Introduction to Psychiatric /

Mental Health Nursing

Philosophy and Theories for
Interdisciplinary Psychiatric Care
Chapter 1, 2 & 5
West Coast University
NURSING 204

Caring for Psychiatric Mental Health Clients

Feelings, Concerns, QuestionsWhat Are They?

Who Are They?

People with Mental Illness

Factors Influencing Expectations

Media

Upbringing

Culture

Other?

Expectations

Life
experiences

Psychiatric Mental Health Clients

Psychiatric mental health clients are everyday, ordinary
people.

Removing the stigma of Mental Illness

Definition of Stigma: a mark of disgrace or infamy;
a stain or reproach, as on ones reputation
Best defined as ignorance, prejudice and
discrimination

Factors Impacting Mental Health and Mental

Illness
Biological

Mental
Illness
or
Mental
Health
Social

Cultural

What do these terms mean?

Crazy?

Berserk?

Wacky?

Insane?
Weird?
Lunatic ?
Nervous
Breakdown?
Melancholy?

Historical Approaches
Era of Magico-Religious Explanations
Era of Organic Explanations (4th Century)
Era of Alienation (1300 1600)
Era of Confinement (17th Century)
Era of Moral Treatment (18th 19th Century)
Reform leaders:
William Cullen
Philippe Pinel
William Tuke
Benjamin Franklin
Benjamin Rush Father of American Psychiatry

A ward in Bethlehem Hospital about 1745. A patient is being chained in the

foreground, and in the background are two Sunday visitors on an
entertainment outing. Source: Philosophical Library.

Historical Approaches - continued

Era of Psychoanalysis (19th to 20th Century)
Sigmund Freud

Contemporary Developments (mid 20th Century)

Social dimensions
Brain dysfunction
Neurochemical
Medication therapy

21 Century Research
st

Bases for mental disorders

Psychotropic medications
Role of nutrients, biology, and genetics

Mental Disorder Statistics

High incidence with physical illness
Account for 47% of all disability in economically
developed countries

Account for 28% of all disability worldwide

Mental Illness
Characteristics
Distress
Disability
Risks

Prevalence Rates for Various Mental Disorders

Leading Causes of Mental Disability Worldwide

Mental Health Studies

Epidemiologic Catchment Area (ECA)
Global Burden of Disease (WHO)
U.S. Surgeon Generals Report
Healthy People 2020

Healthy People 2020

Reduce suicide rate
Reduce the rate of suicide attempts by adolescents
Increase services for homeless adults with serious
mental illness (SMI)

Reduce relapse with eating disorders in adolescents

Increase mental health screening in primary care
services

Increase mental health services in children

Healthy People 2020 - continued

Screening in juvenile justice
Track consumers satisfaction with mental health services
Jail diversion programs for SMI
Cultural competency
Plan that address specialized mental health services for the
elderly persons.

Increase services for person with co-occurring substance

abuse and SMI

Employee stress in the workplace

Psychiatric-Mental Health Nurses

What do they do?

Chapter 2

Standards
Standards of Psychiatric-Mental Health Nursing
Practice:
Guidelines for providing quality care

Psychiatric-Mental Health Nursing Standards of

Practice
1. Assessment
2. Diagnosis
3. Outcomes Identification
4. Planning

Standards - continued
Psychiatric-Mental Health Nursing Standards of
Practice
5. Implementation

A. Coordination of Care
B. Health Teaching and Health Promotion
C. Milieu Therapy
D.Phamacological, Biological, and Integrative Therapies
E. Prescriptive Authority and Treatment (APRN only)
F. Psychotherapy (APRN only)
G.Consultation (APRN only)
6. Evaluation

Standards - continued
Standards of Professional Performance
7. Quality of Practice
8. Education
9. Professional Practice Evaluation
10.Collegiality
11.Collaboration
12.Ethics
13.Research
14.Resource Utilization
15.Leadership

Psychiatric-Mental Health Nurses

Generalist level
Advanced practice level
Prescriptive authority
Psychotherapy
Consultation

Estimated Number of Mental Health Workers in the United States

The Mental Health Team

Effective Mental Health Services

Client

Partnerships

PMH Team

Family

Lessons on Collaboration
Know thyself
Value diversity
Know that conflict is natural
Share your power with others
Master communication skills
Think life-long learning.
Embrace interdisciplinary situations.
Appreciate spontaneity.
Balance unity with autonomy.

The Role of the Psychiatric-Mental Health Nurse

Custodial

Multifaceted

Psychiatric-Mental Health Nursing (1940-1990)

Nurses begin to educate nurses.
Psychiatric theory includes interpersonal and emotional dimensions.
National Mental Health Act of 1946
Elimination of single-focus psychiatric nursing schools
Period of role clarification
Hildegard Peplau
Gwen Tudor
Frances Sleeper
Community Mental Health Centers Act of 1963
Psychiatric nursing journals

Psychiatric-Mental Health Nursing (1940-1990) continued

Birth of clinical nurse specialists and nurse therapist role
First standards of psychiatric-mental health nursing practice
Increase role of nurses at national level
Shift in psychiatric nursing toward humanistic interactionism
Decrease in numbers of psychiatric nurses
Decreased funding for training
Psychiatric nursing diagnoses

