EVOLUTION OF PSYCHIATRIC NURSING

PSYCHIATRIC MENTAL HEALTH NURSING

specialty within nursing: theories of and research on human behavior as science interpersonal process: purposeful use of self as its art promotes mental health assessment diagnosis treatment of human responses to mental health problems and psychiatric disorders

PSYCHIATRIC MENTAL HEALTH NURSING

Essential components health and wellness promotion through identification of mental health issues prevention of mental health problems care of mental health problems treatment of persons with psychiatric disorders

SIX STANDARDS OF PRACTICE (NURSING PROCESS)

Standard 1: Assessmentcollects comprehensive health data pertinent to the patients health or situation. Standard 2: Diagnosisanalyzes data to determine diagnoses or problems, including level of risk. Standard 3: Outcomes Identificationidentifies expected outcomes for a plan individualized to the patient or to the situation. Standard 4: Planningdevelops a plan that prescribed strategies and alternatives to attain expected outcomes.

SIX STANDARDS OF PRACTICE (NURSING PROCESS)

Standard 5: Implementationimplements the plan. Standard 5A: Coordination of Care Standard 5B: Health Teaching and Health Promotion Standard 5C: Milieu Therapy Standard 5D: Pharmacological, Biological, and Integrative Therapies Standard 5E: Prescriptive Authority and Treatment (APRN only) Standard 5F: Psychotherapy (APRN only) Standard 5G: Consultation (APRN only)

NINE STANDARDS OF PROFESSIONAL PERFORMANCE (PROFESSIONAL ROLE ACTIVITIES)

Standard 6: Evaluationevaluates progress toward attainment of expected outcomes. Standard 7: Quality of Practicesystematically enhances the quality and effectiveness of nursing practice. Standard 8: Educationattains knowledge and competency that reflect current nursing practice. Standard 9: Professional Practice Evaluation evaluates ones own practice in relation to the professional practice standards and guidelines, relevant statutes, rules, and regulations.

NINE STANDARDS OF PROFESSIONAL PERFORMANCE (PROFESSIONAL ROLE ACTIVITIES)

Standard 10: Collegialityinteracts with and contributes to the professional development of peers and colleagues. Standard 11: Collaborationcollaborates with patients, families, and others in the conduct of nursing practice. Standard 12: Ethicsintegrates ethical provisions in all areas of practice. Standard 13: Researchintegrates research findings into practice.

NINE STANDARDS OF PROFESSIONAL PERFORMANCE (PROFESSIONAL ROLE ACTIVITIES)

Standard 14: Resource Utilizationconsiders factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services. Standard 15: Leadershipprovides leadership in the professional practice setting and the profession.

LEVELS OF PSYCHIATRIC NURSING FUNCTIONS

Psychiatric Mental Health Nurse Basic Level of Practice RN with BSN degree Clientele: Individual, family, group, community Focus Health promotion, assess dysfunction, assist client to regain or improve coping, prevent further disability, intake screening, case management, milieu therapy, self-care activities, psychobiological interventions, health teachings, crisis intervention, counseling, home visiting, community action, advocacy

LEVELS OF PSYCHIATRIC NURSING FUNCTIONS

Psychiatric Mental Health Advanced Practice Registered Nurse Advanced Level of Practice/Sub-specialization RN with master or doctoral educational preparation Clientele: Age category/ Illness category Focus: mental health promotion, illness care, diagnosis and treatment of mental disorders, psychotherapy, psychobiologic interventions, prescriptive authority for drugs, clinical supervision/consultation, liaison nursing

PSYCHIATRIC NURSING: AN EVOLUTION

PSYCHIATRICMENTAL HEALTH NURSING IN THE 19TH CENTURY Kaiserwerth (1836): First school of nursing founded in Germany Florence Nightingale organized the Saint Thomas Hospital school stressed the importance of an optimum environment for clients Influence of nurses on clients goes beyond physical care and has psychologic and social components

PSYCHIATRIC NURSING: AN EVOLUTION

PSYCHIATRICMENTAL HEALTH NURSING IN THE 19TH CENTURY Early 1870s, the first three American nursing schools opened in New York, Boston, and New Haven Linda Richards (1873) First American psychiatric nurse Theory of care It stands to reason that the mentally sick should be at least as well cared for as the physically sick

