Psychiatric-Mental Health Nursing INFLUENCES OF MENTAL HEALTH

UNIT I. FOUNDATIONS OF PSYCHIATRIC- BIOLOGICAL INFLUENCES/FACTORS

MENTAL HEALTH NURSING
 Biologic makeup
Difference between Psychiatric and  Sense of harmony in life
Medical-Surgical Nursing  Emotional resilience/hardiness
 Spirituality
Physical efforts prove to students that they
 Positive identity
are working and accomplishing something.
In psychiatric nursing one has to be INTERPERSONAL INFLUENCES
psychologically active, but physically passive
much of the time.  Effective communication
 Ability to help others
It takes some time to realize that LISTENING  Intimacy
to what aches in the hearts of patients may  Balance of separateness and connection
touch them more profoundly than back rub.
SOCIOCULTURAL INFLUENCES
HEALTH
 Sense of community
“A state of complete physical, mental and  Access to adequate resources
social well-being without the absence of  Intolerance of violence
disease or infirmity” - World Health  Support of diversity among people
Organization (WHO)
MENTAL ILLNESS
MENTAL HEALTH
“a clinically significant behavioural or
“The successful performance of mental psychological syndrome experienced by a
function, resulting in productive activities, person, marked by distress, disability, or the
fulfilling relationships, and the ability to risk of suffering, disability, or loss of
adapt to change and cope with adversity” - freedom”- (American Psychiatric
(USDHHS, 1999) Association)
A state of emotional, psychological, and PSYCHOPATHOLOGY
social wellness evidenced by satisfying
interpersonal relationships, effective • Psychopathology examines the nature
behavior, and coping, positive self-concept, and development of abnormal
and emotional stability.
– Behavior, Thoughts, Feelings
ELEMENTS OF MENTAL HEALTH
• Definitions of abnormality vary widely
• Self-governance and may not capture all aspects of
• Progress toward growth or self- psychopathology
realization
– Psychopathological aspect
• Tolerance of uncertainty
(causes, mechanisms)
• Self-esteem
• Reality orientation – Clinical aspect (assessment,
• Mastery of environment treatment)
• Stress management
EARLY VIEWS OF PSYCHOPATHOLOGY • Pinel (1793) advocated for humane
treatment of patients in asylums
Demonology (Supernaturalism)
(“moral treatment”)
- is the view that abnormal mental
– Removed shackles, improved
function is due the occupation by
diet, better treatment
an evil being of the mind of a
person MODERN APPROACHES TO MENTAL
- Treatment requires exorcism ILLNESS
Somatogenesis • Systems of classification were
developed which argued that mental
- is the view that disturbed body
illness has a biological cause
function produces mental
abnormality – Kraepelin suggested that
clusters of symptoms form a
Psychogenesis
syndrome
- is the belief that mental disturbance
– Each syndrome has its own
has psychological origins
unique cause, course,
DEMONOLOGY DURING THE DARK AGES symptoms, treatment, and
outcome
• The Dark ages were marked by a decline
in Greek and Roman civilizations and by TREPHINATION
an increase of influence of churches

• Church authorities came to view

witchcraft as an explanation of
abnormality

– Witches were in the league with

the Devil

– Torture was required to elicit

“confessions” of witchcraft;
death by fire was required to
drive out supposed demons
TRANQUILIZER CHAIR
ASYLUMS

• Asylums were created in the 15th

century for the care/treatment of the
mentally ill.

