Psychiatric and mental health nursing in the United States Army

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Psychiatric and mental health nurses in the U.S. Army Nurse Corps employing groundbreaking protocols and treatments in psychiatric issues to address the unique challenges that our service men and women face, [1] more commonly post-traumatic stress disorder and traumatic brain injuries. [2] Most people understand that trauma exposure is a popular occupational hazard for military members. Psychiatric screenings, before and during their enlistment, and treatments after being exposed to warfare, death, destruction, and torture have been extremely beneficial for military personnel and their dependents. [3]

Contents

Psychiatric and mental health nurses treat individuals diagnosed with conditions like schizophrenia, post-traumatic stress disorder, bipolar disorder, and depression. They are also trained in behavioral therapy which allows these nurses to teach patients and their loved ones how to deal with, react to, and overcome challenges that go along with different psychiatric disorders. Nurses in the psychiatric and mental health field can assess, examine, and treat patients with mental illness. [4] Nurses with proper training are able to identify and understand the needs and help-seeking behaviors of military members and, with military cultural competence and knowledge about stress injuries, including psychological damage, they are able to deliver patient-centered care to patients with military culture experiences. [5]

Emergency Psychiatry Process EmergencyPsychiatryProcess.PNG
Emergency Psychiatry Process

Duties and responsibilities [1] [6]

Unique duty positions [1]

Requirements

"Join the Army Nurse Corps" picture, circa June 1943 Join the Army Nurse Corps - poster, 1943.jpg
"Join the Army Nurse Corps" picture, circa June 1943

Active duty [1]

  • Bachelor's of Science in Nursing degree from an accredited nursing program
  • Between 21 and 42 years of age
  • Current, valid and unrestricted nursing license
  • U.S. citizenship

Army reserve [1]

  • Minimum of a Bachelor's or associate degree in Nursing or diploma in nursing from an accredited nursing school
  • At least one year of experience in psychiatric nursing
  • Between 21 and 42 years of age
  • Current, valid and unrestricted nursing license
  • U.S. citizenship or permanent residency

Training

Active duty

In the U.S. Army, the case diversity nurses experience in caring for Soldiers and their families far exceeds the medical care environment of the private sector. Army Nurse Corps officers have access to the most sophisticated and up-to-date technology, the opportunity to consult with experts in both the military and private sector, plus exceptional professional growth opportunities, which may include but are not limited to paid continuing education, clinical specialization, and residencies. [1]

Army reserve

The Army Reserve Nurse Corps begins with the Army Medical Department Basic Officer Leaders Course (BOLC), a three-week program that will expose nurses to the variety of mental and physical challenges they will face as a member of the United States Army's health care team. Candidates learn about the Army's approach to health care firsthand, train with other professionals, and attending lectures, conferences, and demonstrations that cover everything from U.S. Army customs to crisis management. Some candidates even have the opportunity to participate in a hands-on medical simulation of an in-theater field medical unit.

After completing BOLC, nurses will then begin serving with a Reserve unit a minimum of two days each month, and participate in annual training for at least two weeks each year. During this time, duties may include attending professional seminars and military or nursing education courses provided by the U.S. Army as well as the opportunity to work in a wide range of health care environments, whether it be in a modern hospital, working with skilled professionals in a variety of clinical situations or supervising paraprofessionals in a field medical unit. [1]

Walter Reed National Military Medical Center

Walter Reed National Military Medical Center logo Logo of the Walter Reed National Military Medical Center.png
Walter Reed National Military Medical Center logo

The Walter Reed National Military Medical Cente r, formerly known as the Walter Reed Army Medical Center and was open from May 1909 to August 2011 then realigned with the National Naval Medical Center, is located in Washington, D.C. and serves more than 150,000 active and retired military personnel from all branches, admitting 16,000 patients a year. As a provider of specialized care and a referral center for the North Atlantic Regional Medical Command, WRNMMC offers a broad range of clinical and educational opportunities as well as focusing on integrated patient care, teaching, and research opportunities. [7]

