The Ghanaian Nurse: Comparing The General Nurses And The Psychiatric Nurses

Florence Nightingale is the goddess of the nursing profession. She is profoundly referred to as “the mother of nursing” because she laid the foundation and standard for modern nursing and today she is celebrated and remembered for the many things she did in pioneering nursing. At her early age she began caring for sick people in the nearby villages of her parents’ home. At age 16 she knew nursing was her calling.

For her selfless love to care for the sick, her zeal to help the sick and her burning desire of unflinching compassion demonstrated to wounded soldiers and the sick in the war of Crimea, she was nicknamed “the lady with the lamp” and “the angel of Crimea”.

Florence Nightingale is a prototype of a good nurse and her biography explicitly and unequivocally embodies the saying that ‘nursing is a call’. She defines nursing as a calling because she had the inner desire and devoted herself to serving people and the sick.

Nursing is a calling because not everyone has a humane heart to be become a nurse.

The bad nuts who are defacing the image and dignity of the nursing profession are those who entered the profession by accident or as a stepping stone due to economic pressure or lack of job opportunities.

To become a nurse you have to have a deep desire to help people, love, care and compassion. You see people problems as your problems and always willing to help them irrespective of where they are coming from. You don’t see others problems through religious lens, political lens or racial lens. Such are the intrinsic qualities to becoming a nurse. A true called nurse has a genuine clean heart and cares for his patients selflessly and whole-heartedly. A true nurse put himself in his patients’ shoes and feel their plights.

That is what the life of Florence Nightingale teaches nurses today. She earned the name “the lady with the lamp” because she cared so much that she carried a lamp and went round at night to check on her patients (wounded soldiers). Today nurses have world class smartphones with torchlights but what do we see when there is lights out during night shifts.

Nursing as a profession has evolved through many phases from the Nightingales era to the 21st century both theoretically and practically. The earlier female dominance in the profession as was known is almost a thing of the past. Nursing is no more thought to be a reserve for women only. Men are closing the gap even in midwifery, a specialty whose clients are only women, as far as childbirth and care of mothers are concerned.

There are many categories of nurses in contemporary times and taking Ghana as a case study, there are the psychiatric nurses, general nurses, midwives, community nurses, enrolled nurses and what have you. Some of these nurses can further their education and become EN&T nurses, nurse anaesthetists, ophthalmic nurses, nurse prescribers, physician assistants, public health nurses and many others.

Other nurses fall in the ‘unspecified category’. They are the products of the private mushroom nursing schools whose award is certificate in National Vocational Training Institute (NVTI) in health. Nurses from these mushroom schools with certificate in NVTI have been described by some sections as ‘wandering nurses’.

Nurses play a major and crucial role in the health care delivery system. Despite their differences and specialties, they all work towards one goal; to prevent illness, to promote health and to ensure recovery and rehabilitation. Nurses are lifesavers.

Two categories of these descendants from Florence Nightingale is the concern of this musing. This article seeks to juxtapose the two sister nurses, the psychiatric nurses and the general nurses in their scope of work in an objective perspective without any shred of intend to downplay any category.

The comparison is not based on any scientific research than mere observation and experience.

These two category of nurses share some similarities in the area of medicine, surgery, public health, basic nursing, obstetrics and gynaecology, and psychiatry. But they differ in some aspect.

Both psychiatric nurses and general nurses spend three years in their course training to become fully fledged nurses with their licence to practice after qualifying the licensure exams conducted by their regulatory body, Nurses and Midwifery Council (NMC). They all go through additional one year mandatory national service in any part of the country before gaining employment.

The training of psychiatric nurses is an integrated one. The programme is a blend of general nursing and psychiatric nursing. Psychiatric nurses do not only learn psychiatry but are also taught in medicine, surgery, public health, basic nursing, obstetrics and gynaecology, etc. as well as the practical aspect of general nursing.

General Nurses also learn all the above courses in the three year programme with little time for psychiatry.

Whiles the psychiatric nurses learn about 80 percent of general nursing, general nurses lean about 10 percent of psychiatric nursing.

