Introduction to Psychiatric Mental Health Nursing Chapter 1

1
Introduction to Psychiatric Mental Health
NursingChapter 1 2
Psychiatric / Mental Health Nursing

• West Coast University
• NURS 204

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Caring for Psychiatric Mental Health Clients

• Feelings, Concerns, QuestionsWhat Are
  They?

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Factors Influencing Expectations
Media
Other?
Upbringing
Expectations
Life experiences
Culture
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Psychiatric Mental Health Clients

• Psychiatric mental health clients are everyday,
  ordinary people.

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Factors Impacting Mental Health and Mental Illness
Biological
Mental Illness
or
Mental
Health
Social
Cultural
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Mental Disorder Characteristics

• Distress
• Disability
• Risk

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DSM-IV-TR

• Identifies
• Standardizes
• Categorizes

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Deviance

• Is it bad?
• Bizarre in one cultural context acceptable in
  another?
• Deviant political, religious, or sexual behavior
• Mental disorder- yes or no?

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What do these terms mean?
Crazy?
Berserk?
Wacky?
Insane?
Weird?
Lunacy?
Nervous Breakdown?
Melancholy?
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History

• Understanding and approaches to madness
  throughout history were influenced by
• Social attitudes
• Philosophic viewpoints

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Historical Approaches

• Era of Magico-Religious Explanations
• Superhuman forces
• Violation of taboos
• Neglect of rituals
• Loss of soul
• Witchcraft
• Era of Organic Explanations
• Imbalance in the bodys humors (Hippocrates, 4th
  century BCE)
• Era of Alienation
• Social exclusion
• Imprisonment
• Ships of fools
• Lunacy
• The exception Arab belief was that the insane
  were divinely inspired.

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A ward in Bethlehem Hospital about 1745. A
patient is being chained in the foreground, and
in the background are two Sunday visitors on an
entertainment outing. Source Philosophical
Library.
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Historical Approaches - continued

• Era of Confinement
• Confined
• Beaten and tortured
• Enormous asylums
• Hôpital Général
• St. Mary of Bethlehem
• Era of Moral Treatment
• Emergence of reform
• Reform leaders
• William Cullen
• Philippe Pinel
• William Tuke
• Benjamin Franklin
• Benjamin Rush Father of American Psychiatry

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Historical Approaches - continued

• Era of Psychoanalysis
• Sigmund Freud
• Contemporary Developments
• Social dimensions
• Brain dysfunction
• Neurochemical
• Medication therapy

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21st Century Research

• Bases for mental disorders
• Psychotropic medications
• Role of nutrients, biology, and genetics

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Mental Disorder Statistics

• High incidence with physical illness
• Account for 47 of all disability in economically
  developed countries
• Account for 28 of all disability worldwide

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Prevalence Rates for Various Mental Disorders
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Leading Causes of Mental Disability Worldwide
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Mental Health Studies

• Epidemiologic Catchment Area (ECA)
• Global Burden of Disease (WHO)
• U.S. Surgeon Generals Report
• Healthy People 2010

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Healthy People 2010

• Adolescent suicide rate
• Homeless adults with serious mental illness (SMI)
• Relapse with eating disorders
• Mental health screening
• Treatment issues Children and adults

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Healthy People 2010 - continued

• Screening in juvenile justice
• Jail diversion programs for SMI
• Cultural competence issues
• Services for older adults crisis intervention,
  screening, treatment
• Employee stress in the workplace

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Psychiatric-Mental Health Nurses

• What do they do?

Chapter 2
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Psychiatric-Mental Health Nurses - continued

• Psychiatric-mental health nursing promotes mental
  health through
• Assessment, diagnosis, and treatment of human
  responses to mental health problems and
  psychiatric disorders (ANA, APNA, ISPN, 2007)

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Standards

• Standards of Psychiatric-Mental Health Nursing
  Practice
• Guidelines for providing quality care
• Psychiatric-Mental Health Nursing Standards of
  Practice
• Assessment
• Diagnosis
• Outcomes Identification
• Planning

