What is Psychiatric nursing

• Interpersonal process that promotes and maintains behavior that contributes to integrated
functioning
• Specialized area of nursing that practices employing theories of human behavior and purposeful
use of self for its therapeutic effects.
• 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.
• 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.

History

• 1882 First training school for psychiatric nursing at McLean Asylum by E. Cowles; first
nursing program to admit men.
• 1913 First nurse-organized program of study for psychiatric training by Euphemia (Effie) Jane
Taylor at Johns Hopkins
• Phipps Clinic.
• 1914 Mary Adelaide Nutting emphasized nursing role development.
• 1920 First psychiatric nursing text published, Nursing Mental Disease, by Harriet Bailey.
• 1950 Accredited schools required to offer a psychiatric nursing experience.
• 1952 Publication of Hildegarde E. Peplau’s Interpersonal Relations in Nursing.
• 1954 First graduate program in psychiatric nursing established at Rutgers University by
Hildegarde E. Peplau.
• 1963 Perspectives in Psychiatric Care and Journal of Psychiatric Nursing published.

• 1967 Standards of Psychiatric–Mental Health Nursing Practice published. American Nurses

Association (ANA) initiated the
• certification of generalists in psychiatric mental health nursing.
• 1979 Issues in Mental Health Nursing published. ANA initiated the certification of specialists
in psychiatric mental
• health nursing.
• 1980 Nursing: A Social Policy Statement published by the ANA.
• 1982 Revised Standards of Psychiatric and Mental Health Nursing Practice issued by the
ANA.
• 1985 Standards of Child and Adolescent Psychiatric and Mental Health Nursing Practice
published by the ANA.
• 1987 Archives of Psychiatric Nursing and Journal of Child and Adolescent Psychiatric and
Mental Health Nursing published.
• 1994 Statement on Psychiatric–Mental Health Clinical Nursing Practice and Standards of
Psychiatric–Mental Health Clinical
• Nursing Practice.
• 1996 Guidelines specifying course content and competencies published by Society for
Education and Research in
• Psychiatric–Mental Health Nursing (SERPN).
• 2000 Scope and Standards of Psychiatric–Mental Health Nursing Practice
 Mental health is a term used to describe either a level of cognitive or emotional wellbeing or an
absence of mental illness. From perspectives of the discipline of positive psychology or holism
mental health may include an individual's ability to enjoy life, procure a balance between life
activities, and efforts to achieve psychological resilience.

Mental wellness is generally viewed as a positive attribute, such that a person can reach enhanced
levels of mental health, even if they do not have any diagnosable mental health condition.

Characteristics of a Mentally Well Person

1. A mentally healthy person is free from internal conflicts. He is not at war with himself.
2. He is well adjusted. He is able to get along well with others. He is able to form effective
relationships. He is able to accept criticisms and is not upset easily.
3. He searches for an identity.
4. He has a strong sense of self-esteem.
5. He knows himself, his needs, problems and goals (self-actualization).
6. He has good control over his behavior.
7. He is productive.
8. He faces problems and tries to solve them intelligently.

Characteristics of Mental Illness

1. When a person’s behavior is causing distress and suffering to the individual and/or others
around him
2. Abnormal changes in one’s thinking, feeling, memory, perceptions and judgment, resulting in
changes in talk and behavior.
3. Abnormal behavior causes disturbance in the person’s day-to-day activities, job and
interpersonal relationships.

NEUROSIS
1. When a person’s behavior is
causing distress and suffering to the
individual and/or others around him
2. Abnormal changes in one’s
thinking, feeling, memory, perceptions
and judgment, resulting in changes in
talk and behavior.
3. Abnormal behavior causes
disturbance in the person’s day-to-day
activities, job and interpersonal
relationships.
PSYCHOSIS
1. Denies that there is something
wrong with him
2. Loses contact with reality
3. Personality is often disorganized
and deteriorates.
4. Cannot act normally in society and
may harm self and others.
5. Often requires hospitalization

Diagnostic and Statistical manual of Mental Disorders (Multi-axial Diagnosis)

• Axis 1&2- clinical syndromes (e.g. bipolar, antisocial personality, mental disorders)
• Axis 3-physical disorders and symptoms
• Axis 4- psychosocial and environmental problems: acute and long term severuuty of stressors
 • Axis 5- GAF

PREVENTION OF MENTAL ILLNESS

• Primary prevention seeks to reduce the incidence( rate of occurrence of new cases) of mental
disorders within a population over time. For example,primary prevention interventions targeted
at suicide focus on preventing the development of suicidal tendencies in individuals. These
interventions include restricting access to suicide methods(gun control), establishing
community-based services, and educating the public and health care professionals.

