having epidemic of mental health problems right now that respond better to psychological interventions as opposed to pharmacological.counselling than medicine. Notwithstanding, the dominant medical model of mental healthcaredominate health care delivery in Australia inhibits the system’s ability respond adequately to conditions such as social anxiety that respond better to , so psychological therapy not populare. This essay suggest psychiatric nurses should provider of of psychological therapies. After exploring the scope of the problem, this essay proposes that mental health nurses are ideally poised to become to primary providers of these psychological therapiestherapy.
Context
context
According to the Australian Institute of Health and Welfare ([AIHW], (2007), mental health problems are the primaryproblems leading cause of non-fatal disability in Australia. Data from the 2007 National Survey of Mental Health and WellbeingWelfare (Slade et al., 2009) indicates that approximately 45show that45.5% of the population have or will experience a mental health problem at some point in their lifetime. Anxiety disorders comprise the bulk of theseis most common mental health problems,problem affecting 1 in 7 AustraliansAustralian (Slade et al. 2009). The prevalencePrevalence of anxiety disorders in Australia also exhibits a noticeable has gender biasdifferences, with women being significantlysuffering more likely to experience an anxiety disorder than malesthan men (17.9% v. 10.8%) (Slade et al. 2009). These mental healthMental problems are also expensive, with approximately AUD (e.g., $8 billion,,000,000,000 or AU$D344 per person, having been ), which is how much was spent on mental health-relatedpsychiatric services in Australia in thefrom 2013– and 2014 period (AIHW, (Australian Institute of Health and Welfare, 2015).
Barlow (2004) observes that psychological interventions are efficacious and safe for the treatment of social anxiety disorder. More recently, following a systematic review of the literature and large scale meta-analysis, Mayo-Wilson et al. (2014) concluded that cognitive behavioural therapy (CBT) was actually more effective than pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs), such as sertraline, for the treatment of social anxiety. Additionally, . Moreover, while sertraline has been regarded as the gold standard of pharmacological interventions for social anxiety, Gordon and Melvin (2013) report on a number of disconcertinglisted many side -effects, especially in adolescentfor teenager patients, that would suggest that sertraline might not be the ideal first line of treatment.
NotwithstandingBut, while CBT mightmay be a safer treatment and more effective treatment for social anxiety than SSRIs, it can also be taxing in terms of resource usage. Priyamvada et al.and others (2009) report a 17-session treatment regimen for social anxiety, with each session lasting approximatelysocial anxiety over 17 1- hour sessions. Morris, Mensink, and Stewart (n.d.) describe a 12-session regimen, at 2.5-hours per session. From this, we can conclude that hour CBT demands a investment of time. In the Australian context, this commitment might be highly problematic given that clinical psychologists comprise the bulk of cognitive behavioural therapists.behavioral therapy. According to the 2014 National Health Workforce Data Set, there were an estimatedare 23,878 registered (i.e. clinical) psychologists in Australia in 2014 (AIHWAustralian Institute of Health and Welfare, 2016). This would suggest a ratio of 87 clinical psychologists per 100,000 head of population, which is in no way adequate in terms of the scope of the problem posed by anxiety disorders. Moreover, not all these psychologists workworking in healthcare or in clinical roleshealth care, so the trueactual figure is no doubt considerably lower. Training new clinical psychologists might seem like the logical response to this shortfall; however, the minimum training time to qualify as atrain clinical psychologist in Australia is: 6 years: (4 years honoursyear honors and 2 years provisional registration (AIHWinternship (Australian Institute of Health and Welfare, 2016). Either our approach to training clinical psychologists must changepsychology, or we must look elsewhere to meet the workforce demands for cognitive behavioural therapists in order to respond to the high incidence of social anxiety.
Opportunity
Despite the tendency for Chance
Although cognitive behavioural therapists to be clinical psychologists, there are no legal or professional restrictions prohibitingbehavior therapy done mostly by clinical psychologist, the law does not prohibit other disciplines from practicing asusing cognitive behavioural therapists. In fact, the Australian Association for Cognitive and BehaviourBehavior Therapy (2016), the peak training and registering bodyagency for cognitive behavioural therapists in Australia, recognised various other disciplines, such as providers of CBT, including teachers, social workers, dentists and nurses. With mental health nurses comprising make up 77% of the total mental healthpsychiatric workforce in Australia (Fisher 2015), mental health workers are ideally poised to become to become the primary providers of CBT with which to treat social anxiety.
In 2012, there were 334,078 nurses working in Australia, 238,520 of whom were degree prepared Registered Nurses working across a range of clinical, administrative, inpatient, community, medical, surgical and mental health settings (AIHW 2013). According to the 2014 National Health Workforce Data Set, only 1 in 15 of thesethe 334,078 nurses in Australia are Registered Psychiatric Nurses works in mental health. Therefore, the per . Therefore the per capita ratio of mental health nurses per head of population is actually worse than with clinical psychologists, with there being only (82 mental healthpsychiatry nurses perfor every 100,000 population (AIHW, 2016). Notwithstanding, the turnaround time in terms of training for mental health nurses is significantly shorter than that of clinical psychologists, with all registered nurses having untaken afaster to train: 3–4 year bachelor programme. Based on current award wages, registered-4 years. Registered nurses are also a less costly investment as compared tocheaper than clinical psychologists: AUpsychologist: $D57,.754 v. AUversus $D74,.099 (Payscale 2016a, 2016bPayScale, 2016).
ManySome nurses, however, might argue that in undertaking furtherif training as cognitive behaviouralbehavior therapists that, we are further diluting our roles or that they are simply too busy to provide a heavily structured intervention like CBT. This reluctance to provide CBT runs contrary to the literature, which suggests shows that nurses have always had a role in the provision of psychological therapies (Wheeler 2007, Delaney and Handrup 2011).
References
Australian Association forof Cognitive and BehaviourBehavioral Therapy (2016) Membership. Skills.Available at: https://www.aacbt.org.au/product/membership/ (Accessed: 23 November 2016).
Australian Institute of Health and Welfare (2007) The burden of disease and injury in Australia 2003. Canberra: :.Australian Institute of Health and Welfare.
Australian Institute of Health and Welfare (2013) Nursing and midwifery workforce 2012. Canberra: Canberra this :.Australian Institute of Health and Welfare.
Australian Institute of Health and Welfare (2015) Health Expenditure expenditure Australia 2013-–2014. Canberra: Australian Institute of Health and Welfare.
Australian Institute of Health and Welfare (2016)) Registered labor psychologist workforce. .Available at: https://mhsa.aihw.gov.au/Resources_Topics/Labour_force/Registered_psychologist_workforce/ (Accessed: 23 November 2016).
Barlow, D.H.DH (2004) Anxiety and its disordersinterference: The nature and treatment of anxiety and panic. 2nd edn. EDN 2.New York, NY: Guilford Publications.
PayScale (2016b) Registered),registered nurse (RN) salary (Australia). Available at: http://www.payscale.com/research/AU/Job=Registered_Nurse_(RN)/Hourly_Rate (Accessed: 23 November 2016).