To deliver specialized care to those in mental institutions, mental nurses were required to possess specific qualities and demonstrate unique abilities, such as sympathy, intelligence, and trustworthiness (Church, 1982). Other essential attributes included knowing how to calm the nerves of an anxious or suicidal patient by using empathy and tact. Mental nurses' abilities set them apart from other nurses, but were difficult to define and understand, for they were ethereal in nature and not easily describable. (Silverstein, 2006, p. 33)
These understandings, described by Silverstein as "ethereal" have become a basic core set of values for the nurse in training and practice and must not be lost, regardless of the transition to autonomous scientific-based care.
Hales et al. has the most comprehensive description of the modern trend to create specialized autonomous care, focusing on scientific training and assimilation of autonomous specialty nurse practitioners in mental health care.
Major shifts in today's healthcare system have resulted in a clear demonstration that advanced practice nurses (APNs) are able to provide cost-effective, high-quality care to patients and their families (Cooper, 2001; Gabay & Wolfe, 1997; Mundinger et al., 1999; Pinkerton & Bush, 2000). Although much of the focus has been on nurse practitioners (NPs) in the primary care setting, APNs in specialty areas are receiving growing attention. Specifically, psychiatric-mental health APNs (both clinical nurse specialists and psychiatric nurse practitioners) have become significantly more visible in providing care to the mentally ill population (Baradell & Bordeaux, 2001; Puskar & Bernado, 2002; Society, 1997). and, just as primary care NPs have altered and positively affected the primary care environment (Pearson, 2002; Simpson et al., 2001), psychiatric-mental health APNs have become key players in building a mental healthcare environment and infrastructure that increases patients' access to quality care, while reducing overall costs. (Hales, Karshmer, Williams, Mann & Robbins, 2004, p. 93)
Though Hales et al. stresses the significant factors associated with autonomous care trends he also discusses the role of training nurses in science and core values (such as nurturing) at the highest levels of nurse training to maintain a continuum of care that pays particular attention to the strengths of the nursing industry, while still making sure to transition practitioners into autonomous...
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