Stigma in Psychiatric Nursing

TOPIC. Stigmatizing attitudes in psychiatric nursing. PURPOSE. To develop a greater awareness of the existence of stigma associated with psychiatric nursing. SOURCES. Published literature. CONCLUSIONS. Professional self-understanding and knowledge are methods by which psychiatric nursing can elevate its professional image and value. Search terms: Nursing shortage, professional knowledge, psychiatric nursing, research, stigma ********** As demand increases for cost-effective and quality health care, psychiatric nurses who are educated at both the basic and advanced levels are in demand. The traditional emphasis on the therapeutic relationship rather than on technology has allowed psychiatric nurses to provide care in a comparatively autonomous manner. This autonomy will promote a smooth transition to a less physician-dependent healthcare system and provide cost advantages to consumers. Psychiatric nurses will continue to expand their role in the delivery of mental health care in community and rural settings, nurse-run clinics, consultation, and collaborative alliances with primary care physicians. Additionally, despite a current emphasis on a biologic theory of causation, the literature continues to support the use of psychotherapeutic interventions as an effective treatment option, along with medications, for depression (Scott, 2000) and other mental disorders. Most states have passed bills that allow for the prescription of limited medications with varying levels of autonomy by advanced practice nurses (American Nurses Association, 2000). Consumer demand and economic pressure will continue to influence legislation that will expand the scope and authority of nurses in general and psychiatric nurses specifically. While psychiatric nursing has the potential for continued growth and the ability to positively affect mental health care, there are dangers facing the discipline that may serve to undermine our sense of optimism. The current nursing shortage promises to be more fundamental and intractable than previous shortfalls in supply and demand (Villalva, 2000), and will have an impact on psychiatric nursing as demand for our services increases abut our numbers dwindle (Oermann & Sperling, 1999). According to Perese (1996), the numbers of psychiatric nurses need to triple by 2005, yet numbers of nursing students choosing psychiatric nursing declined by 2% in the late 20th century. In order to continue attracting sufficient numbers of psychiatric nurses and to assume our place in an evolving and demanding healthcare environment, it is essential that our discipline engage in a collective self-analysis, recognizing and strengthening areas of weakness. To do this we must acknowledge the existence of negative perceptions, and perhaps stigmatization, of psychiatric nursing by other healthcare professionals, the public, nurse educators, and nursing students themselves. Perceptions Regarding Psychiatric Nursing A review of the literature shows a surprising lack of research concerning perceptions related to psychiatric nursing. The comment, "It is surprising that there has been relatively little research concerning the question of the public's attitude toward mental health professionals" was made in a 1979 investigation (McGuire & Borowy, p. 74); more than 20 years later the same deficit exists in the literature. Studies regarding nursing students, however, provide significant data that may aid the understanding of how our specialty area is perceived. Prospective nurses are susceptible to the same misperceptions as the public, expecting patients to be hostile and violent and likely to injure them (Perese, 1996). Students in Ireland consider psychiatric nursing menial and not really nursing, and feel "exploited" and "second-class" (Wells, Ryan, & McElwee, 2000, p. 79). Students who are considering this field face well-meaning advice from friends and family. …