Vous êtes sur la page 1sur 63

Psychiatric-Mental Health

Nursing
Rubilyn A. Bulquerin-Sumaylo, RN, MSN
UNIT I. FOUNDATIONS OF
PSYCHIATRIC-MENTAL HEALTH
NURSING


Entering Psychiatric Nursing


How will I handle
bizarre or
inappropriate
behavior?
Am I prying
when I ask
personal
questions?
What will I
be doing?
Is my physical
safety in
jeopardy?
What happens if a client
asks me for a date or
displays sexually
aggressive or
inappropriate behavior?
What if I say
something
wrong?
What if no
one will talk
to me?
What if I
encounter
someone I know
being treated on
the unit?
Difference Between Psychiatric
and Medical-Surgical Nursing
Physical efforts
prove to students that
they are working and
accomplishing
something. In
psychiatric nursing one
has to be
psychologically active,
but physically passive
much of the time.
It takes some time to
realize that LISTENING
to what aches in the hearts
of patients may touch
them more profoundly
than back rub.
DEFINITION OF HEALTH
a state of complete physical, mental

and social well-being

without the absence of disease or

infirmity



WORLD HEALTH ORGANIZATION
DEFINITION OF MENTAL HEALTH
the successful performance of mental function,
resulting in productive activities, fulfilling
relationships, and the ability to adapt to
change and cope with adversity


DEFINITION OF MENTAL HEALTH

I probably
have the
most
sanest
mind..hehe
A state of emotional,
psychological, and social
wellness evidenced by
satisfying interpersonal
relationships, effective
behaviour, and coping,
positive self-concept, and
emotional stability.
ELEMENTS OF MENTAL HEALTH
Self-governance
Progress toward growth or self-realization
Tolerance of uncertainty
Self-esteem
Reality orientation
Mastery of environment
Stress management
INFLUENCES ON MENTAL HEALTH






Biological factors
Biologic makeup
Sense of harmony in life
Emotional resilience/hardiness
Spirituality
Positive identity
Social and Cultural factors
Sense of community
Access to adequate resources
Intolerance of violence
Support of diversity among people
Interpersonal factors
Effective
communication
Ability to help
others
Intimacy
Balance of
separateness and
connection

DEFINITION OF MENTAL ILLNESS
a clinically significant behavioral or

psychological syndrome experienced by a

person, marked by distress, disability, or the

risk of suffering, disability, or loss of

freedom

(American Psychiatric Association)
PSYCHOPATHOLOGY
Psychopathology examines the nature
and development of abnormal
Behavior, Thoughts, Feelings
Definitions of abnormality vary widely
and may not capture all aspects of
psychopathology
Psychopathological aspect (causes,
mechanisms)
Clinical aspect (assessment, treatment)
Ch 1.1
Early Views of Psychopathology
Demonology (Supernaturalism) is the
view that abnormal mental function is
due the occupation by an evil being of
the mind of a person
Treatment requires exorcism
Somatogenesis is the view that
disturbed body function produces
mental abnormality
Psychogenesis is the belief that mental
disturbance has psychological origins
Demonology During the Dark Ages
The Dark ages were marked by a decline
in Greek and Roman civilizations and by
an increase of influence of churches
Church authorities came to view witchcraft
as an explanation of abnormality
Witches were in the league with the Devil
Torture was required to elicit confessions of
witchcraft; death by fire was required to drive
out supposed demons
Ch 1.5
Asylums
Asylums were created in the 15th century for
the care/treatment of the mentally ill.
Asylums were meant to be a place of refuge
Care and treatment within an asylum was not always
humane or effective

Pinel (1793) advocated for humane treatment of
patients in asylums (moral treatment)
Removed shackles, improved diet, better treatment
Ch 1.6
Modern Approaches to Mental Illness
Systems of classification were developed
which argued that mental illness has a
biological cause
Kraepelin suggested that clusters of
symptoms form a syndrome
Each syndrome has its own unique cause,
course, symptoms, treatment, and outcome
Ch 1.7
TREPHINATION
TRANQUILIZER CHAIR
O'HALLORAN'S SWING
HYDROTHERAPY
LUNATIC BOX
HOLLOW WHEEL
RESTRAINT CAGE
Benjamin Rush Clifford Beers
Sigmund Freud
Emil Kraepelin
Hildegard Peplau
THERAPEUTIC COMMUNICATION
One-Dimensional Models
ONE CAUSE DISORDER
Multidimensional Models
MANY CAUSES
Biological
Influences
Behavioral
Influences
Social
Influences
Cognitive & Emotional
Influences
PROBLEMS IN TREATING
MENTAL ILLNESS
Cost-related issues
Stigma
Revolving door
treatment
Lack of parity
Limited access to
services
METHODS OF ACHIEVING OPTIMAL
CARE FOR MENTAL ILLNESS
Beyond response to
recovery
Reintegration into
society
Mental health parity
Culturally competent
care
Medication
adherence
PSYCHIATRIC-MENTAL
HEALTH NURSING

the diagnosis and
treatment of
human
responses to actual or
potential mental
health problems

(ANA, APNA, &
ISPN, 2000)
Psychiatric-Mental Health Nursing
Nursing Process and Standards of Care

Levels of Practice

Guiding Principles

Role of the Psychiatric Nurse as a Team
Member
PERSONAL PHILOSOPHY ISSUES
Self-Awareness
The NURSE gains
recognition of his/her
own feelings, beliefs,
and attitudes.