Research

Early research began in the 1950s with the electrophysiology of neurons in the visual system provided the groundwork for Dr. David Hubel's 1981 Nobel Prize in Medicine. This standard of excellence has been kept with years of research innovations leading to over multiple patents for scientific contributions and numerous publications in high-impact journals such as Science, Nature, the New England Journal of Medicine, and the Journal of the American Medical Association. [8]

The United States Army Medical Research Unit - Europe

The United States Army Medical Research Unit - Europe (USAMRU-E), a subordinate command of the Walter Reed National Military Center, is currently located in Heidelberg, Germany. USAMRU-E conducts applied psychological research to protect, optimize, and enhance psychological resilience for military members while also studying factors that can impact current stressors on the unit as well as the individual and their family. USAMRU-E focuses on command-directed behavioral health assessments and the development and validation of resilience training for the deployment cycle and the professional military education system. At USAMRU-E, individuals are exposed to a wide range of stressors that can negatively impact their behavioral health and well-being. Approximately 20% of those exposed report significant behavioral health problems upon returning from a combat deployment. [9]

The National Capital Consortium Psychiatry Residency Program

The National Capital Consortium (NCC) Psychiatry Residency Program, which began in 1996, is unique and innovative graduate medical education program in psychiatry for military medical professionals. For over sixty years, neuropsychiatry investigators at the Walter Reed Army Institute of Research have worked to understand, prevent, and treat the poorly understood and untreated threats to military members health and performance that is just "in their head." [8] Three military medical institutions, WRNMMC, Fort Belvoir Community Hospital (FBCH), and the Uniformed Services University of the Health Sciences (USUHS), are involved with this integrated psychiatry residency program while keeping the tradition of excellence in graduate medical education alive. NCC psychiatry residents consistently score among the highest in the nation on standard training examinations and a large number of graduates have gone on to become national and world leaders in psychiatry. [10]

Program overview

The National Capital Military Psychiatry Residency is a four-year program designed to prepare military physicians and nurses for the practice of general psychiatry in the military and in community settings upon discharge from the military. The program's mission is to train military physicians and nurses to become effective psychiatrists and psychiatric nurses in the variety of future roles they will fill, from military medical operations to multi-disciplinary mental health settings to primary care and other medical-surgical settings. Those who enroll in the psychiatric residency program apply their techniques of social science and psychiatric research to understand and address the many global and day-to-day pressures of military life affecting "mental health" and "psychological resilience." Military psychiatry, psychotherapy, and psychopharmacology are particularly strong areas of emphasis of the program. Faculty members include nationally known leaders in a number of areas of psychiatry, including psychopharmacology, psychoanalysis, neuropsychiatry, child and adolescent psychiatry, consultation-liaison psychiatry, and military psychiatry. [10] [11]

Combined residency training opportunities are also offered by the program. Army residents may apply for a 3+2 child psychiatry fellowship, and if accepted, may complete both general and child and adolescent psychiatry training in a total of five years. There is also a five-year combined internal medicine and psychiatry training program offered by the NCC Psychiatry and Internal Medicine Residency Programs. Graduates of this combined program complete requirements necessary for graduation from both residencies and for board certification in both general psychiatry and internal medicine. They also use traditional methods of individual and small-group interview, standard and specialized psychological tests and surveys, and objective measures such as the rates of suicide, re-enlistment, and post-traumatic stress disorder (PTSD), to make wide-ranging assessments of slider and military family health and to recommend changes to organization, training, and leadership. [10] [11]

Related Research Articles

A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are medical doctors and evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly mental issues. A psychiatrist usually works within a multi-disciplinary team, which may comprise clinical psychologists, social workers, occupational therapists, and nursing staff. Psychiatrists have broad training in a bio-psycho-social approach to assessment and management of mental illness.

Post-traumatic stress disorder mental disorder that can develop after experiencing or witnessing a terrifying or life-threatening event

Post-traumatic stress disorder (PTSD) is a mental disorder that can develop after exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, or other threats on a person's life. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Abnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion and thought, which could possibly be understood as a mental disorder. Although many behaviors could be considered as abnormal, this branch of psychology typically deals with behavior in a clinical context. There is a long history of attempts to understand and control behavior deemed to be aberrant or deviant, and there is often cultural variation in the approach taken. The field of abnormal psychology identifies multiple causes for different conditions, employing diverse theories from the general field of psychology and elsewhere, and much still hinges on what exactly is meant by "abnormal". There has traditionally been a divide between psychological and biological explanations, reflecting a philosophical dualism in regard to the mind-body problem. There have also been different approaches in trying to classify mental disorders. Abnormal includes three different categories; they are subnormal, supernormal and paranormal.

