copyright © 2011 wolters kluwer health | lippincott williams & wilkins chapter 1: foundations...

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 1: Foundations of Psychiatric-

Mental Health Nursing

Chapter 1: Foundations of Psychiatric-

Mental Health Nursing


Mental HealthMental Health

• Difficult to define• No single, universal definition• Many components influenced by factors• Dynamic, ever-changing state• Influencing factors:

– Individual (personal)

– Interpersonal (relationship)

– Social/cultural (environmental)


Mental IllnessMental Illness

• Mental disorder: behavioral or psychological syndrome or pattern (clinically significant)

– Association with present distress or disability or increased risk of death, pain, disability or important loss of freedom


Mental Illness (cont’d)Mental Illness (cont’d)

• General criteria for diagnosis

– Dissatisfaction with characteristics, abilities, accomplishments

– Ineffective or unsatisfying relationships

– Dissatisfaction with one’s place in the world

– Ineffective coping with life events

– Lack of personal growth


Diagnostic and Statistical Manual of Mental DisordersDiagnostic and Statistical Manual of Mental Disorders

• DSM-IV-TR: taxonomy of American Psychiatric Association

• Purposes:

– Standardize nomenclature, language

– Identify defining characteristics or symptoms

– Assist in identifying underlying causes


DSM-IV-TR ClassificationDSM-IV-TR Classification

• Axis I: major psychiatric disorders except mental retardation, personality disorders

• Axis II: mental retardation, personality disorders

• Axis III: current medical conditions potentially relevant

• Axis IV: psychosocial, environmental problems

• Axis V: Global Assessment of Functioning


QuestionQuestion

• Tell whether the following statement is true or false:

• The definition of mental health is standardized and universally accepted.


AnswerAnswer

• False• There is no single universal definition of

mental health, which has many components and is influenced by myriad factors.


Historical PerspectivesHistorical Perspectives

• Ancient times

– Sickness as displeasure of gods; punishment for sins; view as demonic or divine

– Aristotle and imbalances of the four humors (blood, water, yellow and black bile); balance restoration via bloodletting, starving, purging

– Early Christians’ view as possession by demons


Historical Perspectives (cont’d)Historical Perspectives (cont’d)

• Period of Enlightenment (1790s)

– Creation of asylums; moral treatment

– Dorothea Dix

• Sigmund Freud: scientific study, treatment of mental illness


Historical Perspectives (cont’d)Historical Perspectives (cont’d)

• Psychopharmacology (1950s): development of psychotropic drugs

• Community mental health movement

– Deinstitutionalization

– Legislation for disability income

– Changes in commitment laws


Mental Illness and the 21st CenturyMental Illness and the 21st Century

• Current state

– More than 26% of Americans 18 and older have diagnosable mental disorder (NIMH, 2008)

– 15 million adults, 4 million children and adolescents with impaired daily activities

– Economic burden exceeds that by all types of cancer


Mental Illness and the 21st Century (cont’d)Mental Illness and the 21st Century (cont’d)

• Current state

– Leading cause of disability in United States Canada for those 15-44 years of age

– 1 in 4 adults and 1 in 5 children and adolescents getting care needed



• Issues and concerns:

– “Revolving-door” effect due to deinstitutionalization

– Shorter hospital stays, decompensation, rehospitalization, dual diagnoses



• Issues and concerns:

– Homelessness (⅓ estimated to have serious mental illness; over ½ with substance abuse problems)

– Lack of adequate community resources

• ACCESS to address needs of full- or part-time homeless persons with mental illness


QuestionQuestion

• Which statement best reflects the current state of mental health and mental illness?

A. Mental health care costs exceed the costs for cancer care.

B. Most adults and children receive adequate mental health care.

C. Community resources for the homeless with mental illness are adequate.

D. Deinstitutionalization has reduced the revolving door effect.


AnswerAnswer

A. Mental health care costs exceed the costs for cancer care.

• The economic burden of mental illness exceeds that for all types of cancer care.

– Only 1 in 4 adults and 1 in 5 children received the necessary mental health care. Community resources for homeless clients with mental illness are inadequate. Deinstitutionalization has led to the “revolving-door” effect.


