INTRODUCTION TO PSYCHIATRIC NURSING

Prepared by: Jacqueline Arah Lim Tario R.N.

MENTAL HEALTH
A STATE OF WELL BEING WHERE A PERSON CAN REALIZE HIS OR HER OWN ABILITIES TO COPE WITH

NORMAL STRESSES OF LIFE AND WORK PRODUCTIVELY. (WHO)

Factors Affecting Mental Health

Individual ( personal )
Interpersonal ( relationship) Social/Cultural ( Environment )

Mental Disorder
A clinically significant behavior 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.

Mental ILLNESS
A state of which an individual shows deficit in functioning and is unable to maintain personal relationship.

HISTORICAL PERSPECTIVE OF THE TREATMENT OF MENTAL ILLNESS

Primitive Era

-people believed spirits possesed the body and had to be driven away to effect a cure. -sickness indicated displeasure of the gods and was punishment for sins and wrongdoings.

 Early Christians Times( 1-100 AD)

Demonic possessions Exorcism, Bleeding, Flogging,

Starving, Incarceration

 Renaissance (1300-1600)
Hospital of St. Mary as Hospital for Insane Visitors were charged a fee for viewing

Period of enlightenment (1790)

Establishment of asylum Reforms for mental Health

exorcism

flogging

incarceration

starving

St marys hospital

 Hippocrates: proposed that

mental illness was a disturbance of four body fluids, or humors heat, cold, dryness and moisture.

 Aristotle: concluded that the mind

was associated with the heart.

Galen: emotional or mental

disorders were associated with the brain.

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Psychiatric Nursing
-it is a specialized area of nursing practice

that uses theories of human behavior as its scientific framework and requires the purposeful use of self as its art of expression. -involves the diagnosis and treatment of human responses to actual or potential mental health problems.

-it is concerned with promoting optimum

health for society focusing on prevention of mental illness, health maintenance, manangement of or referral of mental and physical health problems, diagnosis and treatment of mental disorders, and rehabilitation.

 Psychiatric Nursing
An Interpersonal Process Concerned with all aspects of care

Both science and an art Science art Clients

Main tool of the nurse: Therapeutic Use of Self

 Phase 1: The Emergence of Psychiatric-Mental Health Nursing

(1773-1881)

Phase 2: Development of the Work Role of the Nurse in

Psychiatric-Mental Health Facilities (1882-1914)

Phase 3: Development of Undergraduate Psychiatric-Mental

Health Nursing Education (1915-1935)

Phase 4: Development of Graduate Psychiatric-Mental health

Nursing Education (1936-1945)

Phase 5: Develpoment of Consultation and Research in

Psychaitric-Mental Health Practice (1946-1956)

 identification of special institutions for individuals with

psychiatric disorders Eastern Lunatic Hospital, Williamsburg, Virginia.

Benjamin Rush: the father of American Psychiatry, wrote the 1st

textbook on psychiatry.
Johann Weyer: first psychiatrist.

 Dorothea Lynde Dix: devoted her life to the cause of

building state mental hospitals and helped improved the humane treatment of mentally ill people.
Emil Kraepelin (1856 to 1929) differentiated manic-

depression psychosis from schizophrenia and stated that schizophrenia was incurable.
Sigmund Freud (1856 to 1939) introduced

psychoanalytic theory and therapy.

 Eugene Bleuler (1857 to 1939) described the psychotic

disorder of schizophrenia.
Alfred Adler (1870 to 1937) focused on the area of

psychosomatic medicine, referring to organ inferiority as the causative factor.

Carl Jung (1875 to 1961) described the human psyche as

consisting of a social mask (persona), hidden personal characteristics (shadow), feminine identification in men (anima), masculine identification in women (animus), and the innermost center of the personality (self).

 McLean Hospital, Belmont Massachusetts (1882)

established the first training school for nurses in the psychiatric setting.
(1890) trained nurses were employed on nursing staff of

state mental hospitals.

Annie Payson Call (1891) wrote the first psychiatric

literature by a psychiatric nurse.

Mary E. May (1899) wrote the first paper about the work of

a nurse in a psychiatric facility: The Work of Nursing the Insane.

 Effie Jayne Taylor: first professor of psychiatric

nursing and outlined the curriculum of the undergraduate psychiatric nursing program at Johns Hopkins Phipps Psychiatric Clinic.

 Linda Richards (1915) first graduate nurse in the US -

first American psychiatric nurse.

Journals published and textbooks focusing on

psychiatric nursing were written.

Harriet Bailey (1920) wrote the first textbook of

psychiatric nursing: Nursing Mental Diseases.

new treatment approaches were introduced:

electroconvulsive therapy (ECT).

 (1937) clinical experiences in psychiatric hospitals were

standardized:
students were given the opportunity to care for patients with

varying degrees of mental disorders including organic origin.

(1939) approximately half of the nursing schools

provided psychiatric nursing courses for students.

(1955) psychiatric nursing became a requirement for

licensure.

 National League of Nursing Education developed curriculum guidelines for graduate education:
60 to 80 hours of theoretical instruction,

and 12 to 16 weeks of clinical experience.

 passage of Mental Health Act of 1946. Helen Render (1947) wrote Nurse-Patient Relationships in

Psychiatry.
(1956) National League of Nursing Education formed a

committee to review and revised a proposed guide for the development of an advanced clinical course in psychiatric nursing.
Brown Report: stressed that the interest in the field of

psychiatry should be stimulated to facilitate research focusing on the prevention and cure of mental illness.

