PSYCHIATRIC

MENTAL HEALTH
NURSING
CHAPTER 1

Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

 Custodial careprevailing mode of care before

1860

"It stands to reason that the mentally sick should be at

least as well cared for as the physically sick"
. Linda Richards (1873)
HISTORICAL
(Considered the 1st psychiatric nurse)
PERSPECTIVES
Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

DEVELOPMENTS IN EARLY 1900S

In 1913 Johns Hopkins was first school of
nursing with fully developed psychiatric
course
In 1930s nursing education recognized
importance of psychiatric knowledge in
nursing care for all illnesses
In 1930s insulin shock therapy, psychosurgery,
and electroconvulsive therapy (ECT)
developed
In 1947 eight graduate programs in
psychiatric nursing had been started
Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

 NLN required accredited schools of

nursing to provide experience in
psychiatric nursing
Hildegard Peplau published
Interpersonal Relations in Nursing
Maxwell Jones published The
Therapeutic Community: A New
Treatment Method in Psychiatry
DEVELOPMENT
Major tranquilizers developed
S IN 1950S

Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

 Described by Tudor in 1952

Peplau defined nursing as
significant, therapeutic process
Evolved role of psychiatric nursing
and was considered Mother of
Psychiatric Nursing
Based clinical competence on
interpersonal techniquesNURSEand use
PATIENT
of nursing process

RELATIONSH
IP

Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

 Insulin shock therapy

Psychosurgery
ECT
Required medical-surgical skills of nurses
Helped control behavior and made
patient more amenable to psychotherapy
Showed need for improved psychological
treatment for nonresponsive patients

DEVELOPMENTS
IN SOMATIC
THERAPIES
Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

THERAPEUTIC COMMUNITY
Social environment provided
therapeutic experience
Patient active participant in care
Involved in daily problems of the unit
Helped solve problems, plan
activities, develop required unit roles
Therapeutic communities became
preferred psychiatric environment

Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

PSYCHOTROPIC DRUGS
Developed in early 1950s
More patients became treatable
Fewer restraints and locked doors needed
More personnel needed to provide therapy
Roles of psychiatric practitioners and
nurses expanded

Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

 Dealing with patient problems of attitude,

mood, interpretation of reality
Exploring disturbing or conflicting thoughts
Using positive feelings from relationship to
bring about psychophysiological
homeostasis
Counseling patients in emergencies
Strengthening well part of patients

EVOLVING
NURSING
FUNCTIONS
Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

DEVELOPMENTS IN 1960S
Focus began to shift to primary prevention,
care, and consultation in community
Community Mental Health Centers Act of
1963
Federal money available to states for
planning, construction, staffing
Treated people in the community and
prevented hospitalization if possible
Formed multidisciplinary treatment teams

Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

10

DEVELOPMENTS IN 1970S
Psychiatric nurses pacesetters in
specialty nursing practice
Developed first standards and
statements on scope of practice
Established generalist and specialist
certification
Psychiatric concepts valued and
blended into nursing education as
psychosocial nursing
Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

11

 Exciting scientific growth with new focus

Brain-imaging techniques
Neurotransmitters and neuronal receptors
Psychobiology of emotions
Understanding the brain
Molecular genetics related to microbiology

DEVELOPMENT
S IN 1980S
Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

12

 Integrating expanding bases of

neurosciences into psychiatric
nursing education and practice
Understanding that knowledge of
the specialty is based on integration
of biological, psychological,
spiritual, social, and environmental
realms of the human experience
CHALLENGES
FACED IN
1980S
Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

13

PSYCHIATRIC NURSING DEFINED

A specialized area of nursing practice committed to promoting

mental health through the assessment, diagnosis, and treatment of
human responses to mental health problems and psychiatric
disorders.

[It] employs a purposeful use of self as its art and a wide range of
nursing, psychosocial, and neurobiological theories and research
evidence as its science.

American Nurses Association (ANA) Scope and Standards

of Psychiatric-Mental Health Nursing Practice (2007)

Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

14

CONTEMPORARY
PRACTICE:
NURSE-PATIENT
PARTNERSHIP
Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

15

CONTEMPORAR
Y PRACTICE:
DOMAINS OF
ACTIVITIES
Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

16

PSYCHIATRIC NURSING ACTIVITIES

Make culturally sensitive
biopsychosocial health assessments
Design and implement treatment plans
for patients and families with complex
health problems and co-morbid
conditions
Organize, access, negotiate, coordinate,
integrate services and benefits for
individuals, families
Provide health care map to guide them
to community resources
Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

17

 Promote and
maintain mental
health, managing
effects of mental
illness through
teaching,
counseling
Provide care for
patients with both
physical and
psychological
problems
Manage and
coordinate systems
of care, integrating
needs of patients,
families, staff,
regulators

PSYCHIATRIC
NURSING
ACTIVITIES

Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

18

LEVELS OF PERFORMANCE: LAWS

Nurse practice act in ones state

Also addresses advanced practice
roles and prescriptive authority

Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

19

LEVELS OF PERFORMANCE:
QUALIFICATIONS
Basic level: psychiatric-mental health
registered nurse cares for mental health
patients in various settings and roles
Advanced level: advanced practice RN psychiatric-mental health (APRN-PMH)
has masters degree or higher and
experience, knowledge of theory and
practice, competence in advanced skills

Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

20

Psychiatric facilities
Community mental health centers
Psychiatric units in general hospitals
Residential facilities
Home health care
Primary care is emerging focus of care
Clinics, schools, industry, HMOs,
prisons, managed care settings, home
health, nursing homes, emergency
departments

PRACTICE
SETTINGS

Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

21

 Support groups
Networking
Professional associations

PERSONAL
INITIATIVE
Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

22

 Psychiatric nurses to focus energy on:

Outcome evaluation
Leadership skills
Political action
Proactive strategies for advancing
mental health system that is fair,
sensitive, responsive to needs of
patients, families, communities

FUTURE
CHALLENGE
S

Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc.

23