psych nursing evolution

8/13/2019 Psych Nursing Evolution

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EVOLUTION OF PSYCHIA

NURSING


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PSYCHIATRIC MENTAL HEALTH NURSING

specialty within nursing: theories of and research

on human behavior as science interpersonal process: purposeful use of self as its

art

promotes mental health

assessment

diagnosis

treatment of human responses to mental

health problems and psychiatric disorders


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PSYCHIATRIC MENTAL HEALTH NURS

Essential components

health and wellness promotion through

identification of mental health issues

prevention of mental health problems

care of mental health problems

treatment of persons with psychiatricdisorders


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SIX STANDARDS OF PRACTICE

(NURSING PROCESS)

Standard 1: Assessmentcollects comprehensive

health data pertinent to the patients health orsituation.

Standard 2: Diagnosisanalyzes data to determine

diagnoses or problems, including level of risk.

Standard 3: Outcomes Identificationidentifies

expected outcomes for a plan individualized to thepatient or to the situation.

Standard 4: Planningdevelops a plan that

prescribed strategies and alternatives to attain

expected outcomes.


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SIX STANDARDS OF PRACTICE

(NURSING PROCESS)

Standard 5: Implementationimplements the plan.

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

(APRN only)

Standard 5F: Psychotherapy (APRN only)

Standard 5G: Consultation (APRN only)


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NINE STANDARDS OF PROFESSIONAL PERFOR

(PROFESSIONAL ROLE ACTIVITIES)

Standard 6: Evaluationevaluates progress toward

attainment of expected outcomes. Standard 7: Quality of Practicesystematically

enhances the quality and effectiveness of nursing

practice.

Standard 8: Educationattains knowledge and

competency that reflect current nursing practice. Standard 9: Professional Practice Evaluation

evaluates ones own practice in relation to the

professional practice standards and guidelines,

relevant statutes, rules, and regulations.


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Standard 10: Collegialityinteracts with and

contributes to the professional development of peersand colleagues.

Standard 11: Collaborationcollaborates with

patients, families, and others in the conduct of

nursing practice.

Standard 12: Ethicsintegrates ethical provisions inall areas of practice.

Standard 13: Researchintegrates research findings

into practice.


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Standard 14: Resource Utilizationconsiders factors

related to safety, effectiveness, cost, and impacton practice in the planning and delivery of

nursing services.

Standard 15: Leadershipprovides leadership in the

professional practice setting and the profession.


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LEVELS OF PSYCHIATRIC NURSING

FUNCTIONS

Psychiatric Mental Health Nurse

Basic Level of Practice

RN with BSN degree

Clientele: Individual, family, group, community

Focus

Health promotion, assess dysfunction, assist client to

regain or improve coping, prevent further disability,

intake screening, case management, milieu therapy,

self-care activities, psychobiological interventions,

health teachings, crisis intervention, counseling, home

visiting, community action, advocacy


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LEVELS OF PSYCHIATRIC NURSING

FUNCTIONS

Psychiatric Mental Health Advanced Practice

Registered Nurse

Advanced Level of Practice/Sub-specialization

RN with master or doctoral educational preparation

Clientele: Age category/ Illness category

Focus: mental health promotion, illness care,diagnosis and treatment of mental disorders,

psychotherapy, psychobiologic interventions,

prescriptive authority for drugs, clinical

supervision/consultation, liaison nursing


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PSYCHIATRIC NURSING: AN EVOLUTION

PSYCHIATRICMENTAL HEALTH NURSING IN THE

19TH CENTURY

Kaiserwerth (1836): First school of nursing founded

in Germany

Florence Nightingale

organized the Saint Thomas Hospital school

stressed the importance of an optimumenvironment for clients

Influence of nurses on clients goes beyond

physical care and has psychologic and social

components


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19TH CENTURY

Early 1870s, the first three American nursing

schools opened in New York, Boston, and New

Haven

Linda Richards (1873)