Awareness of
Environment
Includes recognition of
client needs, belief
systems, and behaviors;
identification of the
factors that contribute
to health and illness in
the client; and
assessment of
resources available to
the client.
Awareness Of Interactions With The
Environment
NURSES identify their:
> specific feelings and thoughts about clients
(including feelings of acceptance or rejection)
> evaluate the consequences of their actions
toward clients
> learn to effectively differentiate between their own
needs and client needs.
An interpersonal process
Employing theories of human behavior
as its science and purposeful use of self as its
art.
The major therapeutic goal is the
prevention, detection, and rehabilitation of
psychiatric disorders.

Emphasis on the interpersonal process
and relationships
Most fundamental goals : To help the
patient accept himself, to improve his
relationship with other people and to
learn to function independently on a
realistic basis.
Psychiatric Nursing Paradigm
Human behavior




Communication
skill
Process Nursing
Therapeutic
Use of self
Other Terms Used
For Psychiatric
Nursing:

Psychosocial
Nursing

Institutional Nursing

Mental Health
Nursing
Self as a Therapeutic
Tool
Nurse uses herself
in order to affect
positive changes
in the patients
behavior.
Principles and Perspectives of the
Psychiatric-Mental Health Nurse
Principles of Psychiatric Nursing
View the client as a holistic being
Focus on the clients strengths and assets, not on
his weakness and liabilities
Accept the client as a human being who has value
and worth
View the clients behavior as designed to meet a
need or to communicate a message
Potential for establishing relationship with clients
Quality of the interaction
View the clients behavior as the best possible
adaptation


N U R S I N G R O L E S



Ward Manager Social Agent Counselor




Teacher Mother Surrogate Technical Role
Essential Qualities of the Psychiatric-
Mental Health Nurse
Therapeutic Use of Self
Genuineness and Warmth
Empathy
Acceptance
Maturity and Self-Awareness

The Mental Health Team
Nurse
Social Worker
Clinical Psychologist
Psychiatrist
Physician
Occupational Therapist
Recreational Therapist
Psychiatric Aide/Clinical Assistant

MULTI-AXIAL SYSTEM OF DIAGNOSIS
AXIS I: Clinical Disorders
AXIS II: Personality Disorders and
Mental Retardation
AXIS III: General Medical Conditions
AXIS IV: Psychosocial and
Environmental Problems
AXIS V: Global Assessment of Functioning
(GAF); 0-100
(APA, 2000)
THE PSYCHIATRIC
HOTLINE

Hello! Welcome to
the Psychiatric
Hotline..
If you are OBSESSIVE-COMPULSIVE,
please press 1 repeatedly.

If you are CO-DEPENDENT, ask someone to
press 2 for you.

If you have MULTIPLE PERSONALITIES,
please press 3, 4, 5, and 6.

If you are DELUSIONAL, press 7 and your
call will be transferred to the mother ship.



If you are PARANOID-DELUSIONAL, we
know who you are and what you want.
Please stay on the line until we can trace
the call.

If you are DYSLEXIC, press 9696969696969

If you have ADD, wander away from the
phone and start another desk.

If you suffer from GENERALIZED ANXIETY
DISORDER, please fidget with the pound
key until a representative comes on the
line.
If you suffer from SOCIAL PHOBIA, please
hang up and go to a party.

If you have AMNESIA, press 8 and state your
name, address, telephone, and mothers
maiden name.

If you have POST-TRAUMATIC STRESS
DISORDER, s-l-o-w-l-y & c-a-r-e-f-u-l-l-y
press 0 0 0.
If you are SCHIZOPHRENIC, please listen
carefully until the voices tell you which
number to press.

If you are BORDERLINE, it doesnt matter
which number you press no one will
answer.

If you are MANIC-DEPRESSIVE, please
press 7 as fast as you can for the next 24
hours, and then crash for the following 24
hours.
If you have BIPOLAR AFFECTIVE
DISORDER, please leave a message after
the beep and before the beep and after the
beep.

If you have LOW-SELF ESTEEM, please
hang up. All operators are busy to talk to
you.
If you have SHORT-TERM MEMORY LOSS,
press 9.

If you have SHORT-TERM MEMORY LOSS,
press 9.

If you have SHORT-TERM MEMORY LOSS,
press 9.

If you have SHORT-TERM MEMORY LOSS,
press 9.



Thank you for
calling
The Psychiatric
Hotline
SELF-AWARENESS
ISSUES
ASSIGNMENT: For Critical
Thinking Activity
In which setting are you most
comfortable discussing your
feelings, in a one-to-one situation
or in a group (or in a SMS way)?
How might you learn to become
comfortable in the other setting?
ASSIGNMENT: Independent Study
Research mental healthcare in
the 17
th
, 18
th
, and early 19
th

centuries, creating a timeline
of events.
FAMOUS
PERSONALITIES
SIGNIFICANT
EVENTS
YEAR/ERA
Recommended Table
ASSIGNMENT: Group Work
Interview different population
groups on their concepts of
mental health and mental
illness and gather data on
social conditions that affect
mental health.
END OF LESSON ONE
Thank you for listening!!!