PSYCHIATRIC NURSING: AN EVOLUTION

PSYCHIATRICMENTAL HEALTH NURSING IN THE 19TH CENTURY Linda Richards (1873) Contributions Developed better nursing care in psychiatric hospitals Organized nursing service and educational programs in state mental hospitals in Illinois Significant contribution: assessment of both the physical and emotional needs of the patient opened the first American school for psychiatric nurses at McLean Psychiatric Asylum in Waverly, Massachusetts in 1880

PSYCHIATRIC NURSING: AN EVOLUTION

PSYCHIATRICMENTAL HEALTH NURSING IN THE 19TH CENTURY McLean Hospital (1882) First school to prepare nurses to care for the mentally ill 2 year program: Physical nursing (1st yr); skills in mental care (2nd yr) Emphasis care was custodial meeting patient's physical needs: medication, nutrition, hygiene and ward activities

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES Johns Hopkins University (1913) First school of nursing to include a fully developed course of psychiatric nursing in the curriculum Nursing Mental Diseases (1920) First psychiatric nursing text not written by a psychiatrist written by Harriet Bailey

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES Late 1930s Psychiatric knowledge included in the general nursing care for all illnesses Emergence of various somatic therapies: MS skills for nurses required Training of student nurses how to assess behavior of patients who are mentally ill, so they may recognize early signs and symptoms instruction on the relationship between environmental conditions and mental disorders teaching them to be resourceful, versatile and adaptable while giving individualized care

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES In 1937, National League for Nursing Education (now the National League for Nursing) NLN begins to standardize and accredit psychiatric nursing education in single-focus psychiatric nursing schools

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES National Mental Health Act of 1946 Initiated development of psychotherapeutic roles for nurses Provided for the establishment of the National Institute for Mental Health (NIMH) Provided funding for development of programs to train professional psychiatric personnel, including psychiatric nurses Support for psychiatric research, and assistance in developing mental health programs

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES Helen Render (1947) Author: Nurse Patient Relationship in Psychiatry N-P partnership Scope: clinical competence; patient-family advocacy; fiscal responsibility; interdisciplinary collaboration; social accountability; legal-ethical parameters

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES 1947
Start of graduate programs in psychiatric nursing Attitude therapy Published in American Journal of Nursing by Weiss Use of attitude patients recovery Implementation: observation; acceptance; respect; understanding, promote interest; participate in reality

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES Bennett and Eaton
Identified problems affecting psychiatric nurses Scarcity Under use of abilities Very little psychiatric nursing carried out in otherwise good psychiatric hospitals and units Supported nurses participation in individual and group therapy Nursing Therapy: activities done by Mellow with schizophrenic patients

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES Hildegard Peplau (1952)
Mother of Psychiatric Nursing published Interpersonal Relations in Nursing first systematic theoretic framework in psychiatric nursing delineated skills, activities, and roles and emphasized the interpersonal nature of nursing and the need for nurses to use psychodynamic concepts and counseling techniques.

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES Gwen Tudor (Will)
nurses can promote emotional growth in clients Published in the journal of Psychiatry: study describing the N-P relationship
Characteristics: unconditional care; few demands; anticipation of patients needs

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES Frances Sleeper
psychiatric nurses as psychotherapists

1950s Significant Developments in Psychiatric Nursing

Therapeutic Community: A New Treatment Method in Psychiatry (1953): use of patients social environment Use of Psychotropic Drugs Made patients treatable and fewer physical constraints More personnel provide therapy Expanded roles of various psychiatric practitioners

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES

NURSING CONCERNS (1958)

Dealing with patients problems of attitude, mood and interpretation of reality Exploration of disturbing and conflicting thoughts and feelings Using the patients positive feelings towards the therapist to bring about psychophysiological homeostasis Counseling patients in emergencies, including panic and fear Strengthening the well part of the patient

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES

Psychiatric Nursing Focus (1960s)

Primary Prevention; Implementation of Care; Consultation in the Community Interdisciplinary approach to alleviate illness and promote mental health Psychiatric nursing psychiatric and mental health nursing

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES

Interpersonal Techniques: The Crux of Psychiatric Nursing (1962)

Published by Peplau Differentiated between general practitioner and psychiatric nurses

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES

Community Mental Health Centers Act of 1963

closing of large mental hospitals in favor of treatment in the community trend toward more expanded and specialized roles in psychiatricmental health nursing. Clinical nurse specialists, prepared at the graduate level, Provided individual, group, and
family psychotherapy and obtained third party reimbursement.