First American psychiatric nurse

Theory of care Itstands to reason that the

mentally sick should be at least as well cared

for as the physically sick


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PSYCHIATRICMENTAL HEALTH NURSING IN THE 19TH

CENTURY

Linda Richards (1873)

Contributions

Developed better nursing care in psychiatric

hospitals

Organized nursing service and educational

programs in state mental hospitals in Illinois Significant contribution: assessment of both the

physical and emotional needs of the patient

opened the first American school for psychiatric

nurses at McLean Psychiatric Asylum in Waverly,

Massachusetts in 1880


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19TH CENTURY

McLean Hospital (1882)

First school to prepare nurses to care for the

mentally ill

2year program: Physical nursing (1styr); skills in

mental care (2ndyr)

Emphasis

care was custodial

meeting patient's physical needs: medication,

nutrition, hygiene and ward activities


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EVENTS OF 19001940: MULTIFACETED ROLE OF

NURSES Johns Hopkins University (1913)

First school of nursing to include a fully

developed course ofpsychiatric nursing in

the curriculum

Nursing Mental Diseases (1920) First psychiatric nursing text not written by

a psychiatrist

written by Harriet Bailey


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EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES

Late 1930s

Psychiatric knowledge included in the general nursing care

for all illnesses

Emergence of various somatic therapies: MS skills for nurses

required

Training of student nurses

how to assess behavior of patients who are mentally

ill, so they may recognize early signs and symptoms

instruction on the relationship between

environmental conditions and mental disorders

teaching them to be resourceful, versatile and

adaptable while giving individualized care


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NURSES

In 1937, National League for Nursing Education

(now the National League for Nursing)

NLN begins to standardize and accredit

psychiatric nursing education in single-focus

psychiatric nursing schools


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EVENTS OF 19001940: MULTIFACETED ROLE OFNURSES

National Mental Health Act of 1946 Initiated development of psychotherapeutic

roles for nurses

Provided for the establishment of the NationalInstitute for Mental Health (NIMH)

Provided funding for development of programsto train professional psychiatric personnel,including psychiatric nurses

Support for psychiatric research, andassistance in developing mental healthprograms


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NURSES

Helen Render (1947)

Author: Nurse Patient Relationship in

Psychiatry N-P partnership

Scope: clinical competence; patient-family

advocacy; fiscal responsibility; interdisciplinarycollaboration; social accountability; legal-ethical

parameters


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NURSES

1947

Start of graduate programs in psychiatric nursing

Attitude therapy

Published in American Journal of Nursing by

Weiss Use of attitude patientsrecovery

Implementation: observation; acceptance;

respect; understanding, promote interest;

participate in reality


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Bennett and Eaton

Identified problems affecting psychiatric nurses

Scarcity

Under use of abilities

Very little psychiatric nursing carried out in

otherwise good psychiatric hospitals and units Supported nurses participation in individual and group

therapy

Nursing Therapy: activities done by Mellow withschizophrenic patients


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EVENTS OF 19001940: MULTIFACETED ROLEOF NURSES

Hildegard Peplau (1952) Mother of Psychiatric Nursing

published Interpersonal Relations in Nursing

first systematic theoretic framework in psychiatricnursing

delineated skills, activities, and roles andemphasized the interpersonal nature of nursing andthe need for nurses to use psychodynamic concepts

and counseling techniques.


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NURSES

Gwen Tudor (Will)

nurses can promote emotional growth in clients

Published in the journal of Psychiatry: study describing

the N-P relationship

Characteristics: unconditional care; few demands; anticipation

of patientsneeds


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Frances Sleeper psychiatric nurses as psychotherapists

1950s Significant Developments in PsychiatricNursing

Therapeutic Community: A New Treatment Method inPsychiatry (1953): use of patientssocial environment

