ROLE AND FUNCTIONS OF THE NURSE

Nurse Role Definition

The role is a set of behaviors that are expected by others to the appropriate person in his position, one system. The role is influenced by social conditions both inside and outside and are stable. The role is a form of behavior expected of people in certain social situations. (Kozier Barbara, 1995:21).
Role of the nurse in question is a way to express the activity of nurses in practice, which has completed his formal education in a recognized and authorized by the government to carry out the duties and responsibilities of professional nursing in accordance with professional code of ethics. Where every role is expressed as a separate character for the sake of clarity.

Care giver:
In this role of nurses expected to
1. Provide nursing services to individuals, families, groups or society as a diagnosis of problems that occur starting from the problem that is simple to the complex problem.
2. Taking into account the context of appropriate individuals in the client's life, nurses must consider the needs of the client based on significantly from clients.
Nurses use the nursing process to identify the nursing diagnoses ranging from physical problems to the psychological problems.
Role Element
Doheny's opinion (1982) there are some elements of the role of professional nurses, among others: care giver, client advocate, counselor, educator, Collaborator, coordinator change agent, consultant and interpersonal processes.
Client Advocate (Defenders Clients)
Task nurses:
1. Responsible for helping clients and families in interpreting information from a variety of service delivery and in providing other information necessary to take consent (inform concern) for any act that is given to nursing.
2. Maintaining and protecting the rights of the client, must be done because the client is ill and hospitalized will interact with many health workers. Nurses are members of the health team the longest contact with the client, so expect nurses to be able to defend the rights of clients.
A client advocate is a defender of the rights of clients. Defense improvements including what is best for clients, ensuring client needs are met and to protect the rights of clients (Disparty, 1998: 140).
Clients Rights include:
1. The right to services that best
2. The right to information about illness
3. Right to privacy
4. The right to self-determination
5. The right to receive compensation due to negligence actions.
Rights of Health Workers, among others:
1. The right to correct information
2. The right to work according to standard
3. The right to terminate relationships with clients
4. The right to reject actions that are less suitable
5. Right to privacy
6. Right to remuneration

Counselor
Counseling is the process of helping clients to recognize and cope with psychological stress or social problems to build good interpersonal relationships and to enhance the development of a person. Therein provided emotional and intellectual support.

Role of nurses:
1. Identifying changes in client interaction patterns of ill health conditions.
2. Changes in the pattern of interaction is a "Basic" in planning methods to improve its ability to adapt.
3. Provide counseling or guidance counseling to individuals or families to integrate health experience with past experience.
4. Solving problems in the focus on nursing issues

Educator:
Teaching is to refer to activities where one teacher helped students to learn. Learning is an interactive process between teachers and students one or more particular object of learning where or desire to change behavior is the goal. (Redman, 1998: 8). The essence of behavioral change always comes from new knowledge or technical skills.

ROLE OF NURSE IN MENTAL HEALTH MENTAL AS MAKING GLOBAL AND NATIONAL PRIORITIES

INTRODUCTION

Mental nursing service has been focused on hospital services are characterized by a number of mental hospitals throughout Indonesia. Mental health services so far is the hospital-based. Based on the information contained most of the asylum using Custodial care services, with service quality standard below. Quality of mental health services, including attention to the fulfillment of those rights, protection and respect for dignity.

According to WHO (2003), strategies to improve the quality of mental health services can delakukan by establishing policies about quality, setting service standards, implementing standards, then do accreditation, further monitoring carried out to measure its success (figure 1). If successful in increasing the quality, the system is integrated into the service. For example, professional nursing practice model standard developed and accredited, then do the monitoring, if lower patient care time, it can be considered as a way of improving the quality of mental health services in a mental hospital, which can be integrated into mental health service system.

Hospital-based services, describes a passive service, which is waiting for people who come to the hospital. Through several studies note that patients who come to the hospital rather than a new case but the cases have been seeking help from the various outside medical treatment. In addition, hospital-based services can not achieve a healthy society and a risk, so that they become vulnerable to mental disorders. Community-based services (community based) can achieve a healthy society to stay healthy through promotional programs and prevention, society of risk can be prevented from interference even be restored to health through prevention programs. According to WHO (2008) 76-85% of cases of serious mental disorders are not receiving treatment in the first year (treatment gap), so in a way closer to the residential services community treatment can be done immediately, so the possibility of recovery and productive return can be achieved.

