Editorial

Moving Child-Psychiatric Nursing Into the 21st Century-Revisited

In November 2002 I attended the inaugural meeting of the Nursing Organizations Alliance. The alliance was formed by more than 60 nursing specialty orga- nizations to work together on nursing and health- care issues. I attended as president of the Intema- tional Society of Psychiatric Mental Health Nurses. Tim Porter-O'Grady 's keynote speech, "Envisioning thefuture: Transforming nursing for a new age," struck a chord. Tim, always a good speaker, pointed out that the nursing of the past would not j t the needs of the 21st centu y. The thought may not be profound, but for me, who has spent most of a career advocating for change in the mental health care of children and their families, the statement made me stop and consider the journey we have t a b and our vision for thefuture. Are we as child-psychiatric nurses still looking back instead of forward? Are we grieving what has been lost instead of looking at the progress that has been made?

As I pondered the past and considered thefiiture of child-psychiatric nursing, I dusted ofla chapter I wrote almost a decade ago for Nursing Clinics of North America. 7'he chapter seemed like a good ruler, since the title was "Child Psychiatric Nurs- ing: Moving into the 22st Centu y" (Finke, 1994). I read through it to see what the needs were in the early 1990s and what progress we have made.

In the chapter I synthesized the literature available at the time that spoke to the histo y of child-psychi- atric nursing and thefuture needs of children and their families with psychiatric problems. At the be-

ginning I delineated the large percentage of children who needed psychiatric care and spoke about the need for e v q child to live in a safe and enriching environment. Hozu that all has changed since 9/11 and the new threat of war! Ten years ago we had no conception of terrorism or the toll it could take on children all over the world. Now, children and par- ents are being separated as the military prepares for war. New threats are on the horizon that make mon- sters in the closet real.

Disease and famine are at a level we have not previ- ously experienced. The new victims of AlDS world- wide are children, who are both orphaned by the dis- ease and aflicted thmselves-41 this on top of growing numbers of children with psychiatric needs. We could not have predicted the growing psychiatric needs of children 10 years ago, yet public attention has been d r a m to these needs. The Surgeon Gen- eral's Report on Children's Mental Health ( U S . Public Health Smices, 2000) placed a spotlight on the problems.

77ze trend that began in the 1990s toward incarcer- ating children with psychiatric problems in the juve- nile justice system has increased. The change has been the added attention to these children, with some finding targeted for this growing group. Needed treatment for these children r m i n s a huge deficit.

The change in treatment modalities to more home- based treatment and fewer children in psychiatric inpatient settings has continued. We have more

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Editorial

attention being paid to prevention of problems and the institution of school-based treatment. Even pri- vate for-profit agencies are partnering with schools to provide treatment in schools. Healthcare agencies are ofering a continuum of care through which families can move easier than a decade ago.

Thr prediction that there would be growth in private for-profit and not-for-profit agencies did come true. Perhaps what we did not see is that it would mean a real scarcity of appropriate care for some children zuho need short-term inpatient care. Proziding inpa- tient care for children is expensive, andfinding fiinds is dz8cult. We have seen changes in treatment to more groups and more home-based care. What we need to do is support prefewed treatment interuen- tions with research and find new treatment modali- ties. Remmiber, just (1 feu) years ago we thought restraint-free environments would lead to chaos and poor outcomes. Have we been creative in response to needed change in seruice delivery? Have we tested the intewaitions we do make?

Perhaps the largest impact on our practice has been the incorporation of neurobwlogy and phamcology into the care of children with mental health disorders. We have removed the blamefrom families and found the genetic and chemical causes of many of the psychi- atric disorders. Are our interventions based on what we know about neurobiology and phamcology ?

We have made important progress. A t the beginning of this century, child-psychiatric nurses are recog-

nized as members of the child-psychiatric treatment team. In fact, nurses may be the only providers of care in some settings. W e have been at the tables as policy is developed.

Yes, we have come a long way. It was helpful, thanks to Tim Porter-O’Grady, to review the progress we have made in child-psychiatric nursing and to re- energzze for the next decade. Our efforts have made a huge dij4erence and we need to look for n m strate- gies to continue to make a dij4erence in thefiture. Psychiatric needs of children and their families are changing. We need to be ahead of those changes in- stead of trying to catch up. Ourfuture practice must be based on evidence and creativity. Our past suc- cess will propel us into this century.

Linda M. Finke, PhD, RN Associate Editor lindaf@stti.iupui.edu

References

Fmke, L. (1994). Child psychiatric nursing: Moving into the 21st cen- tury, mental health nursing. Nursing Clinics qf North Anrerica, 29, 43-43.

PorterO’Grady, T. (2002, November). Enuisionitig the future: Tran$orrn- irig nursingfur n wm age. Paper presented at the inaugural meeting of the Nursing Organizations Alliance, Indianapolis, IN.

U.S. Public Health Services. (ZOOO). Rrpurt of thr %rgeun Goieral’s confer- mice on children’s nzentnl Jltmlth: A national nctioii agenda. Washgton, Dc: Author.

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