PRIMARY PREVENTION- involves the promotion of general mental health and protection
against the occurrence of specific diseases. Primary prevention aims to prevent the onset of a
disease or a disorder, thereby reducing the incidence (number of of new cases occurring in a
specific period in time).
 Elimination of etiological agents
 Reducing risk factors
 Enhancing host resistance or interfering with disease transmission
 Reducing stress factors
 Counseling
 Student’s counseling
 Marriage counseling
 Sex counseling
 Genetic counseling
 Special centers
 Child guidance centers
 Crisis intervention center
 Geriatric center
 Mental health education

• Secondary prevention seeks to lower prevalence (rate of new and old cases at a point in time).
Secondary prevention interventions include hotlines and short-term hospitalizations targeted for
those on the verge of suicide.
SECONDARY PREVENTION- early identification and effective treatment of an illness or
disorder, with the goal of reducing the prevalence (total number of existing cases in a year) is
the aim of secondary prevention.
 Population screening
 Crisis intervention services
 Mental health education

• Tertiary prevention seeks to lower the rate of residual disability, for example by reducing
occupational and role dysfunctioning (Caplan, 1993).

TERTIARY PREVENTION-aims to reduce the prevalence of residual defect or disability

due to illness or disorder. It involves rehabilitation after defect and disability have
been fixed. Community reintegration is also part of tertiary prevention.
Filipino Psychopathology
• Filipino Psychopathology, or sikopatolohiya in Filipino, from Spanish psicopatologia, is the
study of Abnormal Psychology in the Filipino context. As such, there are several 'mental'
disorders that can be found only in the Philippines, or in other nations which Filipinos share
racial connections. Examples of such are:
• Amok: Malayan mood disorder, more aptly called 'Austronesian Mood Disorder', in which a
person suddenly loses control of himself and goes into a killing frenzy, after which he/she is
going to hallucinate and falls into a trance. After he/she wakes up, he has absolutely no
memory of the event.

• Bangungot: A relatively common occurrence in which a person suddenly loses control of his
respiration and digestion, and falls into a coma and ultimately to death. The person is believed
to dream of falling into a deep abyss at the onset of his death. This syndrome has been
repeatedly linked to Thailand's Brugada syndrome and to the ingestion of rice. However, no
such medical ties have been noted.

THE PHILIPPINE MENTL HEALTH SITUATION

• The first known organized care for the mentally ill was established in the late 19th century at
the Hospicio de San Jose, for sailors of the Spanish naval fleet.

• The arrival of the Americans in the 1900s gradually transformed the treatment of mental illness
from the use of traditional indigenous medicines to a more scientific approach.

• Two American physicians opened a clinic for mental disorders, using somatic treatments, such
as fever therapy, insulin shock therapy, Lock’s sol, barbituratesand electro-convulsive
treatment.

• By 1904 the first ‘Insane Department’ was opened in a government hospital, and by 1918 the
City sanitarium was built. In 1928 the mentally ill were transferred to the National
Psychopathic Hospital in Mandaluyong, where it remains to this day, asthe National Center for
Mental Health.
• The first real effort to comprehensively address the growing mental health problems in the
country, including the need to reform the mental health care delivery system, happened in
1986. This was in line with the general demand for reforms following the change in
government as a result of the ‘People Power’ Revolution and the overthrow of the dictatorship
• In April 2001, the Secretary of Health signed the National Mental Health Policy, which is now
known as Administrative Order No.5, Series 2001.

WORLD STATISTICS
In 2000, suicide ranked as the thirteenth leading cause of death, accounting for 815 000 deaths or 1.5%
of all deaths worldwide. Just over a quarter of these deaths occurred in young adult males (i.e. those
aged 15-44 years) (WHO, 2002). In terms of ill-health and disability, the impact of poor mental health
is even greater: according to recent WHO estimates, nearly one-third of all years lived with disability
(YLDs) worldwide can be attributed to neuropsychiatric conditions (i.e. mental disorders and
neurological disorders combined) (WHO, 2001b).

STATISTICS
Study data regarding the prevalence of mental illness in the Philippines

Lubao study (1970s)

• 10.8%–17.2% of adults and 18.6%–29% of children
consulting a health center were found to have psychiatric problems
• 75% of mental illnesses presenting at health centers were
not recognized by the health workers

Sapang palay study

• Results showed a prevalence of mental illness in
12 per 1000 people (the internationally recognized rate is 1/1000)

As part of the WHO seven-nation collaborative study, the Philippine study conducted in three primary
health centers situated in an urban slum in Manila, showed that 17% of adults and 16% of children had
mental disorders.

Findings of a study performed in 1989 by the University of the Philippines’ Department of Psychiatry,
conducted in a rural area 45km from Manila where 34% of those with mental disorders had social
problems.

A study in 1988–1989 in a barrio in San Jose Del Monte Bulacan, showed the prevalence of adult
schizophrenia to be 12 cases per 1000 persons.