Medical approach to mental health system needs to be replaced with a model of integration from the central to the village. Cross-sector in all departments to cross-sector in the country among all departments of service units in the village. In this way all the components of the nation can recognize and subsequent mental health using mental health as a day-to-day behavior. Mental health is not only the responsibility of the health department but the entire community responsibility which means that where there are human beings there is mental health programs, so that all people become productive and useful.

Based mental health services community is the best strategy to reach the entire community to be able to maintain a healthy spirit remains healthy, the risk to health, as well as the disruption to be healed and productive through the "recovery of a good quality of life". With community empowerment in rural mental health allows to reach all communities.

Mental health are: health status where individuals are aware of his abilities, can cope with the stress of everyday life, can work productively and useful, and can contribute to the community (mental health is a state of well being-ability in which the individual realizes his or her ability, can cope with a normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community). Mental health investment in children is a key strategy to realize the future of the nation a strong, productive and useful.

FACTORS THAT NEEDED TO: making mental health a priority

Some of the factors that need to be met in order for mental health is a priority (WHO, 2008):

1. Policy and legislation
Policy and legislation is needed as a basis and an umbrella implementation and change mental health system. This is necessary so that the public (healthy people, the risk of mental disorders, mental disorders) to the protection of their rights as members of society get pelayanana mental health. A third country in the world, half the developing countries and developed countries 93% have a policy and mental health legislation. Indonesia does not have, only integrated in Kes Act No. 23, 1992.

2. Mental health service
Developed countries give priority to mental health services community-based. In the nearly two-thirds have at least one community mental health services. In Southeast Asian countries only 50% who have keswa community-based services. In Indonesia has started based mental health services community and has been declared in the national meeting of mental health in 2008.


3. Community resources
Community resources is a vital aspect to implement the community mental health services. Some resources can be developed in the community are non-governmental organizations (minimum 88% of countries have had one keswa related NGO), associations and families of patients (only 46% of poor countries, developing countries 88%, 100% developed countries have associations and kel patients), a traditional healer (Batra), psychosocial rehabilitation. Very rare families and patients involved in decisions about their care. In Indonesia has started to develop associations of patients and families, community leaders trained as mental health workers and empowering the village as a village health care mental health minister who launched the world mental health day 2008.

4. Human resources
Mental health workers in poor countries consists of nurses soul (0.16/100.000 population) and psychiatrist (0.05/100.000 population). In the world can be seen in figure 2 (WHO 2008)
In countries that have developed, to train primary care workers about mental health as early as possible so that mental health has touched people's lives. In Indonesia has begun to train health nurses of the community mental health care (community mental health nursing) and general practitioner training in mental health clinic, called GP + (medical officer of mental health). In addition, for existing nurse specialist in nursing education equivalent of a soul other education specialists.
5. Financial resources
Third of the world's countries have no specific budget for mental health. In general, the mental health budget is less than 1% of health budget as a whole.

To realize the above five factors needed strong efforts of mental health workers and community mental health care. This requires advocacy and action for mental health a priority.


ROLE OF NURSE IN ADVOCACY

Advocacy is the most effective and least expensive to make changes. There are several kinds of advocacy are:
1. Self advocacy: the individual or group to speak or act on their needs. Mental patients are often difficult to articulate their needs, therefore they need help, they need to unify the voice associations.
2. Citizen advocacy: the person speaking or acting on behalf of the user or help them speak for themselves. Those who do not have rights, and the discriminated. Society jointly develop problem solving skills. Indonesia can be developed in the family associations and associations of patients or mental health worker as pendukun group (support group).
3. Crisis advocacy: the assistance provided in a difficult situation. For example at the time of the disaster.
4. Peer advocacy: that is to help others with the same problem. Association of patients and families is one way.
5. Professional advocacy: to motivate the professional mental health care, help to resolve mental health problems. All professions, not just the health professions.
6. Collective advocacy: the group of people from various backgrounds make the campaign about mental health.

Nurses can facilitate all forms of advocacy to all levels of society aware of mental health and feel the importance of mental health. All members of the community mental health marketers made so that the behavior of mental health throughout society. Patients and their families in a psychiatric hospital is the main target, therefore, provide quality care, provide mental health information mental health through education, so patients and their families feel the impact of nursing service at the self and the soul of life.