Psychiatric-Mental Health Nursing (1990s) Decade of the Brain

Psychobiologic concepts
Nursing Psychopharmacology Project
Health care delivery reform
Outcome-based research
Cultural diversity
Integration of theoretical perspectives

Psychiatric-Mental Health Nursing (2000s) - The

New Millennium
Standards of practice revisions
Knowledge explosion
Renewed focus on physical health
Single point of entry
Advanced practice nurses
Expansion of practice settings

Nursing Theories Impacting Psychiatric

Nursing

Marjory Gordon Functional Health Patterns

(1987)

Hildegard Peplau Interpersonal

Relationships (1952)

Dorothea Orem Self-Care Deficit (1959)

Dorothy Johnson Behavioral System (1968)
Sister Callista Roy Adaptation Model (1976)

Hildegard Peplau, PhD, RN, FAAN

Marjory Gordon ,PhD, RN, FAAN

Nursing Theories - Value

Nursing practice vs. medical practice
Caring vs. curing
Interpretation of meaning
Nurse-client relationship
Advocacy of client dignity
Advocacy of nurse authenticity

Application of Theoretical Frameworks

Application of various theoretical frameworks leads to:
Quality client-centered care.
Efficient use of resources.
Practice-oriented research.
Clinical judgments and actions that can be articulated and
taught to others.

Gordon's 11 Functional Health

Patterns
Functional
Health Pattern

Pattern Describes

Examples

Health Perception/
Health Management

Client's perceived pattern of

health and well-being and how
health is managed.

Compliance with medication

regimen, use of health-promotion
activities such as regular exercise,
annual check-ups.

Nutritional-Metabolic

Pattern of food and fluid

consumption relative to metabolic
need and pattern; indicators of
local nutrient supply.

Condition of skin, teeth, hair,

nails, mucous membranes; height
and weight.

Elimination

Patterns of excretory function

(bowel, bladder, and skin).
Includes client's perception of a
normal" function.

Frequency of bowel movements,

voiding pattern, pain on urination,
appearance of urine and stool.

Activity - Exercise

Patterns of exercise, activity,

leisure, and recreation.

Exercise, hobbies. May include

cardiovascular and respiratory
status, mobility, and activities of
daily living.

Cognitive-Perceptual

Sensory-perceptual and cognitive

patterns.

Vision, hearing, taste, touch,

smell, pain perception and
management; cognitive functions
such as language, memory, and
decision making.

Sleep-Rest

Patterns of sleep, rest, and

relaxation.

Client's perception of quality and

quantity of sleep and energy,
sleep aids, routines client uses.

Gordon's 11 Functional Health

Patterns
Functional
Health Pattern

Pattern Describes

Examples

Role-Relationship

Client's pattern of role

engagements and relationships.

Perception of current major roles

sand responsibilities (e.g., father,
husband, salesman); satisfaction
with family, work, or social
relationships.

Sexuality-Reproductive

Patterns of satisfaction and

dissatisfaction with sexuality
pattern; reproductive pattern.

Number and histories of

pregnancy and childbirth;
difficulties with sexual functioning;
satisfaction with sexual
relationship.

Coping / Stress Tolerance

General coping pattern and

effective of the pattern in terms of
stress tolerance.

Client's usual manner of handling

stress, available support systems,
perceived ability to control or
manage situations.

Value - Belief

Patterns of values, beliefs

(including spiritual), and goals
that guide client's choices or
decisions.

Religious affiliation, what client

perceives as important in life,
value-belief conflicts related to
health, special religious practices.

Self-Perception/
Self Concept

Client's self-concept pattern and

perceptions of self.

Body comfort, body image, feeling

state, attitudes about self,
perception of abilities, objective
data such as body posture, eye
contact, voice tone.

Holistic Practice:
Expanded Role for Nurses

(Chapter 5)

Interactionism
Individuals have purpose and control.
Humanistic cast
Interaction of psychology, psychobiology, and
sociocultural contexts

Humanism
Devotion to individual interests
Spirit of compassion and caring
Affirming of the joy, beauty, and value of living

Nursing Implications
Humanistic Interactionism
Interrelated physical and mental factors
Holistic
Expanded role for psychiatric-mental health nurses
Client and family role includes negotiation and advocacy.

Nursing Implication
Psychobiology
Focus on biological, medical, and human aspects of
care.
Holistic
Integrative

New knowledge
High tech and high touch
Nature and nurture
Biologic sciences and behavioral sciences

Medical-Psychobiologic
Theory
Key concepts

Emotional disturbance indicates illness or

defect.
Illnesses are located in the brain or central
nervous system.
Illnesses have specific characteristics.
Mental diseases have a characteristic course.
Mental disorders respond to physical or somatic
treatments.
Psychobiologic explanations reduce stigma.

Comparison of Traditional
Psychiatric Theories

Psychoanalytic Theory
Sigmund Freud:

All psychological emotional events can be understood.

Childhood experiences adult neuroses
Goal of therapy is gaining insight.

Psychoanalytic
Theory
Levels of awareness in relation to id,
ego, and superego
Id: Present at birth. Serves to satisfy
needs and immediate gratification
Ego: Begins to develop at 4 6
months. Maintain contact with reality,
rational part of personality.
Superego: begins to develop at about
3 6 years. Serves as conscience
(sense of right or wrong)

Cognitive Concepts

SocialInterpersonal
Theories

SocialInterpersonal
Theories

Maslow: Self-Actualization and Hierarchy of

Needs