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ABSTRACT
A mental health nurse, educationally and clinically prepared as a specialist, can be effectively utilized as a consultant to aid nurse generalists in assessment and intervention of patients in a home health care agency. An individual staff nurse consulting with the specialist or a group of nurses provides the setting for consultant led case discussions. Consultation is a highly efficient use of a specialist's knowledge and skills in health care delivery, and also provides learning opportunities for staff.
Clinical specialization in nursing is increasing and mental health nurses have joined this growing field and become active team members in today's multidisciplinary approach to patient care. In community health, as in other areas of health care, the need for skilled mental health assessment and intervention is being recognized as an adjunct to meeting the total needs of the patient.1
I am employed as a mental health consultant at the Visiting Nurse Association of Greater St. Louis. The title of consultant denotes clinical expertise as well as the ability to contribute to the learning experiences of staff as they encounter mental health problems. The position entails individual consultations with staff members, including home visits to patients as needed, group consultations, plus orientation and inservice education in mental health areas. All of these situations present opportunities for staff learning as problems are identified, etiology discussed, and possible therapeutic alternatives explored. The individual staff member's skill and knowledge in dealing with similar problems in the future can be increased.
VNA of St. Louis serves St. Louis city, county and two adjoining counties. The field staff includes registered nurses, home health aides, physical therapists, occupational therapists, speech pathologists and social workers. The consultants, who may carry a case load of patients, include nutritionists, colostomy nurse specialists, pediatric nurse practitioners, hospital coordinators, and a mental health consultant. The patient population consists of people from various socioeconomic levels and differing medical problems. More often, though, they may be elderly and/or poor, and suffering from chronic or terminal illness.
Utilizing the skills of the clinical specialist/ consultant is a challenge for both the specialist and health care agencies. Initially, staff members may feel threatened by a nurse with additional education or experience in a particular area of nursing. They may feel...