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES Nurses began publishing psychiatric nursing journals and textbooks advocating the counseling role as the basis of psychiatric nursing: Perspectives in Psychiatric Care (1963) Journal of Psychiatric Nursing and Mental Health Services (in 1981 changed its name to Journal of Psychosocial Nursing and Mental Health Services) American Journal of Nursing Issues in Mental Health Nursing (1979) Archives of Psychiatric Nursing (1987) Journal of the American Psychiatric Nurses Association (1990s)

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES

ANA position paper (1967)

endorsed clinical nurse specialists in the role of therapist in individual, group, family, and milieu work. By the mid-1970s, certification at both the generalist and specialist levels became the responsibility of ANA.

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES

SPECIALTY NURSING PRACTICE (1970s)

Psychiatric nurses became pacesetters Developed standards and statements on scope of nursing practice Established generalist and specialist certification Caring as core element as defined by nursing profession Psychiatric and mental health nursing Psychosocial nursing Clinical rotations integrate psychosocial aspect of physically ill patients in general medical surgical

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES PSYCHIATRIC-MENTAL HEALTH NURSING PRACTICE by ANA in 1973 first standards to serve as guidelines for providing quality care. Now revised several times, delineate psychiatricmental health nursing roles and functions

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES
Martha Mitchell First nurse to play a major role in national mental health policy
1977 Commission on Mental Health.

Major shift in psychiatric nursing thinking (humanistic interactionism) advocating negotiated goals between nurse and client client advocacy political sensitivity caring, and compassion

PSYCHIATRIC NURSING: AN EVOLUTION

EVENTS OF 19001940: MULTIFACETED ROLE OF NURSES 1980s Major concerns decrease in the number of nurses selecting psychiatric nursing as a specialty shortage of clinical training funding Scientific growth in psychobiology: nurses slow to shift from psychodynamic models to psychobiologic Psychiatric nursing diagnoses (1984) developed and incorporated into NANDA classification system

PSYCHIATRIC NURSING: AN EVOLUTION

1990s DECADE OF THE BRAIN Challenge: integrate neuroscience into the holistic biopsychosocial practice of psychiatric nursing Psychopharmacology guidelines Health care reform Nursing roles in mental health care delivery Mental health promotion and mental illness prevention Case management Holistic perspective Equitable access

PSYCHIATRIC NURSING: AN EVOLUTION

1990s DECADE OF THE BRAIN

Development of out-patient services including private practice for nurses Outcome-based research Accurate image of psychiatric nursing Emphasis of the human aspect of mental health work Cultural diversity among psychiatric nurses Integration of philosophic and theoretical perspectives into practice and research

PSYCHIATRIC NURSING: AN EVOLUTION

THE NEW MILLENNIUM (2000S) Revisions of the standards of practice of psychiatric mental health nurses (ANA, APNA, ISPN) knowledge explosion in psychobiology: biologic foundations of behavior, genetics, psychopharmacologic agents with fewer side effects renewed focus on the physical health problems of psychiatric clients especially those living in the community

PSYCHIATRIC NURSING: AN EVOLUTION

THE NEW MILLENNIUM (2000S) shift to primary care as a point of entry for psychiatric care curriculum shift in graduate programs toward comprehensive health assessment, management of common physical health problems, and prescriptive authority for advanced practice nurses Settings: hospitals and traditional settings to alternative and nontraditional settings

FOUNDATIONS (THEORIES) IN PSYCHIATRIC NURSING

THEORIES
organize data identify problems plan interventions generate goals and nursing actions determine and evaluate outcomes

FOUNDATIONS (THEORIES) IN PSYCHIATRIC NURSING Hildegard E. Peplau was

Hildegard Peplau
the mother of psychiatric nursing, conceptualized the one-to-one nurse client relationship with 4 phases: orientation, identification, exploitation or working, and resolution.

the first published nursing theorist since Florence Nightingale and created the middle-range nursing theory of interpersonal relations, which helped to revolutionize the scholarly work of nurses. Wikipedia

FOUNDATIONS (THEORIES) IN PSYCHIATRIC NURSING

Dorothea Orem
universal self-care requisites: physical and psychosocial human needs clients abilities to perform self-care to maintain life, health, and wellbeing.

