NCM 117

PSYCHIATRIC NURSING

The heart of psychiatric care.

Patient care

Psychiatric nursing involves what?

• Implementation of a specialized set of skills

• Promoting mental health

• providing support to individuals facing mental health challenges.

Psychiatric nurses often work in collaboration with?

PPS

• Psychiatric physician

• Psychologist

• Social Workers

• understanding the physiological basis of behavior.

• involves the study of the structure and function of the nervous system, including the brain, spinal cord, and nerves.

Neuroanatomy

Understanding the complex process of neurotransmission is essential for comprehending the mechanisms underlying various psychiatric disorders.

Neurotransmission

Refers to the brain's ability to adapt and reorganize itself, which is significant in the context of recovery and rehabilitation for individuals with mental health conditions.

 Neuroplasticity

Types of stressors

• acute

• episodic acute

• chronic

The body’s response to stress involves intricate physiological changes, including the release of stress hormones and activation of the sympathetic nervous system.

Physiological Responses

What are the effective coping strategies/ mechanism that plays a pivotal role in managing stress and promoting mental well-being?

• mindfulness

• physical activity

• social support

Factors such as high stress levels, pollution, and limited access to green spaces

Urban Mental Health

face distinct mental health challenges, including social isolation, limited access to healthcare facilities, and economic factors.

Rural Mental Health

Give two (2) state of mental health

• Urban Mental Health

• Rural Mental Health

What are the therapeutic models in Nursing Practice

1. Psychoanalytic Model

2. Developmental Model

3. Interpersonal Model

4. Cognitive Model

emphasizes the importance of early childhood experiences and the unconscious mind in shaping behavior and mental health.

Psychoanalytic Model

it focuses on the impact of developmental stages on mental health, highlighting the significance of milestones and challenges at different life stages.

Developmental Model

it explores how individuals' relationships and social interactions influence their mental well-being.

Interpersonal Model

it examines the role of thoughts and beliefs in shaping emotions and behaviors, offering insight into therapeutic interventions

Cognitive Model

What are the Diagnosis and Statistical Manual of Mental Disorders (DSM)?

1. Evolving Criteria

2. Multiaxial evaluation

3. Global Impact

The DSM undergoes revisions to incorporate advancements in the understanding of mental health, ensuring that diagnostic criteria align with current knowledge and research.

Evolving Criteria

The multiaxial system in the DSM facilitates a comprehensive evaluation of various factors contributing to an individual's mental health, encompassing clinical, psychosocial, and environmental aspects.

Multiaxial Evaluation

The DSM's global influence extends beyond clinical settings, shaping policies, research initiatives, and public awareness of mental health conditions.

Global Impact

State of complete physical, mental, and social wellness, not merely the absence of disease (WHO).

Mental Health

State of emotional, psychological, and social wellness evidenced by:

• satisfying interpersonal relationships

• effective behavior and coping

• a positive self-concept

• emotional stability

Historically viewed as possession by demons, punishment for religious or social transgressions, weakness of will or spirit, and violation of social norms.

Mental Illness

is “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom” (American Psychological Association [APA]).

Mental disorder

Mental Health Ability to:

• Be flexible

• Be successful

• Form close relationship

• Make appropriate judgments

• Solve problems

• Cope with daily stress

• Have a positive sense of self

Mental Health impaired ability to:

• to think

• to feel

• coping with reality

• form strong personal relationships

• to make sound judgments

• to adapt

What are the factors influencing mental health?

• Individuals

• Interpersonal

• Social/Culture

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

Effective communication, ability to help others, intimacy, and a balance of separateness and connectedness.

Interpersonal

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

What are the General Criteria to Diagnose Mental Disorders?

• Dissatisfaction with one’s characteristics, abilities, and accomplishments

• Ineffective or unsatisfying relationships

• Dissatisfaction with one’s place in the world

• Lack of personal growth

• People believed that the mentally ill were possessed by demons who invaded the human body as a form of punishment

• Treatment was designed to drive out demons.

Primitive times

• sickness represented displeasure of the gods and punishment for sins and wrongdoing

• treatments included starving, purging, and bloodletting.

Ancient times

• an Egyptian writing wherein mental disorders were mentioned as being dependent upon evil spirits

• description of senile deterioration, alcoholism, and hysteria was obvious in those writings.

EBERS PAPYRUS 1560 BC

It contains the first classification of mental disorder.

Vedas or works of wisdom (Hindus)

Contained instructions and qualifications for the nurse

Sushruta samhita

E.g. cool headed, pleasant, kind-spoken, strong and attentive to the needs of the sick, and indefatigable following the doctor’s instructions.

Sushruta samhita

First to regard the brain as the central organ of intellectual activity and mental disorder as an illness of that organ.

Alcmaeon (5th Century BC)

• emphasized the natural causes of diseases

• known as the Father of Medicine

Hippocrates (460-370 BC)

Expressed the psychosomatic viewpoint that the body and mind were inseparable.

Plato (427–347 BC)

Attempted to relate mental disorders to physical disorders - developed his theory that the amounts of blood, water, and yellow and black bile in the body controlled the emotions.