– Asylums were meant to be a

place of refuge

– Care and treatment within an

asylum was not always humane
or effective
O’HALLORAN’S SWING

HYDROTHERAPY

RESTRAINT CAGE

LUNATIC BOX

PSYCHIATRY

BENJAMIN
RUSH

“Father of
American
Psychiatry," was
the first to
HOLLOW WHEEL
believe that
mental illness is
a disease of the
mind and not a
"possession of
demons."
 - Believed the chief origin of psychiatric
disease to be biological and genetic
CLIFFORD BEERS
malfunction.
- sparked the
mental health
reform HILDEGARD
movement in PEPLAU
1908
- the "mother
- “A Mind That of
Found Itself”, psychiatric
which nursing“
chronicled his
- introduced
struggle with mental illness and the
the "nurse-
shameful conditions he and millions of
patient
others endured in mental institutions

- created the National Committee for relationship"

Mental Hygiene, later the National
- pioneer in the development of the
Mental Health Association
theory and practice of psychiatric and
SIGMUND mental health nursing.
FREUD
ONE-DIMENSIONAL MODELS
- an Austrian
ONE CAUSE = DISORDER
neurologist
MULTIDIMENSIONAL MODELS
- the founder
of MANY CAUSES

Psychoanalysis, a clinical method for

treating psychopathology through
dialogue between a patient

EMIL KRAEPELIN

- A German
psychiatrist. PROBLEMS IN TREATING MENTAL ILLNESS
- Founder of
modern • Cost-related issues
scientific • Stigma
psychiatry, • Revolving door treatment
• Lack of parity
• Limited access to services
psychopharmacology and psychiatric
genetics.
METHODS OF ACHIEVING OPTIMAL CARE
FOR MENTAL ILLNESS

• Beyond response to recovery

• Reintegration into society
• Mental health parity
• Culturally competent care
• Medication adherence
PSYCHIATRIC-MENTAL HEALTH NURSING

“The diagnosis and treatment of human

responses to actual or potential mental
health problems” - (ANA, APNA, & ISPN,
2000)

- Nursing Process and Standards of Care

- Levels of Practice
- Guiding Principles AWARENESS OF INTERACTIONS WITH THE
- Role of the Psychiatric Nurse as a Team ENVIRONMENT
Member NURSES identify their:

- specific feelings and thoughts about

PERSONAL PHILOSOPHY ISSUES clients (including feelings of acceptance
or rejection)
SELF AWARENESS - evaluate the consequences of their
actions toward clients
The NURSE gains recognition of his/her
- learn to effectively differentiate
own feelings, beliefs, and attitudes.
between their own needs and client
AWARENESS OF ENVIRONMENT needs.

Includes recognition of client needs, belief

systems, and behaviors; identification of the
 An interpersonal process
factors that contribute to health and illness
in the client; and assessment of resources  Employing theories of human behavior
available to the client. as its science and purposeful use of self
as its art.
JOHARI’S WINDOW  The major therapeutic goal is the
prevention, detection, and
rehabilitation of psychiatric disorders.

 Emphasis on the “interpersonal process

and relationships”

 Most fundamental goals : To help the

patient accept himself, to improve his
relationship with other people and to
learn to function independently on a
realistic basis.
 • View the client’s behavior as the
best possible adaptation
PSYCHIATRIC NURSING DIAGRAM

NURSING ROLES

 ward manager
 social agent
 counsellor
 teacher
 mother surrogate
 technical role

Other Terms Used For Psychiatric Nursing:

 Psychosocial Nursing
ESSENTIAL QUALITIES OF THE
 Institutional Nursing
PSYCHIATRIC-MENTAL HEALTH NURSE
 Mental Health Nursing
• Therapeutic Use of Self
• Genuineness and Warmth
SELF AS A THERAPEUTIC TOOL • Empathy
• Acceptance
 Nurse uses herself in order to affect
• Maturity and Self-Awareness
positive changes in the patients’
behavior.
THE MENTAL HEALTH TEAM

 Nurse
PRINCIPLES OF PSYCHIATRIC NURSING
 Social Worker
• View the client as a holistic being  Clinical Psychologist
 Psychiatrist
• Focus on the client’s strengths and
 Physician
assets, not on his weakness and
 Occupational Therapist
liabilities
 Recreational Therapist
• Accept the client as a human being  Psychiatric Aide/Clinical Assistant
who has value and worth

• View the client’s behavior as

designed to meet a need or to
communicate a message

• Potential for establishing

relationship with clients

• Quality of the interaction