Mental health, defined by the World Health Organization (WHO), is "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community". According to WHO, mental health includes "subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others". From the perspectives of positive psychology or of holism, mental health may include an individual's ability to enjoy life and to create a balance between life activities and efforts to achieve psychological resilience. Cultural differences, subjective assessments, and competing professional theories all affect how one defines "mental health".

Institute of Mental Health (Singapore) Hospital in Buangkok Green Medical Park, Singapore

The Institute of Mental Health, formerly known as Woodbridge Hospital, is a psychiatric hospital in Singapore. It is located on a 25-hectare campus at Buangkok Green Medical Park in the north-east of Singapore.

Psychiatric nursing or mental health nursing is the appointed position of a nurse that specialises in mental health, and cares for people of all ages experiencing mental illnesses or distress. These include: schizophrenia, schizoaffective disorder, mood disorders, anxiety disorders, personality disorders, eating disorders, suicidal thoughts, psychosis, paranoia, and self-harm.

Emergency psychiatry Clinical application of psychiatry in emergency settings

Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, depression, psychosis, violence or other rapid changes in behavior. Psychiatric emergency services are rendered by professionals in the fields of medicine, nursing, psychology and social work. The demand for emergency psychiatric services has rapidly increased throughout the world since the 1960s, especially in urban areas. Care for patients in situations involving emergency psychiatry is complex.

Mental health in China is a growing issue. Experts have estimated that about 173 million people living in China are suffering from a mental disorder. The desire to seek treatment is largely hindered by China's strict social norms, as well as religious and cultural beliefs regarding personal reputation and social harmony. While the Chinese government is committed to expanding mental health care services and legislation, the country struggles with a lack of mental health professionals and access to specialists in rural areas.

A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the 1970s to assist individuals moving from state hospitals, to prevent admissions, and to provide support in homes, jobs, education, and community. These individuals were the forefront brigade to develop the community programs, which today may be referred to by names such as supported housing, psychiatric rehabilitation, supported or transitional employment, sheltered workshops, supported education, daily living skills, affirmative industries, dual diagnosis treatment, individual and family psychoeducation, adult day care, foster care, family services and mental health counseling.

Animal-assisted therapy

Animal-assisted therapy is an alternative or complementary type of therapy that includes the use of animals in a treatment. It falls under the realm of Animal Assisted Intervention, which encompasses any intervention that includes an animal in a therapeutic context such as emotional support animals, service animals trained to assist with daily activities, and animal assisted activity. Animal-assisted therapy can be classified by the type of animal, the targeted population, and how the animal is incorporated into the therapeutic plan. The most commonly used types of animal-assisted therapy are canine-assisted therapy and equine-assisted therapy. The goal of animal-assisted therapy is to improve a patient's social, emotional, or cognitive functioning and literature reviews state that animals can be useful for educational and motivational effectiveness for participants. Studies have documented the positive effects of the therapy as reported on subjective self-rating scales and on objective physiological measures such as blood pressure and hormone levels.

The Institute of Living is a comprehensive psychiatric facility in Hartford, Connecticut, that offers care across the spectrum of psychiatric services, including:

Madigan Army Medical Center Hospital in Washington, United States

The Madigan Army Medical Center, located on Joint Base Lewis-McChord just outside Lakewood, Washington, is a key component of the Madigan Healthcare System and one of the largest military hospitals on the West Coast of the United States.