The general nurses work in general hospitals whiles the psychiatric nurses work in psychiatric hospitals and in the general hospital as well. Though general nurses also work in psychiatric hospitals, they are scarce as compared to the number of psychiatric nurses working in the general hospitals. Suffice it to say that the psychiatric nurse is a versatile nurse whose adaptability defies all nursing barriers. Psychiatric nurses can work in every environment as far as health care delivery is concerned.

Apart from working in the general wards, psychiatric nurses also work in psychiatric wings in the regional hospitals, community psychiatric units in health centres and district hospitals dotted across the country.

In terms of workload general nurses are confronted with more work than psychiatric nurses. They really perform and define basic nursing in the wards since most of their patients are either bedridden or vegetative. Some patients maybe unconscious or in coma. Patients who have undergone major surgeries are also confined to bed for healing process to take place. These patients are bed bathed, fed, given medications, wound dressing, served bedpan when they need to empty their bowels, take blood samples, change bed sheets when dirty or soiled with urine or faeces, collect vomitus, monitored closely and so forth all by the general nurse.

This make the general nurses highly prone to infections. The situation becomes dire in facilities where the word improvise is sung like Pentecost hymn. No gloves, no protective garment, no alternative source of light when there is lights out at night, yet the nurse is supposed to attend to those infectious patients. Sometimes two nurses on night duty against forty patients.

Psychiatric nurses on the other hand, though faces similar situations, such cases are rare like mice in a church room. They are also prone to infections and improvise more than the general nurses. But the case of general nurses outweighs that of psychiatric nurses. Most psychiatric patients can perform some chores by themselves but they need supervision by the nurse. Those that are unable are guided and guarded to perform. This is essential to ensure early recovery and reintegration. It also avert institutional neurosis, a situation where mental patients become dependable and passive due to long stay in a psychiatric hospital.

General nurses are prone to occupational stress whereas psychiatric nurses relatively release stress at work. Some mental patients in the acute wards can be a source of fun. The bizarre mannerisms, antics display and the pseudo-inflated ego of some deluded mental patients are irresistible to pop up ones cheeks. In the case of general nurses, the workload and many tasks to perform by few nurses especially in understaffed facilities induce stress.

Psychiatric nurses are more understandable and accommodating than general nurses. The general nurses deem their patients and relatives as normal persons thus expect them to ‘behave’ but disease conditions can make patients frustrated and irritable. Some general nurses are not able to condone such splenetic jibes from patients and their relative and sometimes resort to applying Newton’s third law of motion.

Unlike general nurses, psychiatric nurses are more tolerable and can take barrage of ‘nonsense’ either from patients or their relative without a freak. The psychiatric nurse presumes every human as a mad person until proving otherwise. They understand human behaviour and hence believe that every behaviour is meaningful to the person exhibiting it. This is attributable to the fact that psychiatric nurses are trained in abnormal psychology and ought to understand human behaviour better.

Psychiatric nurses suffer stigma just like their patients. It is the perception of many that psychiatric nurses also develop mental illness once they care for mad people. Contrary, general nurses seem to earn more ‘respect’ from the public than their sisters.

Both general nurses and psychiatric nurses care so much about their patients but psychiatric nurses seem to care more and have the extra patience to approach their patients and find out their problems. It is no joke when a mental patient refuses food and tells the nurse that he has no mouth or stomach to eat the food. The psychiatric nurse must move heaven and earth to conjure all the words to persuade him to eat.

Notwithstanding these minor differences, nurses in general, irrespective of the category and area of expertise remain an integral part of health care delivery system. Nurses are intelligent. They are the pillars that anchor patients’ health to recovery. No category of nurses is better or superior to the other. Each nurse is unique, innovative and creative and performs well at any given time and anywhere.

However a nurse’ output is determine by the facility and logistics to work with. Availability of basic logistics such as gloves, disinfectants, gauze and bandages, cotton, plasters, et cetera, good working condition and incentives boosts a nurse’ morale to give out his best.

God bless all nurses!
The writer, Malcolm Akatinga is a staff nurse at Ankaful Psychiatric Hospital, Cape Coast.

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Malcolm Akatinga.