In 1993–1994, a population survey for mental disorders was conducted by the University of the
Philippines Psychiatrists Foundation Inc, in collaboration with the Regional Health Office. The study
areas covered both urban and rural settings in three provinces (Region VI). The prevalence of mental
disorders was 35%. The three most frequent diagnoses among the adults were: psychosis (4.3%),
anxiety (14.3%) and panic (5.6%). For children and adolescents, the top five most prevalent psychiatric
conditions were: enuresis (9.3%), speech and language disorder (3.9%), mental sub-normality (3.7%),
adaptation reaction (2.4%) and neurotic disorder (1.1%).

Therapeutic Nursing Process

• G oal directed
• U nderstanding and empathic
• C oncreteness
• H onest, open communication
• A cceptance; non judgmental attitude

Pre-orientation Phase
• Charts
• SELF AWARENESS
 Sense of an ongoing attention to one’s internal states
  Accdg to Freud, “evenly hovering awareness” (takes in whatever passes through
awareness with impartiality, as an interested yet unreactive witness)
 Not an attention that gets carried away by emotions, overreacting and amplifying what
is perceived.
 Neutral mode that maintains self reflectiveness even amidst turbulent emotions

Orientation Phase
• T rust and rapport
• E nvironment (Therapeutic)
• A ssess client’s strengths and weaknessess
• C ontract (therapeutic)
• H elp Communicate

Working Phase
• P romote positive self concept
• R ealistic goal setting
• O rganize support system
• V erbalize feelings (encourage)
• I mplement action plan
• D evelop positive coping behaviors
• E valuate the results of plan of action

Terminating Phase
• P romote self care
• R ecognize increasing anxiety
• I ncrease independence
• D emonstrate emotional stability
• E nvironmental support

ASSESMENT
• Assessment data:
• Subjective data
– Client’s current problem and reason for seeking help
– Past mental illnesses and treatment
– Family history of mental illness
– Medical history
– Allergies to medications, foods and other substances
– Past and present medications and their effects
– Social history including relationships with family, friends, co-workers, neighbors,
authority figures
– Past and present abuse
– Substance abuse history
– Educational and/or vocational history
– Health habits
– Safety issues
– Cultural beliefs and practices
–
 • Objective data
– Behavior
– Communication
– Physical Assessment
– Laboratory/testing data
– Mental Status
– Formalized assessment instruments
– Reports from other sources

Mental Status Exam

• Appearance- hygiene, grooming, appropriateness of clothing, posture, gestures

• Behavior- eye contact, motor behavior, body language, behavioral responses to others and the
environment, volume and speed of speech, tone of voice, flow of words
• Affect and mood- happy, sad, anxious, sullen, hostile, inappropriate for situation, silly, range of
emotions
• Orientation- 3 spheres, situation, relationship with others
• Memory- immediate recall, recent and remote
• Sensorium/attention- ability to concentrate on a task or conversation, perception of stimuli
• Intellectual functioning- general fund of knowledge about the world, cognitive abilities such as
simple arithmetic , ability to think abstractly or symbolically
• Judgment- decision making ability, esp. re: delay of gratification
• Insight- awareness of one’s responsibility for and analysis of current problem, understanding of
how the client arrived in the current situation
• Thought content- recurrent topics of conversation, themes
• Thought process- processing of events in the situation, awareness of one’s thoughts, logic of
thought
• Perception- awareness of reality versus fantasy

Communications Essential Conditions

1. Rapport
2. Trust
3. Respect
4. Empathy
5. Genuineness

CRISIS
Refers to the state of the reacting individual who finds himself in a hazardous situation in
which the habitual problem solving activities are not adequate and do not lead to rapidly to the
previously achieved balance state.
Self limiting within 4-6 weeks

Types
• Maturational or Developmental Crisis
– Associated with expected normal and predictable growth and development requiring
role changes in these transitional periods
• Situational Crisis
– Unexpected crisis that originates from environmental, personal, physical or
psychosocial sources
Stages
• Pre-Crisis Phase

– State of equilibrium
• Impact Phase

– High level of stress and possible panic

• Crisis Phase

– Ineffective and disorganized behavior, avoids or withdraw or deny the problem

• Resolution Phase

– Acknowledge and attempts to solve problem successfully leading to less anxiety

• Post Crisis Phase

– Achieve higher level of maturity and new coping skills.

CRISIS INTERVENTION
• Active but temporary entry into the life situation during crisis

Goals
• P rotect client from additional stress and other harm
• A ssist clients in organizing mobilizing resources or support system
• R eturn to pre-crisis state or higher level of functioning
• E liminate emotional stress

CONCEPT OF LOSS

GRIEF
-is the process of coping with a loss.

Kubler-Ross’ Stages of Death and Dying

· Denial and isolation “No! Not me! I’m Healthy”
· Anger “Why me?!”
· Bargaining “Yes me, but…”
· Depression “Yes me! I want to be alone”
· Acceptance “My time has come”

Engel’s model of Grief

 Shock and disbelief
 Developing awareness
 Restitution and resolution of the loss
 Idealization
 Outcome