Military psychology is a specialization within psychology that applies psychological science to promote the readiness of military members, organizations, and operations. Military psychologists provide support to the military in many ways, including through direct clinical care, consultation to military commanders, teaching others and supporting military training, and through research relevant to military operations and personnel. The stressors associated with military service are many to include exposure to high-risk training and combat. As such, psychologists are critical support components that assist military leaders in designing appropriate training programs, providing oversight to those programs, and assisting military members as they navigate the challenges of military training and military life in general. Most issues facing military members are not that dissimilar from those faced by their civilian counterparts. Specific examples of the issues faced by military personnel that may be somewhat distinct include posttraumatic stress disorder (PTSD) associated with combat, or guilt and family/partner difficulties accompanying extended or frequent deployments due to separation. Clinical providers in military psychology are often focused on the treatment of stress, fatigue, and other personal readiness issues.

The Massachusetts General Hospital Psychiatry Academy is an educational organization for psychiatrists, psychologists, other mental health professionals, and other healthcare professionals who diagnose and treat patients with mental health disorders. It is directly organized and managed by the Department of Psychiatry at Massachusetts General Hospital, which is owned by Partners HealthCare, the largest healthcare provider in Massachusetts.

A psychiatric assessment, or psychological screening, is the process of gathering information about a person within a psychiatric service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for various legal purposes. The assessment includes social and biographical information, direct observations, and data from specific psychological tests. It is typically carried out by a psychiatrist, but it can be a multi-disciplinary process involving nurses, psychologists, occupational therapist, social workers, and licensed professional counselors.

Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry.

Kevin Joseph Michael Gournay CBE FMedSci FRCN FRSM FRCPsych (Hon) PhD RN CSci Cert CBT is a registered psychologist, chartered scientist and a registered nurse by background. He is an emeritus professor at the Institute of Psychiatry, King's College London. He was a consultant psychologist at the Priory Hospital North London; retiring in December 2018. He has now returned to clinical work as part of the response to COVID19. He is currently an Honorary Professor at the Matilda Centre; University of Sydney., where his work focusses on the combination of mental health problems and substance use. He has been responsible over many years for a very wide range of research, policy and practice development in mental health care. He also works as an Expert Witness; he has provided reports on more than 250 suicides; 20 homicides and hundreds of reports on people who have suffered the consequences of traumatic events, including accidents, terrorist related incidents, natural disasters, war related events and stillbirth and perinatal death. He has also provided numerous reports on patients receiving care and treatment in high secure and Medium secure settings, including Broadmoor, Rampton and Ashworth hospitals

The primary care behavioral health (PCBH) consultation model is a psychological approach to population-based clinical health care that is simultaneously co-located, collaborative, and integrated within the primary care clinic. The goal of PCBH is to improve and promote overall health within the general population. This approach is important because approximately half of all patients in primary care present with psychiatric comorbidities, and 60% of psychiatric illness is treated in primary care.

Exposure to trauma induces an intense amount of stress as a result of an individual directly or indirectly experiencing some type of threat, also referred to as a Potentially Traumatic Experience (PTE). PTEs can include—but are not limited to—sexual violence, physical abuse, unexpected death of a loved one, witnessing another person badly hurt, exposure to natural disaster, being a victim of a serious crime, car accident, combat, interpersonal violence and many other stressful experiences. PTEs can also include learning that a traumatic event occurred to another person or witnessing the traumatic event; an individual does not have to experience the event themselves to develop Posttraumatic Stress Disorder (PTSD). PTEs are labeled as such because not everyone who experiences one or more of the events listed will develop PTSD. However, PTSD is estimated to develop in about 4% of individuals who experience some type of traumatic experience. Approximately 8% of adults the United States population will have PTSD at some point in their lives. That means about 8 million U.S. adults have PTSD during a given year, which is only a small portion of individuals who experience traumatic events. Biological stress responses can be adaptive at the time of the traumatic event, but prolonged biological stress responses can lead to impairing symptoms known as PTSD.

Donald Jay Cohen was a psychiatrist, psychoanalyst, and director of the Yale Child Study Center and the Sterling Professor of Child Psychiatry, Pediatrics and Psychology at the Yale School of Medicine. According to the New York Times, he was "known for his scientific work, including fundamental contributions to the understanding of autism, Tourette's syndrome and other illnesses, and for his leadership in bringing together the biological and the psychological approaches to understanding psychiatric disorders in childhood"; his work "reshaped the field of child psychiatry". He was also known as an advocate for social policy, and for his work to promote the interests of children exposed to violence and trauma.

References

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