Foundations of Psychiatric–Mental Health Nursing

The World Health Organization defines health as

state of complete physical, mental, and social wellness, not merely the absence of disease or infirmity.

state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability.

Mental health

Factors influencing a person’s mental health can be categorized as.

individual, interpersonal, and social/cultural

factors include a person’s biologic makeup, autonomy and independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardiness, sense of belonging, reality orientation, and coping or stress management abilities.

Individual, or personal

factors include effective communication, ability to help others, intimacy, and a balance of separateness and connectedness.

Interpersonal, or relationship

factors include a sense of community, access to adequate resources, intolerance of violence, support of diversity among people, mastery of the environment, and a positive, yet realistic, view of one’s world.

Social/cultural, or environmental

includes disorders that affect mood, behavior, and thinking, such as depression, schizophrenia, anxiety disorders, and addictive disorders.

Mental illness

Factors contributing to mental illness can also be viewed within

individual, interpersonal, and social/cultural

biologic makeup, intolerable or unrealistic worries or fears, inability to distinguish reality from fantasy, intolerance of life’s uncertainties, a sense of disharmony in life, and a loss of meaning in one’s life.

Individual, or personal

include ineffective communication, excessive dependency on or withdrawal from relationships, no sense of belonging, inadequate social support, and loss of emotional control.

Interpersonal, or relationship

include lack of resources, violence, homelessness, poverty, an unwarranted negative view of the world, and discrimination such as stigma, racism, classism, ageism, and sexism.

Social/cultural, or environmental

describes all mental disorders, outlining specific diagnostic criteria for each based on clinical experience and research.

Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)

Who published the DSM-5

American Psychiatric Association

The DSM-5 has three purposes:

All of the above

Era where they believed that any sickness indicated displeasure of the gods and, in fact, was a punishment for sins and wrongdoing.

ancient times

He attempted to relate mental disorders to physical disorders and developed his own theory

Aristotle (382–322 BC)

Aristotle (382–322 BC) Theory

amounts of blood, water, and yellow and black bile in the body controlled the emotions

The four substances, or humors, corresponded with

happiness, calmness, anger, and sadness.

Imbalances of the four humors were believed to cause mental disorders; therefore, treatment was aimed at restoring balance through

bloodletting, starving, and purging

In __, primitive beliefs and superstitions were strong. All diseases were again blamed on demons, and the mentally ill were viewed as possessed.

early Christian times (1–1000 AD)

In England during the __, people with mental illness were distinguished from criminals. Those considered harmless were allowed to wander the countryside or live in rural communities, but the more “dangerous lunatics” were thrown in prison, chained, and starved

Renaissance (1300–1600)

In 1547, the __ was officially, was officially declared a hospital for the insane, the first of its kind.

Hospital of St. Mary of Bethlehem

By __, visitors at the institution were charged a fee for the privilege of viewing and ridiculing the inmates, who were seen as less than human animals

1775

In the __, a period of enlightenment concerning persons with mental illness began.

1790

They formulated the concept of asylum as a safe refuge or haven offering protection at institutions where people had been whipped, beaten, and starved because they were mentally ill

Philippe Pinel in France and William Tuke in England

In the United States, ___ began a crusade to reform the treatment of mental illness after a visit to Tuke’s institution in England.

Dorothea Dix (1802–1887)

She was instrumental in opening 32 state hospitals that offered asylum to the suffering.

Dorothea Dix (1802–1887)

She believed that society was obligated to those who were mentally ill; she advocated adequate shelter, nutritious food, and warm clothing

Dorothea Dix (1802–1887)

The period of scientific study and treatment of mental disorders began with_ and others, such as _ and _.

Sigmund Freud (1856–1939)

Emil Kraepelin (1856–1926)

Eugen Bleuler (1857–1939)

He challenged society to view human beings objectively. He studied the mind, its disorders, and their treatment as no one had done before.

Sigmund Freud (1856–1939)

He began classifying mental disorders according to their symptoms

Emil Kraepelin (1856–1926)

He coined the term schizophrenia.

