Introduction to Psychiatric Nursing

Have you encountered a mentally ill person?

How they behave?

What was your reaction upon knowing that the

person is insane?

Is it possible that you will become one of them in the

future?
 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 stability.
 fulfill life responsibilities, function effectively and
are satisfied with their Interpersonal relationship
and themselves.
 MENTAL ILLNESS

- A Clinically significant behavioral or

psychological syndrome or pattern that occurs
in an individual and is associated with present
distress or disability or with significantly
increased risk of suffering or death, pain,
disability or an important loss of freedom
(APA)
- *Consider Culture
 What is a mental illness?
It is when someone lacks the ability to
manage day to day events and/or control
their behavior so that basic physical and
emotional needs are threatened or unmet.
These disorders can affect persons of
any age, race, sex, religion, or income.
Psychosis
 an extreme mental disturbance involving distorted
perceptions of reality and irrational behavior;
basically, a complete break with reality.

Neurosis
 a relatively mild mental illness that is not caused
by organic disease, involving symptoms of stress
(depression, anxiety, obsessive behaviour,
hypochondria) but not a radical loss of touch with
reality
 The Psychiatric/mental Health
Nursing
 “Mental Health Nursing is a specialized field of
nursing which focuses on meeting the mental
health needs of the consumer, in partnership with
family, significant others and the community in
any setting. It is a specialized interpersonal process
embodying a concept of caring….”
 PSYCHIATRIC NURSING
– is an interpersonal process that promotes and
maintains pt behavior that contributes to integrated
functioning.
- a specialized area of nsg practice, employing the
wide range of explanatory theories of human
behavior as its science and purposeful use of self
as its art (ANA 2000)
HISTORICAL PERSPECTIVE OF THE TREATMENT OF
MENTAL ILLNESS
Ancient times
- Cause: Punishment of wrongdoing
- divine or demonic
- (Aristotle 382-322 BC) amounts of
blood, phlegm and yellow and black bile
control emotions
- aimed at resorting balance through
bloodletting, starving, and purging
EARLY CHRISTIAN (1-1000AD)
 Primitive beliefs and superstitions were strong
 Priest performed exorcisms to rid evil spirits;
incarceration, flogging & starving.

RENAISSANCE (1300-1600)
 St Mary of Bethlem Hospital in England (1547)
- charge visitors for amusement; bleeding,
bathing, vomiting, purging, forced feeding,
ridiculing; Tx: ABC
 Bicetre (France) – attendants “ringmasters”
 PERIODS OF ENLIGHTENMENT (1790s)

Philippe Pinel ( France) and William Tuke ( England)

ASYLUM – safe refuge or haven offering protection;

unchained, fed, clothed & abolished whips
- upheld human dignity

DOROTHEA DIX (1800s , U.S.A)

- State hospitals; alleviate suffering with adequate shelter,
nutritious food & warm clothing
 Period of Scientific Study
 Sigmund Freud (1856-1939): focused on
understanding the mind and mental illness; focus on
life experience
- introduced: motivation, catharsis, meaning of dreams,
psychoanalysis, id, ego, supergo, free association
- challenged society to view person objectively.
 Emil Kraepelin (1856-1926) : began classifying mental
disorders according to their symptoms; brain pathology
 Eugene Bleuler (1857-1939) : coined the term
Schizophrenia
PERIOD OF PSYCHOTROPIC DRUGS ( 1950)
Chlorpromazine ( Thorazine); Lithium
Imipramine (Tofranil)
MAOI ( Monoamine oxidase inhibitor)
Haloperidol ( Haldol)
Tricyclic antidepressants, were introduced 10 years after
Benzodiazepines

Advantages:
1. Shorter hospital confinement
2. Noise and chaos diminished
3. Reduced agitation, psychotic thinking, depression
 PERIOD OF COMMUNITY MENTAL HEALTH (
1960s)
 theenactment of the Community Mental Health
Center Act.
 DEINSTITUTIONALIZATION