Use of Psychotropic Drugs

Made patients treatable and fewer physicalconstraints

More personnel provide therapy

Expanded roles of various psychiatric practitioners


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NURSING CONCERNS (1958) Dealing with patients problems of attitude, mood

and interpretation of reality

Exploration of disturbing and conflicting thoughtsand feelings

Using the patients positive feelings towards the

therapist to bring about psychophysiologicalhomeostasis

Counseling patients in emergencies, includingpanic and fear

Strengthening the well part of the patient


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EVENTS OF 19001940: MULTIFACETED

ROLE OF NURSES Psychiatric Nursing Focus (1960s)

Primary Prevention; Implementation of

Care; Consultation in the Community

Interdisciplinary approach to alleviate illnessand promote mental health

Psychiatric nursing psychiatric and

mental health nursing


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EVENTS OF 19001940: MULTIFACETED

ROLE OF NURSES Interpersonal Techniques: The Crux of

Psychiatric Nursing (1962)

Published by Peplau

Differentiated between general practitionerand psychiatric nurses


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Community Mental Health Centers Act of1963

closing of large mental hospitals in favor oftreatment in the community

trend toward more expanded and specialized

roles in psychiatricmental health nursing. Clinical nurse specialists, prepared at thegraduate level, Provided individual, group, andfamily psychotherapy and obtained third partyreimbursement.


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Nurses began publishing psychiatric nursing journals and

textbooks advocating the counseling role as the basis of psychiatric

nursing:

Perspectives in Psychiatric Care (1963)

Journal of Psychiatric Nursing and Mental Health Services (in

1981 changed its name to Journal of Psychosocial Nursing and

Mental Health Services) American Journal of Nursing

Issues in Mental Health Nursing (1979)

Archives of Psychiatric Nursing (1987)

Journal of the American Psychiatric Nurses Association

(1990s)


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ANA position paper (1967) endorsed clinical nurse specialists in therole of therapist in individual, group, family,

and milieu work.

By the mid-1970s, certification at both the

generalist and specialist levels became theresponsibility of ANA.


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SPECIALTY NURSING PRACTICE (1970s)

Psychiatric nurses became pacesetters

Developed standards and statements on scope of

nursing practice

Established generalist and specialist certification

Caring as core element as defined by nursing profession

Psychiatric and mental health nursing Psychosocialnursing

Clinical rotations integrate psychosocial aspect of

physically ill patients in general medicalsurgical


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NURSES

PSYCHIATRIC-MENTAL HEALTH NURSING

PRACTICE by ANA in 1973

first standards to serve as guidelines for

providing quality care.

Now revised several times, delineatepsychiatricmental health nursing roles

and functions


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NURSES

Martha Mitchell

First nurse to play a major role in national mental health

policy

1977 Commission on Mental Health.

Major shift in psychiatric nursing thinking (humanistic

interactionism) advocating negotiated goals between nurse and client

client advocacy

political sensitivity

caring, and compassion


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1980s

Major concerns

decrease in the number of nurses selecting

psychiatric nursing as a specialty

shortage of clinical training funding

Scientific growth in psychobiology: nurses slow to

shift from psychodynamic models to psychobiologic Psychiatric nursing diagnoses (1984)

developed and incorporated into NANDA classification

system


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1990sDECADE OF THE BRAIN

Challenge: integrate neuroscience into the holistic

biopsychosocial practice of psychiatric nursing

Psychopharmacology guidelines

Health care reform

Nursing roles in mental health care delivery

Mental health promotion and mental illness

prevention

Case management

Holistic perspective

Equitable access


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1990sDECADE OF THE BRAIN

Development of out-patient services including

private practice for nurses

Outcome-based research

Accurate image of psychiatric nursing

Emphasis of the human aspect of mental health

work Cultural diversity among psychiatric nurses

Integration of philosophic and theoretical

perspectives into practice and research


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THE NEW MILLENNIUM (2000S)