 Phenothiazines and other major tranquilizers were

developed and used to treat the major symptoms of pyschoses.

(1963) the Community Mental Health Act authorized

funding for the establishment of community health centers to provide services to the public.
20th Century - Psychiatric nursing began to evolve as a

clinical specialty.

PHILIPPINE SETTING

Mental Health in the Philippines

DOH- National Objectives
Promote Mental Health in the general

Population Reduce the risk and prevalence of mental disorders Improve the quality of life of those who are affected

 National Center for Mental Health- main referral unit in the Philippines
Acute Psychiatric Unit

Latest Survey ( 2006)

Specific Phobias 15% Alcohol Abuse 10%

Depression 6%

CONCEPTUAL MODELS IN PHN

Psychoanalytical Developmental Cognitive Interpersonal

Sigmund Freud Psychoanalytical theory

Personality Components composed of three personality structures
Id the pleasure seeking, no regard for

rules and social convention Ego- the balancing and mediating force Superego opposite of id, reflects moral and ethical concepts

Psychosexual Development

Oral stage
Birth to 18 months Major site of gratification is mouth, lips and tongue; includes biting ad sucking Id present at birth Ego starts to develop

Anal stage
18- 36 months
Anus and

surrounding area are major interest Toilet Training

Phallic stage
3-5 years Genital focus of interest,

stimulation and excitement Penis is organ of interest for both sexes ( Penis envy) Electra and oedipal Complex

Latency stage
5-11 or 13 years
Resolution of

oedipal Complex Sexual drive rechanneled Formation of superego

Genital stage
11- 13 years
Begins with

puberty, capacity to orgasm and true intimacy

Summary of Freuds Psychoanalytical

Psychosocial Developmental theory

Erik erikson

 In each stage the person must complete a task that

is essential to his mental health and well being.

Stages of developement
Trust vs Mistrust
Hope 0-18 mos. infancy Viewing the world

as safe and reliable; relationships as nurturing, stable and dependable

Autonomy vs shame and doubt

Will
18 mos. 3 years Toddler Achieving sense of

control and free will

Initiative vs guilt
Purpose
3- 6 Pre school Beginning

development of a conscience; learning to manage conflict and anxiety

Industry vs inferiority
Competence
6-12 School age Emerging

confidence in own abilities ; taking pleasure in accomplishments

Identity vs role confusion/diffusion

Fidelity
12- 18 Adolescent Formulating a sense

of belonging

Intimacy vs isolation
Love
18-25/30 Young adult Forming adult;

loving relationships and meaningful attachments to others

Generativity vs stagnation/ self absorption

Care
30-45/65 Middle adult Being creative and

productive; establishing the next generation

Ego integrity vs despair

Wisdom
45/65 above Maturity/senile Accepting

responsibility for ones self and life

Interpersonal theory

Harry stack sullivan

 Harry Stack Sullivan

ones personality involves more than individual characteristics, particularly how one interacts with others.

STAGE Infancy

AGES

FOCUS

Birth to Primary need for bodily contact and tenderness onset of Prototaxic mode dominates language Primary zones are anal and oral Solitary play ( mobile and rattles) Language to 5 years Parents viewed as source of praise and acceptance Shift to parataxic mode Primary zone is anal, gratification leads to self esteem Parallel Play ( building blocks) No stage and tantrums Shift to syntaxic , opportunities for approval and acceptance of others; learn to negotiate own needs Associative Play Why stage, Imaginary Friend

Childhood

Juvenile

5-8 years

Preadolescence Adolescence

8-12 years Same sex relationship Move away from family as source of satisfactions Puberty to Opposite sex relationship Adulthood Lust is added to interpersonal equation Social experimentation

Types of Play
Solitary- infancy Parallel-childhood stage

Associative-juvenile

Competitive- adolescence

PIAGETS COGNITIVE DEVELOPMENT

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STRESS

REALITY THERAPY

LEGAL ISSUES AFFECTING PSYCHIATRIC NURSING PRACTICE

Psychiatric-Mental Health Nursing Today

Use of Psychiatric-Mental Health Nursing Skills in Career Opportunities

Obstetric Nursing -helping the mother in labor and support person cope with anxiety or stress during labor and delivery. -providing support to bereaved parents in the event of fetal demise, inevitable abortion, or the birth of an infant with congenital anomalies. -providing support to a mother considering whether to keep her child or give the child up for adoption.

Forensic Nursing
-providing services to incarcerated clients.
-acting as a consultant to medical and legal agencies. -serving as an expert witness in court. -providing support for victims of violent crime.

Industrial (Occupational Health) Nursing

-implementing or participating in industrial substance abuse programs for employees and thier families. -providing crisis intervention during an industrial accident or the acute onset of a physical or mental illness. -teaching stress management.

Public Health Nursing

-assessing the person both

physically and psychologically

Office Nursing
assisting the client by explaining somatic or emotional concerns during assessment. -providing support with the problem-solving process when people call the office and the physician is unavailable.

-acting as a community resource person.

Emergency Room Nursing

providing crisis intervention as the need arises.
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Thank you!!!