A deliberate shift from institutional care in state

hospitals to community facilities began
(community treatment centers & community living
arrangements)
 Decade of the Brain 1990s
- Increase in brain research (funding)
- Significant change in public awareness
- Nursing more educated
 MENTAL ILNESS IN THE 21ST
CENTURY
 Due to revolving door effect.
A. Community based care
> Cost Containment Managed Care
B. Managed Care
> people receive care based on need rather
than on request
C. Case Management
 SIGNIFICANT PERSON IN PSYCHIATRIC
NURSING PRACTICE
LINDA RICHARDS
- The first american Psychiatric Nurse
 1st Psychiatric Nursing Textbook (1920) by Harriet
Bailey “Nursing Mental Disease”
 1st Psychiatric Nursing Theorist:
Hildegard Peplau “Interpersonal Relations in Nursing”
(1952), Interpersonal Techniques : The Crux of
Psychiatric Nursing ( 1962); NPI
June Mellow “Nursing Therapy” 1968
- focusing on clients psychosocial needs and strengths.
 SIGNIFICANT HOSPITALS IN PSYCHIATRIC
NUSING
Mc LEAN HOSPITAL, Belmont Massachussetts
- FIRST TRAINING Hospital for nurses in 1882
- Insulin Shock Therapy( 1935)
- Psychotherapy ( 1936)
- ECT ( 1937)

John Hopkins (1913)

– First school of Nursing to include psychiatric
Nursing in its curriculum
 HISTORY OF PSYCHIATRY IN THE
 Pre Spanish
PHILIPPINES
- Material and spiritual
- Tx: rituals, ceremonies; “babaylan (shaman). Sorcerer
 Spanish
- Act of sorcery “mangkukulam”, “manggagaway”
- Tx: Herbolarios
 Early 19th Century - Hospicio de san Jose
 American Era (1900s– Civil Hospital
San Lazaro Hospital (Dr. Elias Domingo)
Japanese Occupation (1941)
- Electroshock ( Electro Convulsive Therapy)
 PSYCHIATRIC NURSING
HISTORY IN THE PHILIPPINES
 The National Center for Mental Health (NCMH) Public
Works Act 3258
 first known as INSULAR PSYCHOPATHIC HOSPITAL,
situated on a hilly piece of land in Barrio Mauway,
Mandaluyong, Rizal and was formally opened on
December 17, 1928.
 PSYCHIATRIC NURSING
HISTORY IN THE PHILIPPINES
 later known as the NATIONAL MENTAL HOSPITAL.
1946. On November 12, 1986 - NATIONAL CENTER
FOR MENTAL HEALTH thru Memorandum Circular No.
48 of the Office of the President. On January 30, 1987,
NCMH was categorized as a Special Research Training
Center and hospital under Department of Health.
 PSYCHIATRIC NURSING
HISTORY IN THE PHILIPPINES
Today, NCMH has an authorized bed capacity of
4,200 and a daily average of 3,400 in-patients. It
sprawls on a 46.7 hectare compound with a total of
35 Pavilions/Cottages and 52 Wards. The Center
has an authorized personnel component of 1,993,
consisting of 116 Doctors, 375 Nurses, 655 Nursing
Attendants, 651 Administrative Staff and 196
Medical Ancillary Personnel.
 PSYCHIATRIC NURSING
HISTORY OF SPMC
 1871 - Davao Public Hospital with a 25-bed capacity.
Davao General Hospital - 1946 with a 200-bed capacity.
Davao Regional Medical and Training Center in 1957
under R.A. 1859 with a 350-bed capacity to be established
in Bajada with an area of 12.8 hectares. New building in
Bajada inaugurated in December 1964 but transfer was
completed in 1966
 Medical Center for Mindanao and Sulu by the
Department of Health under A.O. 157 effective
January 1, 1971. The 200-bed Davao Mental
Hospital was attached in 1986 and became under
full administrative and fiscal control of DMC by
1991. Upgraded in 1992 as 400-bed hospital for a
total of 600-bed capacity for both main hospital
and the Mental Hospital.
Mental Illness in the Philippines
( Philippines Star )

 Cases of mental illness in the

country are on the rise with the
increase in population, but the
Filipinos’ faith in God and sense
of humor help them cope with
situations that can lead to
insanity, psychiatrists said .
Dr. Noel Reyes, a psychiatrist at the National Center for
Mental Health in Mandaluyong City, said one of the most
common brain diseases among Filipinos is schizophrenia,
which afflicts one percent of the total population.
Dr. Lourdes Ignacio, president of the Philippine
Psychiatrists' Association, said some of the factors that
trigger the disease include stress factors like traffic, loss of
loved ones, disasters and even bombings.

Among overseas Filipino workers, Ignacio said seamen

were found to be the most vulnerable to mental disorders
because they tend to rely on alcohol or drugs to ease their
homesickness.

