lecture notes for mental health nursing (psych nursing)

Download Lecture Notes for mental health nursing (psych nursing)

Post on 14-Nov-2014




1 download

Embed Size (px)


here are some great notes for psych! also, what nursing schools are you all from??? leave me a comment since I'm curious! thanks and good luck!


Chapter One Foundations of Psychiatric Mental Health Nursing

Mental Health

The WHO defines health as a state of complete physical, mental, and social wellness, not merely the absence of disease or infirmity. Mental health is influenced by individual factors, including biologic makeup, autonomy, and independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, resilience or hardiness, sense of belonging, reality orientation, and coping or stress management abilities; by interpersonal factors, including effective communication, helping others, intimacy, and maintaining a balance of separateness and connectedness; and by social/cultural factors, including sense of community, access to resources, intolerance of violence, support of diversity among people, mastery of the environment, and a positive yet realistic view of the world (damn, that was a mouthful!).

Mental Illness

The APA (2000) defines a mental disorder as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. Deviant behavior does not necessarily indicate a mental disorder.

Diagnostic and statistical manual of mental disorders

The DSM-IV-TR is a taxonomy published by the APA. The DSM-IV-TR describes all mental disorders, outlining specific criteria for each based on clinical experience and research. The DSM-IV-TR has 3 purposes: o To provide standardized nomenclature and language for all mental health professionals. o To present defining characteristics or symptoms that differentiates specific diagnoses. o To assist in identifying the underlying causes of disorders. A multiaxial classification system that involves assessment on several axes, or domains of information, allows the practitioner to identify all the factors that relate to a persons condition. o Axis I is for identifying all major psychiatric disorders except MR and personality disorders. Examples include depression and schizophrenia. o Axis II is for reporting mental retardation and personality disorders as well as prominent maladaptive personality features and defense mechanisms. o Axis III is for reporting current medical conditions that are potentially relevant to understanding or maintaining the persons mental disorder as well as medical conditions that might contribute to understanding the person. o Axis IV is for reporting psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders. Included are problems with the primary support group, the social environment, education, occupation, housing, economics, access to health care, and the legal system. o Axis V presents a Global Assessment of Functioning which rates the persons overall psychological functioning on a scale of 0 to 100. This represents the clinicians assessment of the persons current level of functioning.

All clients admitted to a hospital or psychiatric treatment will have a multiaxis diagnosis from the DSMIV-TR.

Period of Enlightenment and Creation of Mental Institutions

In the 1790s Phillippe Pinel in France and Willian Tukes of England formulated the concept of asylum as a safe refugee or haven offering protection at institutions where people had been beaten, whipped, and starved for their mental illness. In the US, Dorothea Dix (1802-1887) began a crusade to reform the treatment of mental illness after a visit to the Tukes institution in England. She was instrumental in opening 32 state hospitals that offered asylum to the suffering. 100 years after establishment of the first asylum, state hospitals were in trouble. Attendants were accused of abusing the residents, the rural locations of the hospitals were viewed as isolating patients from their families and homes, and the phrase insane asylum took on a negative connotation.

Development of Psychopharmacology

In the 1950s the development of psychotropic drugs were used to treat mental illness. Chlorpromazine (Thorzine), an antipsychotic drug, and lithium, an anti-manic agent, were the first drugs to be developed. 10 years later, monoamine oxidase inhibitors, haloperidol (Haldol), an antipsychotic; tricyclic antidepressants; and antianxiety agents (benzodiazepines), were introduced.

Because of these new drugs, hospital stays were shortened, and many people were well enough to go home.

Move toward Community Mental Health

The enactment of the Community Mental Health Centers Act came about in 1963. Deinstitutionalization, a deliberate shift from institutional care in state hospitals to community facilities, began. In addition to deinstitutionalization, federal legislation was passed to provide an income for disabled persons: SSI and SSDI. This allowed people with mental illnesses to be more independent financially and not to rely on family for money.

Mental Illness in the 21st Century

The Department of Health and Human Services (DHHS) estimates that 56 million Americans have a diagnosable mental illness. The term Revolving door effect is used to explain how people with severe and persistent mental illness have shorter hospital stays, but they are admitted more frequently. People with severe and persistent mental illness may show signs of improvement in a few days but are not stabilized. Thus, they are discharged into the community without being able to cope with community living. Substance abuse issues cannot be dealt with in the 3-5 days typical for admissions in the current managed care environment. Many providers believe todays clients are to be more aggressive than those in the past. Between 4% and 8% in clients seem in Psychiatric ERs are armed. People

not receiving adequate mental health care commit about 1,000 homicides each year. In state prisons, 1 in 10 prisoners take psychotropic medications and 1 in 8 receives counseling or therapy for mental health issues. 85% of the homeless population has a psychiatric illness and/or a substance abuse problem. The United States has the largest percentage of mentally ill citizens (29.1%) and provided care for only 1 in 3 people who needed it (Bijl et al., 2003). Persons with minor or mild cases are most likely to receive treatment while those with severe and persistent mental illness were least likely to be treated.

Cost containment and managed care

Managed Care is a concept designed to purposely control the balance between the quality of care provided and the cost of that care. In a managed care system, people receive care based on need rather than request. Case management or management of care on a caseby-case basis represented an effort to provide necessary services while containing costs. The client is assigned a case manager, a person who coordinates all types of care needed by the client. In 1996, Congress passed the Mental Health Parity Act, which eliminated annual and lifetime dollar amounts for mental health care for companies with more than 50 employees. However, substance abuse was not covered by this law, and companies could limit the number of days in the hospital or the number of clinic visits per year. Thus, parity did not really exist.

Psychiatric Nursing Practice

In 1873, Linda Richards improved nursing care in psychiatric hospitals and organized educational programs in state mental hospitals in Illinois. Richards is called the first American psychiatric nurse. The first training of nurses to work with persons with mental illness was in 1882. The care focused on nutrition, hygiene and activity. Nurses adapted medicalsurgical principles to the care of clients with psychiatric disorders and treated them with tolerance and kindness. Treatments such as insulin shock therapy (1935), psychotherapy (1936), and electroconvulsive therapy (1937) required nurses to use their medical skills more extensively. John Hopkins was the first school of nursing to include a course on psychiatric nursing in its curriculum. In 1950, the National League for Nursing (which accredits nursing programs) required schools to include an experience in psychiatric nursing. In 1973, the ANA developed Standards of care, which states the responsibilities for which nurses are accountable. Psychiatric nursing practice has been profoundly influenced by Hildegard Peplau and June Mellow, who wrote about the nurse-client relationship, anxiety, nurse therapy, and interpersonal nursing therapy.

Psychiatric Mental Health Nursing Phenomena of Concern

The maintenance of optimal health and well-being and the prevention of psychobiologic illness. Self-care limitations or impaired functioning related to mental and emotional distress. Deficits in the functioning of significant biologic, emotional, and cognitive symptoms. Emotional stress or crisis components if illness, pain, and disability.

Self-concept changes, developmental issues, and life process changes. Problems related to emotions such as anxiety, anger, sadness, loneliness, and grief. Physical symptoms that occur along with altered psychological functioning. Alterations in thinking, perceiving, symbolizing, communicating, and decision making. Difficulties relating to others Behaviors and mental states that indicate the client is a danger to self or others or has a significant disability. Interpersonal, systemic, sociocultural, spiritual, or environmental circumstances or events that affect the mental or emotional well-being of the individual, family, or community. Symptom management, side effects/toxicities associated with psychopharmacologic intervention, and other aspects of the treatment regimen.

Standards of Psychiatric mental health clinical nursing practice.

Standard I. Assessment o The psyc