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Foundations of

Psychiatric Mental
Health Nursing
Jeselo Ouano Gorme, RN

Mental Health

Is a state of emotional, psychological, and social wellness

evidenced by satisfying interpersonal relationships, effective
behavior and coping, positive self-concept, and emotional

Factors influencing mental health

Individual / Personal Factors

Persons biologic make-up

Autonomy and independence


Capacity for growth


Ability to find meaning in life

Emotional resilience or hardiness

Sense of belonging

Reality orientation

Coping or stress management abilities

Factors influencing mental health

Interpersonal / Relationship Factors

Effective communication

Ability to help others


Balance of separateness and connectedness

Social / Cultural / Environmental

Sense of community

Access to adequate resources

Intolerance of violence

Support of diversity among people

Mastery of the environment

Positive, yet realistic view of ones world

Mental Illness

clinically significant behavioral or

psychological syndrome or pettern that occurs
in an individual and is associated with present
distress (e.g. painful symptom) or disability
(e.g. impairment in one or more areas of
functioning) or with a significantly increased
risk of suffering death, pain, diability, or an
important loss of freedom.
~ American Psychiatric Association (APA)

Criteria to diagnose mental


Dissatisfaction with ones characteristics, abilities and


Ineffective or unsatisfying relationships

Dissatisfaction in ones place in the world

Ineffective coping with life events

Lack of personal growth

Diagnostic and Statistical Manual of Mental

Disorders, 4th edition, Text Revision (DSM-IVTR)

It is a taxonomy published by the APA.

It describes all mental disorders, outlining specific diagnostic

criteria for each based on clinical experience and research.

Used by all mental health clinicians who diagnose psychiatric



To provide a standardized nomenclature and language for all mental

health professionals

To present defining characteristics or symptoms that differentiate

specific diagnosis

To assist in identifying the underlying causes of disorders

Historical Perspectives of the

Treatment of Mental Illness

Ancient times

People of ancient times believed that any sickness indicated

displeasure of the gods and in fact was punishment for sins or

Aristotle (382-322 BC) attempted to relate mental disorders to

physical disorders and developed his theory that the amounts of
blood, water, yellow and black bile in the body controlled the

Imbalances in these four substances, or humors, were believed to

cause mental disorders and treatments in restoring balance
include bloodletting, starving, and purging.

In early Christian times, priests performed exorcisms to rid evil

spirits. When that failed, they used more severe and brutal
measures such as incarceration in dungeons, flogging, and

The Hospital of St. Mary of Bethlehem in 1547 was officially

declared a hospital for the insane.

By 1775, visitors at the institutions were charged a fee for the

privilege of viewing and ridiculing the inmates, who were seen as
animals less than humans.

Philippe Pinel in France and William Tukes in England formulated

the concept of asylum as a safe refuge or haven offering
protection at institutions where people had been whipped,
beaten, and starved just because they were mentally ill.

In US, Dorothea Dix began a crusade to reform the treatment of

mental illness and was instrumental in opening 32 state hospitals
that offered asylum for the suffering.

The period of scientific study and treatment of mental disorders

began with Sigmund Freud, Emil Kraepelin, and Eugene Bleuler.

Freud challenged society to view human beings objectively;

Kraepelin began classifying mental disorders according to their
symptoms and Bleuler coined the term schizophrenia.

Chlorpromazine (Thorazine) and lithium were the first drugs to be


Linda Richards is called the first American psychiatric nurse and she
believed that the mentally sick should be at ,east as well as cared as
the physically sick.

Nursing Mental Diseases (1920) by Harriet Bailey was the first

psychiatric nursing textbook.

Johns Hopkins (1913) was the first school of nursing to include

psychiatric nursing in its curriculum.

Hildegard Peplau published Interpersonal Relations in Nursing in 1952

and Interpersonal techniques: The Crux of Psychiatric Nursing in 1962.

Nursing Therapy (1968) by June Mellow described her approach of

focusing on clients psychosocial needs and strengths. Mellow
contended that the nurse as therapist is particularly suited to working
with those with severe mental disorders in the context of daily
activities, focusing on here and now to meet each persons
psychosocial needs.