Objectives for the FutureObjectives for the Future

• Healthy People 2010 objectives

– Increase number of people identified, diagnosed, treated, helped to live healthier lives

– Decrease rates of suicide, homelessness

– Increase employment for those with serious mental illness

– Provide more services for incarcerated persons with mental health problems


Community-Based CareCommunity-Based Care

• Lack of appropriate number of community mental health centers to provide services

• Development of community support programs– Availability, quality of services highly variable

– Inaccurate anticipation of extent of people’s needs

– Despite flaws, positive aspects making them preferable for treatment


Cost Containment and Managed CareCost Containment and Managed Care

• Managed care movement (early 1970s)• Development of utilization review

firms/managed care organizations (1990s); case management

• Separation of mental health care from physical care for insurance coverage


Cost Containment and Managed Care (cont’d)Cost Containment and Managed Care (cont’d)

• Mental health care management through privately owned behavioral health care firms

– If no private insurance, reliance on counties of residence for payment

• HCFA: Medicare, Medicaid• Mental health parity, insurance coverage


Cultural ConsiderationsCultural Considerations

• Culturally diverse population• Cultural differences influencing mental

health, treatment of mental illness• Changes in family structure


QuestionQuestion


• Community-based programs are preferable for treating many people with mental illness.


AnswerAnswer

• True• Although there are flaws in the system,

community-based programs have positive aspects that make them preferable for treating many people with mental illness.


Psychiatric Nursing PracticePsychiatric Nursing Practice

• Linda Richards: first American psychiatric nurse

• McLean Hospital, Belmont MA: site of first training for nurses to work with persons with mental illness

• Expansion of role with development of somatic therapies


Psychiatric Nursing Practice (cont’d)Psychiatric Nursing Practice (cont’d)

• First psychiatric nursing textbook (Nursing Mental Diseases) published in 1920

• Johns Hopkins: first school of nursing to include psychiatric nursing course (1913)

• National League for Nursing (1950) requiring schools to include psychiatric nursing experience


Psychiatric Nursing Practice (cont’d)Psychiatric Nursing Practice (cont’d)

• H. Peplau: therapeutic nurse-client relationship; interpersonal dimension (foundation for current practice)

• J. Mellow: focus on client’s psychosocial needs, strengths

• American Nurses Association and Standards of Care (see Box 1.3)

• Psychiatric-Mental Health Nursing Phenomena of Concern (see Box 1.2)


Psychiatric Nursing Practice (cont’d)Psychiatric Nursing Practice (cont’d)• Basic-level functions

– Counseling

– Milieu therapy

– Self-care activities

– Psychobiologic interventions

– Health teaching

– Case management

– Health promotion, maintenance

• Advanced-level functions

– Psychotherapy

– Prescriptive authority for drugs

– Consultation, liaison

– Evaluation


Student Concerns and Psychiatric-Mental Health Clinical ExperienceStudent Concerns and Psychiatric-Mental Health Clinical Experience

• Saying the wrong thing• Knowing what to do • Being rejected or not talking to student• Asking personal questions • Handling bizarre, inappropriate, or sexually

aggressive behavior• Handling feeling unsafe


Student Concerns and Psychiatric-Mental Health Clinical ExperienceStudent Concerns and Psychiatric-Mental Health Clinical Experience

• Seeing someone known on the unit• Dealing with similar problems or

backgrounds


QuestionQuestion


• The National League for Nursing required schools to include a psychiatric nursing experience before the first nursing school included a psychiatric nursing course in its curriculum.


AnswerAnswer

• False• Johns Hopkins was the first school of nursing

to include a course in psychiatric nursing in its curriculum; this was done in 1913. It was not until 1950 that the National League for Nursing required schools to include an experience in psychiatric nursing.


Self-Awareness IssuesSelf-Awareness Issues

• Everyone with unique or different values, ideas, beliefs

• Possible conflict between personal values/beliefs, those of client

• Need to accept differences, view each client as worthwhile regardless of opinions or lifestyle

• Self-awareness through reflection

copyright © 2011 wolters kluwer health | lippincott williams & wilkins chapter 1: foundations...

Documents

mental health nursing

mental health care costs

adequate mental health

necessary mental health

current state of mental

mental retardation

treatment of mental

serious mental illness