Dorothea Elizabeth Orem, born in Baltimore, Maryland, was a nursing theorist and creator of the self-care deficit nursing theory, also known as the Orem model of nursing.Wikipedia

FOUNDATIONS (THEORIES) IN PSYCHIATRIC NURSING

Martha Rogers
defined nursing as a holistic science of unitary human beings Central to nursing
identified principles of homeodynamics the notions of life processes change human-environmental interactions

Martha Elizabeth Rogers was an American nurse, researcher, theorist, and author. Rogers is best known for developing the Science of Unitary Human Beings and for her landmark book, An Introduction to the Theoretical Basis of Nursing. Wikipedia

FOUNDATIONS (THEORIES) IN PSYCHIATRIC NURSING

Sister Callista Roy

adaptation theory: people as psychosocial beings, constantly faced with the need to adapt to internal and external demands.

Sister Callista Roy (born October 14, 1939) is an American nursing theorist, professor and author. She is known for creating the adaptation model of nursing. Roy was designated as a 2007 Living Legend by the American Academy of Nursing

FOUNDATIONS (THEORIES) IN PSYCHIATRIC NURSING

Ernestine Wiedenbach developed theory around the clients need for help validation: client perceptions, and the nurses role in observing, assessing, exploring, and validating feelings, thought, and fears. Ida Jean Orlando deliberative nursing action: meanings, validated between the nurse and the client

FOUNDATIONS (THEORIES) IN PSYCHIATRIC NURSING

Joyce Travelbee
meaning in nurseclient interactions explained sympathy, rapport, and suffering, emphasized communication and stages of the nurseclient relationship.

Paterson, Josephine and Zderad, Loretta

observations: basis of nursing theory incorporated an intersubjective transaction: client and nurse are present in the experience in an existential way emphasized freedom of human choice and responsibility
Josephine Paterson Loretta Zderad

FOUNDATIONS (THEORIES) IN PSYCHIATRIC NURSING

Jean Watson human caring: helpingtrusting relationship, incorporates the values of kindness, concern, love of self and others, and the ecology of the earth emphasized sensitivity to self, values clarification, congruency, empathy, authenticity and genuineness, and the clients expression of emotions.

Jean Watson is an American nurse theorist and nursing professor who is best known for her Theory of Human Caring. She is the author of numerous texts, including Nursing: The Philosophy and Science of Caring.Wikipedia

FOUNDATIONS (THEORIES) IN PSYCHIATRIC NURSING

Patricia Benner
added to nursings understanding of caring: observed and interviewed nurses engaged in clinical practice in order to disclose the nature of clinical wisdom along with caring and comforting practices

introduced the concept that expert nurses develop skills and understanding of patient care over time through a sound educational base as well as a multitude of experiences (From Novice to Expert)

THREE PRIMARY DOMAINS OF PSYCHIATRIC NURSING CARE

DIRECT CARE COMMUNICATION MANAGEMENT OVERLAPPING FUNCTIONS TEACHING COORDINATING DELEGATING COLLABORATING

PSYCHIATRIC NURSING
INTERPERSONAL PROCESS: Communication, Caring GOAL Dealing with emotional responses to stress and crisis Learning effective ways of behaving Developing a healthful lifestyle Achieving a realistic and positive self concept RESPONSIBILITIES Therapeutic Relationship Therapeutic Environment

PSYCHIATRIC NURSING
USE NURSING PROCESS Assessment Diagnosis Planning Implementation Evaluation ROLES
Counselor Teacher Patients advocate Leader, Coordinator, Manager Mother Creator of a therapeutic environment Technician