Psychiatric-Mental Health Nursing

Katherine Conlu-Bengan, RN

UNIT I. FOUNDATIONS OF PSYCHIATRIC-MENTAL

HEALTH NURSING

Entering Psychiatric Nursing

How will I handle bizarre or

inappropriate behavior?

Am I prying when I ask personal

questions?

What will I be doing?

Is my physical safety in

jeopardy?

What happens if a client asks me for a date or

displays sexually aggressive or

inappropriate behavior?

What if I say something

wrong?

What if no one will talk

to me?

What if I encounter

someone I know being treated on

the unit?

Difference Between Psychiatric and Medical-Surgical Nursing

Physical efforts prove to students that they are working and accomplishing something. In psychiatric nursing one has to be psychologically active, but physically passive much of the time.

It takes some time to realize that LISTENING to what aches in the hearts of patients may touch them more profoundly than back rub.

DEFINITION OF HEALTH

“a state of complete physical, mental

and social well-being

without the absence of disease or infirmity”

WORLD HEALTH ORGANIZATION

DEFINITION OF MENTAL HEALTH

“the successful performance of mental function,

resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity”

(USDHHS, 1999)

DEFINITION OF MENTAL HEALTH

I probably have the

most sanest

mind..hehe

A state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior, and coping, positive self-concept, and emotional stability.

ELEMENTS OF MENTAL HEALTH

• Self-governance• Progress toward growth or self-

realization• Tolerance of uncertainty• Self-esteem• Reality orientation• Mastery of environment• Stress management

INFLUENCES ON MENTAL HEALTH

kcbengan/SACRNursing/2004

Biological factors Biologic makeup Sense of harmony in life Emotional resilience/hardiness Spirituality Positive identity

kcbengan/SACRNursing/2004

Social and Cultural factors Sense of community Access to adequate resources Intolerance of violence Support of diversity among people

kcbengan/SACRNursing/2004

Interpersonal factors Effective

communication Ability to help

others Intimacy Balance of

separateness and connection

DEFINITION OF MENTAL ILLNESS

“a clinically significant behavioral or

psychological syndrome experienced by a

person, marked by distress, disability, or the

risk of suffering, disability, or loss of

freedom”

(American Psychiatric Association)

Psychopathology

• Psychopathology examines the nature and development of abnormal – Behavior, Thoughts, Feelings

• Definitions of abnormality vary widely and may not capture all aspects of psychopathology– Psychopathological aspect (causes,

mechanisms)– Clinical aspect (assessment, treatment)

Ch 1.1

Early Views of Psychopathology

• Demonology (Supernaturalism) is the view that abnormal mental function is due the occupation by an evil being of the mind of a person – Treatment requires exorcism

• Somatogenesis is the view that disturbed body function produces mental abnormality

• Psychogenesis is the belief that mental disturbance has psychological origins

Demonology During the Dark Ages• The Dark ages were marked by a decline

in Greek and Roman civilizations and by 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

Ch 1.5

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

• Pinel (1793) advocated for humane treatment of patients in asylums (“moral treatment”)– Removed shackles, improved diet, better

treatment

Ch 1.6

Modern Approaches to Mental Illness

• Systems of classification were developed which argued that mental illness has a biological cause– Kraepelin suggested that clusters of

symptoms form a syndrome– Each syndrome has its own unique

cause, course, symptoms, treatment, and outcome

Ch 1.7

TREPHINATION

TRANQUILIZER CHAIR

O'HALLORAN'S SWING

HYDROTHERAPY

LUNATIC BOX

HOLLOW WHEELRESTRAINT CAGE

Benjamin Rush Clifford Beers

Sigmund FreudEmil Kraepelin

Hildegard Peplau

THERAPEUTIC COMMUNICATIONTHERAPEUTIC COMMUNICATION

One-Dimensional ModelsOne-Dimensional Models

ONE CAUSEONE CAUSE DISORDERDISORDER

Multidimensional ModelsMultidimensional Models

MANY CAUSESMANY CAUSES

BiologicalBiological

InfluencesInfluences

BehavioralBehavioral

InfluencesInfluences

SocialSocial

InfluencesInfluences

Cognitive & EmotionalCognitive & Emotional

InfluencesInfluences

PROBLEMS IN TREATING MENTAL ILLNESS

• Cost-related issues

• Stigma• Revolving door

treatment• Lack of parity• Limited access to

services

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)

Psychiatric-Mental Health Nursing

• Nursing Process and Standards of Care

• Levels of Practice

• Guiding Principles

• Role of the Psychiatric Nurse as a Team Member

PERSONAL PHILOSOPHY ISSUES• Self-Awareness

The NURSE gains recognition of his/her own feelings, beliefs, and attitudes.

• Awareness of Environment

Includes recognition of client needs, belief systems, and behaviors; identification of the factors that contribute to health and illness in the client; and assessment of resources available to the client.

• Awareness Of Interactions With The Environment

NURSES identify their:> specific feelings and thoughts about clients (including feelings of acceptance or rejection)> evaluate the consequences of their actions toward clients> learn to effectively differentiate between their own needs and client needs.

An interpersonal process Employing theories of human behavior

as its science and purposeful use of self as its art.

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.

Psychiatric Nursing Paradigm

Human behavior

Communicationskill

Process Nursing

Therapeutic Use of self

Other Terms Used For Psychiatric Nursing:

Psychosocial Nursing

Institutional Nursing

Mental Health Nursing

Self as a Therapeutic

Tool

Nurse uses herself in order to affect positive changes in the patients’ behavior.

Principles and Perspectives of the Psychiatric-Mental Health Nurse

Principles of Psychiatric Nursing• View the client as a holistic being

• Focus on the client’s strengths and assets, not on his weakness and liabilities

• Accept the client as a human being 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 • View the client’s behavior as the best possible

adaptation

N U R S I N G R O L E S

Ward Manager Social Agent Counselor

Teacher Mother Surrogate Technical Role

Essential Qualities of the Psychiatric-Mental Health Nurse

• Therapeutic Use of Self• Genuineness and Warmth• Empathy• Acceptance• Maturity and Self-Awareness

The Mental Health Team

• Nurse• Social Worker• Clinical Psychologist• Psychiatrist• Physician• Occupational Therapist• Recreational Therapist• Psychiatric Aide/Clinical Assistant

MULTI-AXIAL SYSTEM OF DIAGNOSIS

• AXIS I: Clinical Disorders• AXIS II: Personality Disorders and Mental Retardation• AXIS III: General Medical Conditions• AXIS IV: Psychosocial and Environmental Problems• AXIS V: Global Assessment of Functioning (GAF); 0-100

(APA, 2000)