The ultimate goal of advocacy is to improve the fulfillment of basic human rights of mental health, eliminate stigma and discrimination


ROLE OF NURSE IN COMMUNITY ACTION

Community action is the action for themselves or for others, the time is now. Some of the key public actions:

1. National ownership for mental health
In Indonesia have built a sense of ownership of mental health, such as the Mental Health Nurses Association of Indonesia (IPKJI), Nurse MPKP, CMHN Nurses, Nurse PICU
2. Local carer
Mental health care villages, KKJ associations, associations of patients and family (self help group) is a local force that must be built.
3. Mental Antistigma
Optimal effort needed health recovery mental patients, and making mental health a community needs.
4. Budget adequate and consistent

Many more actions can be done by a nurse profesionl namely:
1. Informed: the soul master of nursing science. Looking for mental health information from local, national and internacional and integrate them into strengths together. One way is to share knowledge and experience of nursing mmelalui national conference of the soul.
2. Raise awareness: to build public awareness about mental health: healthy, risk and disruption. Including the process, how to prevent it and how to restore it with evidence - real evidence.
3. Education: disseminate information adequate mental health, so many people who know.
4. Networking: building relationships / networking with key individuals, organizations, and various sources in the community.
5. Capacity building: improve the ability of nurses: skills, knowledge and resources necessary to provide a quality nursing service.
6. Lobbying: lobbying in the parliament, which will affect the government in establishing policies and legislation.
7. Campaigning: mental health campaign with a regular plan, so that participants could become a campaign representasika to community mental health and the government.

CLOSING
Nurses in mental hospitals (mental hospitals, general hospitals, mental health nursing, caring foundation which mental patients), mental nursing faculty in nursing schools, nurses in mental health department and the structure of health services is expected to unite mental health voiced at every start from now desempatan everyone lepada encountered. The activities of advocacy and action.

Organization of mental health care

Psychiatric mental health nurses work in a variety of hospital and community settings.

* People generally require an admission to hospital, voluntarily or involuntarily if they are experiencing a crisis that means they are dangerous to themselves or others in some immediate way. However, people may gain admission for a concentrated period of therapy or for respite. Despite changes in mental health policy in many countries that have closed psychiatric hospitals, many nurses continue work in hospitals though patient length of stay has decreased significantly.

* Community nurses in mental health work with people in their own homes (case management) and will often emphasize work on mental health promotion. Psychiatric mental health nurses also work in rehabilitation settings where people are recovering from a crisis episode and the where the aim is social inclusion and a return to living independently in society.

* Psychiatric mental health nurses also work in forensic psychiatry with people who are detained as they have committed a crime or are particularly dangerous.

* People in the older age group who are more prone to dementia tend to be cared for in separate places than younger adults and there are also specialist services for the care of adolescents with mental health problems. Occasionally there have been efforts to integrate psychiatric units across the age spectrum.

The role of the nurse on the health care team

The patient is the centre of the nurse's concern
Nurses care for the sick and injured in hospitals, where they work to restore health and alleviate suffering. Many people are sent home from the hospital when they still need nursing care, so nurses often provide care in the home that is very similar to the care they give to patients in the hospital. In clinics and health centres in communities which have few doctors, nurses diagnose and treat common illnesses, prescribe and dispense medications and even perform minor surgery. Nurses are also increasingly working to promote people’s health and to prevent illness in all communities.

There are many roles in nursing. The nurse cares for the patient, carries out procedures ordered by the doctor and, in collaboration with the doctor and other team members, assesses the patient and treats his or her problems. The nurse coordinates the work of others involved in caring for the patient, including the patient's family, who may do a lot of the caring for the patient. The nurse also protects the patient, working to prevent infection and ensure a safe, healthy environment in the hospital. Finally, the nurse teaches the patient and family about health-related matters and promotes patients’ well-being in all situations, speaking for them (advocating), if necessary. The hospital nurse plays many roles on the health care team.

Care for the patient
Nurses care for patients continuously, 24 hours a day. They help patients to do what they would do for themselves if they could. Nurses take care of their patients, making sure that they can breathe properly, seeing that they get enough fluids and enough nourishment, helping them rest and sleep, making sure that they are comfortable, taking care of their need to eliminate wastes from the body, and helping them to avoid the harmful consequences of being immobile, like stiff joints and pressure sores.
The nurse often makes independent decisions about the care the patient needs based on what the nurse knows about that person and the problems that may occur. For example, the nurse may decide that, in order to prevent pressure sores, the patient needs to be turned every two hours. However, the nurse may consult the doctor about this if it is possible that turning the patient might cause some other problem. Thus the nurse uses understanding of medical conditions, as well as knowledge of nursing, in deciding on patient care.
The nurse not only takes care of the patient but also gives comfort and support to the patient and his or her family. When the patient cannot recover, the nurse helps to make sure that the death is peaceful. In caring for the patient, the nurse cares about the patient.
Caring is the very heart of nursing.

