Concepts of psychiatric

and mental health

nursing

Mihaela E. Olson, APNC, PMHRNC

Family Nurse Practitioner
Associate Professor of Nursing

Chapter 1

Practicing the Science and Art of

Psychiatric Nursing

Psychiatric and mental health

nursing (PMHN)
Focuses on the treatment of human

responses to mental health problems and

psychiatric disorders
A core mental health profession,
employs a purposeful use of self as its art
and a wide array of nursing, psychological
and neurobiological theories and research
evidence as its science. (ANA, 2007)

Evidence based practice nursing

Method for using treatment approaches to

medical and mental health illness that are
scientifically grounded or evidence based

In psychiatry, this focus extends to treatment

approaches in which there is scientific evidence
for psychological and sociological treatment
approaches as well as for evidence related to
the neurobiology of psychiatric disorders and
psychopharmacology

Mental health recovery model

Refers primarily to managing symptoms, reducing

psychosocial disability and improve role performance
(Pratt, et al., 2006)
Views recovery as personal journey of healing
Goal is to empower those with mental illness to find
meaning and satisfaction in their lives, realize personal
potential and function at their optimum level of
independence
Supportive relationships, social inclusion, attain coping
skills, recovery oriented services, and sense of hope for
future can lead to high quality of life with this illness

The science of nursing: finding the

evidence for practice

Florence Nightingale (1820-1910) founder of

modern nursing, her philosophy was a reflection
of evidence-based practice

Nightingale proposal (1860) resulted in the 1st

model for systemic collection of hospital data
using a uniform classification of diseases and
operations and was to form the basis of
International Statistical Classification of Diseases
and Related Health Problems used worldwide
today (Keith, 1988)

Hildegard Peplau (1909-1999)

Considered the mother of psychiatric nursing

Former professor at Rutgers University
Developed the art and science of professional nursing
practice
Believed that a scientific approach was essential to
practice psychiatric nursing
Introduced the concept of advance nursing practice and
promoted professional standards and regulation
through credentialing among other significant
contributions to nursing (Tomey, 2006)

The 5 As of EBN

Multistep process of integrating evidence-based

practice into clinical practice
1.
2.
3.

4.
5.

Ask a question: identify a problem or need for change

Acquire literature: search literature for scientific studies
and articles that address the area of concern
Appraise the literature: evaluate and synthesize the
research evidence as to its validity , relevance and
applicability using criteria of scientific merit
Apply the evidence: Interventions based on best available
evidence with patient preference and needs
Assess the performance: Evaluate outcomes, use clearly
defined criteria, reports, and document results

Hierarchy of evidence and grading

of recommendations
Each recommendation has been allocated
grading that directly reflects the hierarchy
of evidence on which it has been based
Hierarchy of evidence: includes level and
type of evidence
Grading of recommendations: includes
level and type of evidence

Guidelines for practice

Mental Health Web Resources: focus on sites

maintained by professional societies or org
whose quality is evidenced based
Clinical Practice Guidelines; systematically dev
statements that identify, appraise and
summarize best evidence
Clinical Algorithms: step by step guidelines
prepared in a flowchart format
Clinical/critical pathways: usually specific to the
institution using them

The art of nursing: developing the

skills for practice
1.

Caring: involves how we relate to one another,

how we show concern in daily life

Evidenced by empathetic understanding , actions, and patience on

another's behalf
Caring for one another by actions, words, and being there leads to
happiness and touches the heart
Defined as giving of self while preserving the importance of self
A nurse must demonstrate a level of competence and the art of caring
Absence of caring can leave memorable scars and make pts feel
distrustful, disconnected, uneasy, and discouraged

The art of nursing: developing the

skills for practice
2. Attending: refers to the intensity of presence,
being there in tune with the pt

When a human connection is made between the nurse and the pt,
the pt sense of isolation is minimized or eliminated
Attending behaviors include listening, touching, or giving attentive
physical care
Through active listening skills and effective communication we can
fully understand another persons immediate experience and
distressing fears, perceptions and concerns

The art of nursing: developing the

skills for practice
3. Patient advocacy: One who speaks up for another s
cause , who helps another by defending and comforting
them, especially when the other lacks knowledge, skills,
ability to stand up for themselves

Ethical role
Patient advocate in 1976 ANA Code of Ethics
Advocacy in nursing includes commitment to pts health, well-being,
and safety across the life span, the alleviation of suffering and
promoting a peaceful, comfortable and dignified death (ANA, 2001)

In order to become successful...

We must all suffer from one of two pains:

the pain of discipline or the pain of regret.
The difference is discipline weighs
ounces, while regret weighs tones.
Jim Rohn,
motivational speaker