Aristotle (382–322 BC)

His system consisted of hygienic measures which included attention to diet, bath, friction and methods of keeping the skin pores open

Asclepiades of Bithynia (129 – 40 BC)

• world's first and oldest institution to specialize in the mentally ill

• variously known as St. Mary Bethlehem, Bethlem Hospital, Bethlehem Hospital and Bedlam

• founded as a priority in 1247 and as a hospital in 1330

Middle Ages Bethlem Royal Hospital

• English physician who published in 1758 the first lengthy book on the treatment of mental illness.

• A Treatise on Madness.

• Extending methods of treatment to the poor as well as the affluent, helped raise psychiatry to a respectable specialty

Early modern period William Battie (1704-76)

The creation of asylums as a safe refuge or haven offering protection.

Period of Enlightenment (1790s)

Who is the Father of American Psychiatry?

Benjamin Rush (1745- 1813)

Two (2) approaches of tx of mentally ill:

1. Physical treatment

2. Occupational treatment

Initiated the moral treatment of mentally ill individuals

Philippe Pinel (1745- 1826)

• English businessman, philanthropist

• development of more humane methods in the custody and care of people with mental disorders

• York Retreat (1796)

William Tuke (1732 – 1822)

• German physician

• revived the age-old art of suggestive healing

• divine trance

 

Franz Anton Mesmer (1734-1815)

• American activist on behalf of the indigent insane

• created the first generation of American mental asylums

19th Century : The Evolution of the Psychiatric Nurse Dorothea Dix (1802-1887)

Nightingale’s Notes on Nursing was published

1859

First training school for nursing of the mentally ill established at Mclean Asylum, Waverly, Massachusetts

1882

• first professionally trained American nurse

• created the first system for keeping individual medical records for hospitalized patients

Linda Richards (1841- 1930)

• Swiss psychiatrist

• President of the American Psychiatric Association } Patients could best be understood through consideration of their life situations } need to study a person’s whole environment

20^th Century: The Era of Psychiatry Adolf Meyer (1866- 1950)

• founder of the American

• mental hygiene movement (1908)

• a patient himself, experienced and witnessed serious

• maltreatment at the hands of the staff A Mind That Found Itself (1908) autobiographical account of his hospitalization and the abuses he suffered.

Clifford Beers (1876-1943)

• German psychiatrist who devised a classification of mental disorders

• credited with the classification of what was previously considered to be a unitary concept of psychosis, into two distinct forms: Mania Dementia Praecox

Emil Kraepelin (1856-1926)

Also recognized today for having a neurological condition called synesthesia.

“Schizophrenia” was first named by Eugen Bleuler (1857-1939)

• challenged society to view human beings objectively

• studied the mind, its disorders, and their treatment as no one had before

• dev’t of psychoanalysis, psychosexual theories, and neurosis

• psychoanalysis as for treatment and a theory of personality development

Sigmund Freud(1856- 1939)

Believed that anxiety interfered with ability to cope & communicate effectively resulting in mental illness -interpersonal theories stimulated the dev’t of multidisciplinary approaches to psychiatric and milieu therapy.

Harry Stack Sullivan (1892-1949)

• emphasized the nurse-client relationship as the foundation of nursing practice

• Developmental Stages of the Nurse-Client Relationship

• Seven Nursing Roles

Hildegard Peplau (1909-1999)

The three purposes of DSM-IV-TR

1. To provide a standardized nomenclature and language for all mental health professionals

2. To present defining characteristics or symptoms that differentiate specific diagnoses T

3. To assist in identifying the underlying causes of disorders.

In what year is the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published by APA?

1952

is a taxonomy published by APA and is used by all mental health professionals.

Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR)

DSM-IV-TR Multiaxial Classification System

• Axis I (Clinical Syndrome) - Signs and Symptoms

• Axis II (Personality Disorders)

• Axis III ( Pathological Disorders)

• Axis IV ( Environmental & Psychosocial Stressors)

• Axis V (Global Assessment of Functioning)

Identifying all major psychiatric disorders except mental retardation and personality disorders.

Axis I (Clinical Syndrome) - Signs and Symptoms

Mental retardation and personality disorders as well as prominent maladaptive personality features and defense mechanisms.

Axis II (Personality Disorders)

Current medical conditions that are potentially relevant to understanding or managing the person’s mental disorder as well as medical conditions that might contribute to understanding the person.

Axis III ( Pathological Disorders)

Psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders.

Axis IV ( Environmental & Psychosocial Stressors)

Rates the person’s overall psychological functioning on a scale of 0 to 100.

Axis V (Global Assessment of Functioning)

What are the severity of the Psychosocial Stressor Scale for Adults?

1. None

2. Mild

3. Moderate

4. Severe

5. Extreme

6. Catastrophic

7. Inadequate Information or no Change in Condition

Adult and Children & Adolescents: No acute events may be relevant to the disorders.

Example:

• Adult and Children & Adolescent: No enduring circumstances that may be relevant to the disorder.

None

Adult: Broke up with boyfriend or girlfriend; started or graduated from school; child left home.