Revisions of the standards of practice of psychiatric

mental health nurses (ANA, APNA, ISPN)

knowledge explosion in psychobiology: biologic

foundations of behavior, genetics,

psychopharmacologic agents with fewer side effects

renewed focus on the physical health problems of

psychiatric clients especially those living in the

community


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THE NEW MILLENNIUM (2000S)

shift to primary care as a point of entry for

psychiatric care

curriculum shift in graduate programs toward

comprehensive health assessment, management of

common physical health problems, and prescriptive

authority for advanced practice nurses

Settings: hospitals and traditional settings to

alternative and nontraditional settings

FOUNDATIONS (THEORIES) IN PSYCHIAT


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NURSING

THEORIES

organize data

identify problems

plan interventions

generate goals and nursing actions determine and evaluate outcomes



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NURSING

Hildegard Peplau

the mother of psychiatric nursing,

conceptualized the one-to-one nurse

client relationship with 4 phases:

orientation, identification, exploitation

or working, and resolution.

Hildegar

the first

theorist

Nighting

middle-rtheory o

relations

revolutio

work of



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NURSING

Dorothea Orem

universal self-care requisites:

physical and psychosocial human

needs

clients abilities to perform self-care

to maintain life, health, and well-

being.

Dorothe

born in B

was a nucreator o

deficit nu

known a

of nursin



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NURSING

Martha Rogers

defined nursing as a holistic

science of unitary human beings

Central to nursing

identified principles of homeodynamics the notions of life processes

change

human-environmental interactions

Marth

an Am

resea

authofor de

Unitar

for he

Introd

Theor

Nursin



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NURSING

Sister Callista Roy adaptation theory: people as psychosocial

beings, constantly faced with the need to adapt

to internal and external demands.

Sister C

Octobe

America

professknown f

the ada

nursing

as a 20

the Ame

Nursing



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NURSING

Ida Jean Orlando deliberative nursing action: meanings, validated

between the nurse and the client

Ernestine Wiedenbach

developed theory around the clients need for

help

validation: client perceptions, and the nurses

role in observing, assessing, exploring, and

validating feelings, thought, and fears.



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OU O S ( O S) S C

NURSING

Joyce Travelbee

meaning in nurseclient interactions explained sympathy, rapport, and suffering,

emphasized communication and stages of the nurseclient

relationship.

Paterson, Josephine and Zderad, Loretta

observations: basis of nursing theory

incorporated an intersubjective transaction: client and

nurse are present in the experience in an existential way

emphasized freedom of human choice and responsibility

Josephin

Paterson



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( )

NURSING

Jean Watson

human caring: helpingtrusting relationship,incorporates the values of kindness,

concern, love of self and others, and the

ecology of the earth

emphasized sensitivity to self, values

clarification, congruency, empathy,authenticity and genuineness, and the

clientsexpression of emotions.

Jean Wats

nurse theo

professor

for her Th

Caring. Sh

numerous

Nursing: T

Science o



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( )

NURSING

Patricia Benner

added to nursings understanding of caring: observedand interviewed nurses engaged in clinical practice in

order to disclose the nature of clinical wisdom along

with caring and comforting practices

introduced the concept that expert nurses develop

skills and understanding of patient care over time

through a sound educational base as well as amultitude of experiences (From Novice to Expert)

THREE PRIMARY DOMAINS OF PSYCHIA


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NURSING CARE

DIRECT CARE

COMMUNICATION MANAGEMENT

OVERLAPPING FUNCTIONS

TEACHING

COORDINATING

DELEGATING

COLLABORATING

PSYCHIATRIC NURSING


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PSYCHIATRIC NURSING

INTERPERSONAL PROCESS: Communication, Caring

GOAL Dealing with emotional responses to stress and crisis

Learning effective ways of behaving

Developing a healthful lifestyle

Achieving a realistic and positive selfconcept

RESPONSIBILITIES

Therapeutic Relationship

Therapeutic Environment

PSYCHIATRIC NURSING


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PSYCHIATRIC NURSING

USE NURSING PROCESS

Assessment Diagnosis

Planning

Implementation

Evaluation

ROLES

Counselor Teacher

Patients advocate

Leader, Coordinator,

Mother

Creator of a therapeu

environment

Technician

psych nursing evolution

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