Work with the doctor to cure the patient
When a person becomes ill or is injured, generally the doctor assesses the patient, diagnoses the patient's problem and decides on the treatment needed to cure the problem or relieve the patient's symptoms. In the past only the doctor assessed and diagnosed. Today, however, nurses play a large role in evaluating patients and detecting problems. In some rural areas, nurses admit patients to hospital and manage their care, referring only the most critical patients to distant medical centres.
In every hospital nurses carry out many of the treatments prescribed for the patient. For example, the doctor may prescribe surgery or bed rest or a certain therapy. The doctor will perform some of these treatments, such as surgery. It is the nurse who gives most of the treatments. If a patient needs intravenous therapy, usually the nurse sets up the intravenous line and gives the patient the fluids and drugs prescribed. If the patient needs an injection, it is the nurse who gives it. The nurse changes the patient's dressings and monitors the healing of the wound. The nurse gives medication for pain. Many physicians order medication for pain "to be given as needed". They let the nurse decide when to give the medication.
The nurse also monitors the patient's progress to make sure that the recovery has no complications. Because nurses have more frequent contact with patients than other staff, they often find problems before anyone else.

Coordinate the care of the patient
In taking care of patients, the nurse collaborates with other members of the health care team. The nurse works closely with the doctor, as well as with other nurses, physical therapists, and any other professionals involved in the patient's care. In many hospitals today the team members together plan the care of the patient. The nurse is the person who coordinates the work of all the team members and sees that the plan is carried out. For example, the nurse makes sure that the patient's appointments for laboratory investigations are made and kept, sees that treatments are given, and checks to be sure that any needed referrals are made before the patient is discharged.
The nurse also plans and supervises the care given by nursing assistants, checks on the work of housekeeping staff assigned to clean the patient's room, and ensures that the patient gets enough healthy food. The family learns how to give basic care from the nurse, who also helps them where necessary. This includes learning how to use traditional ways of healing with modern health care. The nurse supports the family in giving basic care to their sick loved one. It is the nurse who has the final responsibility for the quality of the care the patient receives during the hospital stay.
In coordinating the work of others, the nurse always keeps the patient at the centre of concern.

Protect the patient
When a person is ill and weak, he or she is more vulnerable to infection and injury. One of the major responsibilities of the nurse is to protect the patient by ensuring that the environment is safe and healthy. In particular, the nurse takes every precaution to prevent the spread of infection from one patient to another. The nurse sees that the patient's room is clean, the patient is clean, water has been boiled or is safe, needles and other materials used for procedures are sterile, soiled materials are kept away from the patient, and needles and other sharp objects are placed in safety containers after use. The nurse washes hands carefully before and after patient care and between patients. The nurse protects the patient’s dignity and tries to save the patient from embarrassment or shame. When the patient’s clothing must be removed, the nurse tries to ensure the patient’s privacy.
The nurse also makes sure that the patient is physically safe, cannot fall out of bed, or fall when trying to walk, or slip on a wet floor. The nurse tries to protect the patient against anything that might be harmful in the environment.

Teach the patient and family
Teaching is a major role of the nurse in restoring health, promoting health and preventing illness. When a person is ill, the nurse demonstrates things the patient can do to help with recovery. For example, nurses teach patients to cough and breathe deeply after surgery to prevent lung complications. They show patients how to walk on crutches. They teach people with diabetes to monitor their blood sugar.
Whenever the nurse works with a patient, the nurse uses the opportunity to teach that person about self-care. Nurses teach both patients and their families about proper diet and nutrition, cleanliness and hygiene, exercise, sleep and rest and all the other aspects of a healthy life. Before the patient leaves the hospital, the nurse teaches the patient and family about care at home. For example, nurses teach family members how to bathe the person or wash his or her hair in bed, and how to feed the person or change dressings. Nurses teach people how to minimize the effects of disability so that they will have the best quality of life.

Advocate for the patient
Nurses are with people during the most critical times of their lives. Nurses are with people when they are born, when they are injured or ill, when they die. People share the most intimate details of their lives with nurses; they undress for nurses, and trust them to perform painful procedures. Nurses are at the bedside of the sick and suffering 24 hours a day. They are there when patients cannot sleep because of pain or fear or loneliness. They are there to feed patients, bathe them, and to support them. Nurses have a long history of caring for the patient and speaking for his or her needs. That is what advocacy is about: supporting the patient, speaking on that person’s behalf, and interceding when necessary. This advocacy is a part of the nurse's caring and a part of the closeness and trust between nurse and patient that gives nursing a very special place in health care.