C&A: Broke up with boyfriend or girlfriend; change of school.

Examples:

• Adult: Family arguments; job dissatisfaction; trouble with loss; being a single parent.

• C&A: Overcrowded living quarters; family arguments.

Mild

C&A: Expelled from school; the birth of a sibling.

Adult: Marriage; marital separation; loss of job; retirement; miscarriage.

Examples:

• Adult: Marital disorder; serious financial problem; trouble with loss; being a single person.

• C&A: Chronic disabling illness in the parent; chronic parental discord.

Moderate

C&A: Divorce of parents; unwanted pregnancy; arrest.

Adult: Divorce; birth of first child

Examples:

• Adult: Unemployment; poverty.

• C&A: Harsh or rejecting parents; chronic life-threatening illness in the parent; multiple foster home placements.

Severe

Adult: Death of spouse; serious physical illness diagnosed; victim of rape.

C&A: Sexual or physical abuse; death of a parent.

Examples:

• Adult: Serious chronic illness in self or child; ongoing physical or sexual abuse.

• C&A: Recurrent sexual or physical abuse

Extreme

Adult: Death of child; suicide of spouse; devastating natural disaster.

C&A: Death of both parents.

Examples:

• Adult: Capacity of hostage; concentration camp experience

• C&A: Chronic life-threatening illness.

Catastrophic

PSYCHIATRIC–MENTAL HEALTH NURSING: SCOPE AND STANDARDS OF PRACTICE

• Standard 1. Assessment

• Standard 2. Diagnosis

• Standard 3. Outcome Identification

• Standard 4. Planning

• Standard 5. Implementation

• Standard 5a. Coordination of care

• Standard 5b. Health Teaching and Health Promotion

• Standard 5c. Milieu Therapy

• Standard 5d. Pharmacological, Biological, and Integrative Therapies

• Standard 5e. Prescriptive Authority and Treatment

• Standard 5f. Psychotherapy

• Standard 5g. Consultation

• Standard 6. Evaluation

• Standard 7. Quality of Practice

• Standard 8. Education

• Standard 9. Professional Practice Evaluation

• Standard 10. Collegiality

• Standard 11. Collaboration

• Standard 12. Ethics

• Standard 13. Research

• Standard 14. Resource Utilization

• Standard 15. Leadership

The psychiatric–mental health registered nurse collects comprehensive health data that is pertinent to the patient’s health of situation.

Standard 1. Assessment

The psychiatric–mental health registered nurse analyzes the assessment data to determine diagnoses of problems, including level of risk.

Standard 2. Diagnosis

The psychiatric–mental health registered nurse identifies expected outcomes for a plan individualized to the patient or the situation.

Standard 3. Outcome Identification

The psychiatric–mental health registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.

Standard 4. Planning

The psychiatric–mental health registered nurse implements the identified plan.

Standard 5. Implementation

The psychiatric–mental health registered nurse coordinates care delivery.

Standard 5a. Coordination of care

The psychiatric–mental health registered nurse employs strategies to promote health and a safe environment.

Standard 5b. Health Teaching and Health Promotion

The psychiatric–mental health registered nurse provides, structures, and maintains a safe and therapeutic environment in collaboration with patients, families, and other health-care clinicians.

Standard 5c. Milieu Therapy

The psychiatric–mental health registered nurse incorporates knowledge of pharmacological, biologic, and complementary interventions with applied clinical skills to restore the patient’s health and prevent further disability.

Standard 5d. Pharmacological, Biological, and Integrative Therapies

The psychiatric–mental health advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations.

Standard 5e. Prescriptive Authority and Treatment

The psychiatric–mental health advanced practice registered nurse conducts individual, couple, group, and family psychotherapy using evidence-based psychotherapeutic frameworks and nurse– patient therapeutic relationships.

Standard 5f. Psychotherapy

The psychiatric–mental health advanced practice registered nurse provides consultation to influence the identified plan, enhance the abilities of other clinicians to provide services for patients, and effect change.

Standard 5g. Consultation

The psychiatric–mental health registered nurse evaluates progress toward attainment of expected outcomes.

Standard 6. Evaluation

The psychiatric–mental health registered nurse systematically enhances the quality and effectiveness of nursing practice.

Standard 7. Quality of Practice

The psychiatric–mental health registered nurse attains knowledge and competency that reflect current nursing practice.

Standard 8. Education

The psychiatric–mental health registered nurse evaluates one’s own practice in relation to the professional practice standards and guidelines, relevant statues, rules, and regulations.

Standard 9. Professional Practice Evaluation

The psychiatric–mental health registered nurse interacts with and contributes to the professional development of peers and colleagues.

Standard 10. Collegiality

The psychiatric–mental health registered nurse collaborates with patients, family, and others in the conduct of nursing practice.

Standard 11. Collaboration

The psychiatric–mental health registered nurse integrates ethical provisions in all areas of practice.

Standard 12. Ethics

The psychiatric–mental health registered nurse integrates research findings into practice.

Standard 13. Research

The psychiatric–mental health registered nurse considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services.

Standard 14. Resource Utilization