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Standards - continued

• Psychiatric-Mental Health Nursing Standards of
  Practice
• Implementation
• Coordination of Care
• Health Teaching and Health Promotion
• Milieu Therapy
• Phamacological, Biological, and Integrative
  Therapies
• Prescriptive Authority and Treatment (APRN only)
• Psychotherapy (APRN only)
• Consultation (APRN only)
• Evaluation

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PsychiatricMental Health Nursing Standards of
Practice
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Standards - continued

• Standards of Professional Performance
• Quality of Practice
• Education
• Professional Practice Evaluation
• Collegiality
• Collaboration
• Ethics
• Research
• Resource Utilization
• Leadership

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PsychiatricMental Health Nursing Standards of
Professional Performance
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Psychiatric-Mental Health Nurses

• Generalist level
• Advanced practice level
• Prescriptive authority
• Psychotherapy
• Consultation

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The Psychiatric-Mental Health Team

• Psychiatric-mental health nurse
• Psychiatrist
• Clinical psychologist
• Psychiatric social worker
• Marriage and family therapist
• Occupational therapist
• Recreational therapist
• Creative arts therapist
• Psychosocial rehabilitation worker

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Estimated Number of Mental Health Workers in the
United States
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The Mental Health Team
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Effective Mental Health Services
Client
Partnerships
PMH Team
Family
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Lessons on Collaboration

• Know thyself
• Value diversity
• Know that conflict is natural
• Share your power with others
• Master communication skills
• Think life-long learning.
• Embrace interdisciplinary situations.
• Appreciate spontaneity.
• Balance unity with autonomy.

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The Role of the Psychiatric-Mental Health Nurse
Multifaceted
Custodial
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Early Psychiatric-Mental Health Nursing (19th
century)

• First school of nursing
• Florence Nightingales thoughts
• American nursing schools
• First American psychiatric nurse
• Single-focused training schools
• Custodial, mechanistic, directed by psychiatrists

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Psychiatric-Mental Health Nursing (1900-1940)

• Psychiatric nursing curricula
• Psychiatric nursing texts
• Single-focus psychiatric nursing schools

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Psychiatric-Mental Health Nursing (1940-1990)

• Nurses begin to educate nurses.
• Psychiatric theory includes interpersonal and
  emotional dimensions.
• National Mental Health Act of 1946
• Elimination of single-focus psychiatric nursing
  schools
• Period of role clarification
• Hildegard Peplau
• Gwen Tudor
• Frances Sleeper
• Community Mental Health Centers Act of 1963
• Psychiatric nursing journals

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Psychiatric-Mental Health Nursing (1940-1990) -
continued

• Birth of clinical nurse specialists and nurse
  therapist role
• First standards of psychiatric-mental health
  nursing practice
• Increase role of nurses at national level
• Shift in psychiatric nursing toward humanistic
  interactionism
• Decrease in numbers of psychiatric nurses
• Decreased funding for training
• Psychiatric nursing diagnoses

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Psychiatric-Mental Health Nursing (1990s) -
Decade of the Brain

• Psychobiologic concepts
• Nursing Psychopharmacology Project
• Health care delivery reform
• Outcome-based research
• Cultural diversity
• Integration of theoretical perspectives

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Psychiatric-Mental Health Nursing (2000s) - The
New Millennium

• Standards of practice revisions
• Knowledge explosion
• Renewed focus on physical health
• Single point of entry
• Advanced practice nurses
• Expansion of practice settings

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Nursing Theories

• Assist nurses to
• Organize assessment data
• Identify problems
• Plan interventions
• Generate goals and actions
• Evaluate outcomes

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Nursing Theories Impacting Psychiatric Nursing

• Hildegard Peplau
• Dorothea Orem
• Martha Rogers
• Sister Callista Roy
• Ida Jean Orlando
• Ernestine Wiedenbach
• Joyce Travelbee
• Paterson and Zderad
• Jean Watson
• Patricia Benner

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Nursing Theories - Value

• Nursing practice vs. medical practice
• Caring vs. curing
• Interpretation of meaning
• Nurse-client relationship
• Advocacy of client dignity
• Advocacy of nurse authenticity

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Application of Theoretical Frameworks

• Application of various theoretical frameworks
  leads to
• Quality client-centered care.
• Efficient use of resources.
• Practice-oriented research.
• Clinical judgments and actions that can be
  articulated and taught to others.