Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Consultation-Liaison Nursing: A Personal Reflection

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Consultation-Liaison Nursing: A Personal Reflection

Article excerpt

INTRODUCTION

Psychiatric disorders occur co-morbidly in the medical and surgical patient population at a significant rate with evidence of psychiatric symptoms in 30-50% of patients with primary medical diagnoses (Arolt and Driessen, 1996; Clarke, Smith, & Herrman, 1993; Mayou and Hawton, 1986; Saravay, Pollack, Steinberg, Weinschel, & Habert, 1996; Saravay, Steinberg, Weinschel, Pollack, & Alovis, 1991; Savoca, 1999). Psychiatric consultation-liaison nursing (PCLN) has evolved as a specialist area in mental health nursing in response to nurses working in the general hospital setting reporting that they lack the knowledge and skills necessary to assess and manage patients with mental health problems (Bailey, 1998; Brinn, 2000; Roberts, 1998; Sharrock and Happell, 2002; Wand and Happell, 2001). These two factors serve to underpin the significance of the PCLN role in assisting nurses working in non-psychiatric settings to develop the skills and confidence to manage mental health problems in their patients.

This paper will provide a brief history of PCLN before focusing on the writer's experience of working in this specialist area in Western Australia, which will cover a brief period of work in the emergency department and later in the general hospital. Clinical supervision will be discussed and a brief narrative provided relating to the 2002 Bali bombing aftermath. Finally, there will be a brief discussion relating to some similarities and differences in the way nurses and doctors work to provide care for their patients in the area of consultation-liaison psychiatry.

HISTORY OF PSYCHIATRIC CONSULTATION-LIAISON NURSING

United States of America

Consultation-Liaison Psychiatry originated in the USA during the post World War 1 years and many years later psychiatric nurses began to develop an interest in this area (Robinson, 1991). Psychiatric liaison nursing was first mentioned in the literature by Johnson and Peplau in USA in the 1960s. Johnson (1963) describes her role as a psychiatric Clinical Nurse Specialist and as a member of a specialist team of nurses who provided consultation to nurses in the general hospital and Peplau (1964) discusses the use of psychiatric nursing skills to improve the care of patients in the general hospital with particular emphasis on verbalizations and communication skills and the nurse-patient relationship. The psychiatric nurse consultant role evolved during the 1970s in the USA with the nurse becoming part of a multidisciplinary team and taking their expertise into the emergency department. Robinson (1982) provides us with a comprehensive review of the literature relating to the development and expansion of the psychiatric liaison role from 1962-1982 and draws our attention to a paper by Nelson and Schilke (1976) which discusses the evolution of psychiatric liaison nursing and the teaching role of liaison nurses aimed at improving staff skills and patient care in the general hospital. They identified characteristics of the clinical nurse specialist role such as consultation to nursing staff and education of the team involved in the care of the patient, understanding the interconnectedness of physical and psychological states, providing direct psychological care to patients and their families and liaison between disciplines. In addition they state that the role is unique in that it provides

a framework within which the nursing staff can understand the patient's experience of illness and hospitalisation and their own experience of caring for patients within the hospital system (Nelson and Schilke, 1976, p. 64).

The role of psychiatric consultation-liaison nursing in the USA is outlined and identified as a subspecialty of psychiatric mental health using and requires a masters degree to practice by the American Nurses Association (1990).

United Kingdom

During the 1970s, psychiatric nurses in the UK were involved in some functions and activities similar to those of their liaison nursing colleagues in USA but the role evolved predominantly in response to heightened concern about the increase in suicide attempts in the UK (Catalan et al. …

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