Eugen Bleuler (1857–1939)

A great leap in the treatment of mental illness began in about __ with the development of psychotropic drugs, or drugs used to treat mental illness.

1950

were the first drugs to be developed

Chlorpromazine (Thorazine), an antipsychotic drug, and lithium, an antimanic agent

Over the following 10 years, these are meds. that were developed

monoamine oxidase inhibitor antidepressants; haloperidol (Haldol), an antipsychotic; tricyclic antidepressants; and antianxiety agents, called benzodiazepines, were introduced.

The movement toward treating those with mental illness in less restrictive environments gained momentum in __ with the enactment of the Community Mental Health Centers Construction Act.

1963

In 1963, what act was created

Community Mental Health Centers Construction Act

a deliberate shift from institutional care in state hospitals to community facilities, began.

Deinstitutionalization

What does community mental health centers provide

emergency care, inpatient care, outpatient services, partial hospitalization, screening services, and education.

federal legislation was passed to provide an income for disabled persons:

supplemental security income (SSI) and Social Security disability income (SSDI).

When pt. is repeatedly admitted & discharged from a psych facility

revolving door effect.

When psych pt. stays in hospital longer than necessary even though they are already stable or ready to discharge

Boarding

The practice of __ leads to frustration of health care personnel, dissatisfaction with care for clients and their families, and some believe an increase in suicide.

Boarding

is a concept designed to purposely control the balance between the quality of care provided and the cost of that care.

Managed care

In the __, a new form of managed care was developed by utilization review firms or managed care organizations

1990

to control the expenditure of insurance funds by requiring providers to seek approval before the delivery of care.

utilization review firms or managed care organizations

on a case-by-case basis, represented an effort to provide necessary services while containing cost.

Case management, or management of care

The Health Care Finance Administration administers two insurance programs:

Medicare and Medicaid

covers people 65 years and older, people with permanent kidney failure, and people with certain disabilities.

Medicare

is jointly funded by the federal and state governments and covers low-income individuals and families.

Medicaid

covers people receiving either SSI or SSDI until they reach 65 years of age, though people receiving SSDI are not eligible for 24 months.

Medicaid

In 1996, the Congress passed the __, which eliminated annual and lifetime dollar amounts for mental health care for companies with more than 50 employees.

Mental Health Parity Act

Mental Health Parity Act was established at

1996

In 1873, __ graduated from the New England Hospital for Women and Children in Boston.

Linda Richards

first American psychiatric nurse; she believed that “the mentally sick should be at least as well cared for as the physically sick”

Linda Richards

The first training of nurses to work with persons with mental illness was in 1882 at ___

McLean Hospital in Belmont, Massachusetts.

The first psychiatric nursing textbook

Nursing Mental Diseases by Harriet Bailey

When was the first psychiatric nursing textbook published

1920

In 1913, __ was the first school of nursing to include a course in psychiatric nursing in its curriculum.

Johns Hopkins

It was not until 1950 that the __, that accredits nursing programs, required schools to include an experience in psychiatric nursing.

National League for Nursing

Two early nursing theorists shaped psychiatric nursing practice:

Hildegard Peplau and June Mellow

Peplau published __ in 1952

Interpersonal Relations in Nursing

Peplau published __ in 1962.

Interpersonal Techniques: The Crux of Psychiatric Nursing

She described the therapeutic nurse–client relationship with its phases and tasks and wrote extensively about anxiety

Hildegard Peplau

Mellow’s 1968 work, __, described her approach of focusing on clients’ psychosocial needs and strengths.

Nursing Therapy

The __ describe the 13 areas of concern that mental health nurses focus on when caring for clients

phenomena of concern

is the process by which the nurse gains recognition of his or her own feelings, beliefs, and attitudes.

Self-awareness

Points to Consider When Working on Self-Awareness

Keep a diary or journal that focuses on experiences and related feelings.

Talk with someone you trust about your experiences and feelings.

Engage in formal clinical supervision.

Seek alternative points of view.

Do not be critical of yourself (or others) for having certain values or beliefs.

The goal of self-awareness

to know oneself so that one’s values, attitudes, and beliefs are not projected to the client, interfering with nursing care