Reyes explained that the increase in the incidence of

mental illness was also due to the widespread use of
prohibited drugs.
 Drug addicts or substance abusers have dual diagnosis:
substance addiction or substance dependence, and
psychiatric disorder whether it’s depression, anxiety,"
Reyes said, adding that these patients become drug
addicts because they are self-medicating.

"Some of the statistics in the hospital would say that

yes, they started as saying they have psychiatric
disorder but they end up being addicts. These factors
add up to the mental health of the Philippines," he said.
However, Ignacio said Filipinos have their own natural
coping mechanism compared to other nationalities.

She said Filipinos’ strong faith in God, sense of humor

and concern for others, are among the mechanisms that
help them cope with depression.

"We are very much crisis-oriented and we have natural

ways of coping with it," she said.
On the other hand, Ignacio revealed that the Philippines
is facing an acute shortage of psychiatrists due to the
unabated migration of mental health doctors who seek
greener pastures abroad.

She said there are only 400 psychiatrists in the country,

and most them are in the National Capital Region.
Ignacio said the provinces of Cotabato and Surigao, in
particular, lack the service of psychiatrists.

According to Reyes, some of the symptoms of

schizophrenia include a change in behavior, forgetting
basic functions such as in personal hygiene, social and
occupational dysfunction like when the person does not
want to go back to work.
 Factors Influencing Mental Health
INDIVIDUAL OR PERSONAL;
1. Age, growth and development
2. Genetic and Biologic Factors
3. Physical health and health Practices
4. Response to Drugs
5. Self Efficacy
6. Hardiness
7. Resilience and resourcefulness
8. Spirituality
 Factors Influencing Mental Health
INDIVIDUAL OR PERSONAL;
1. Age, growth and development
- A PERSONS AGE SEEMS TO AFFECT HOW HE
SHE COPES WITH ILLNESS
2. Genetic and Biologic Factors
- Disorders tends to appear more frequently
- Influences persons response to illness
3. Physical health and health Practices
 Factors Influencing Mental Health
4. Response to Drugs
- biologic differences can affect to a clients response to
treatment
5. Self Efficacy
- Belief that personal abilities and efforts affect the events
in our lives
- High self efficicacy set personal goals, are self-motivated,
cope effectively with stress and request support from
others when needed
 Four Ways in developing Efficacy:

1. Experience of success or mastery in overcoming

obstacles
2. Social modeling
3. Social Persuasion
4. Reducing stress building physical strength, and
learning how to interpret physical sensations
positively
 Factors Influencing Mental Health
6. Hardiness
- Ability to resist illness
Components:
1. Commitment : active involvement in life activities
2. Control : ability to make approachable decisions in life
activities
3. Challenge : ability to perceive change as beneficial rather
than just stressful
 Factors Influencing Mental Health
7. Resilience and resourcefulness
- healthy response to stressful circumstances or risky
situations
Resourcefulness - Involves using problem- solving abilities
and believing that one can cope with adverse or novel
situations
8. Spirituality
- Involves the essence of a persons being and his or her
belief about the meaning of life and the purpose for
living
- Include belief in God or a higher power, the practice of
religion, cultural beliefs and practices and a relationship
 Factors Influencing Mental Health
8. Spirituality
- Involves the essence of a persons being and his or her
belief about the meaning of life and the purpose for
living
- Include belief in God or a higher power, the practice of
religion, cultural beliefs and practices and a relationship
with the environment
Interpersonal or relationship

1. Sense of belongingness
2. Value
3. Fit
4. Social Networks and Social Support

Social / Cultural or environmental

Factors contributing Mental illness
1. Individual
2. Interpersonal
3. Socio-cultural
Individual

1. Biologic make up
2. Intolerable or unrealistic worries or fears
3. Inability to distinguish reality from fantasy
4. Intolerance of life's uncertainties
5. Sense of disharmony in life
 Interpersonal;
1. Ineffective communication
2. Excessive dependency
3. No sense of belonging
4. Inadequate social support
5. Loss of emotional control
 Socio-culutral
 Lack or resources
 Violence
 Homelessness
 Poverty
 Unwarranted negative view of the world
 Discrimination ( stigma, racism, classism, ageism.
Sexism)
 What IS Psychiatric and/or Mental
Health Nursing, Anyway??
 Help!! This is NOT something I want to do!
 I did NOT go into nursing to baby-sit “crazies”…
 It’s ridiculous to spend my day just passing out
pills to keep these people quiet!
 What good does it do, ANYWAY??!

 Well……
 We are so glad you asked!!
 First of all… WHAT do psychiatric nurses do, anyway??
Isn’t it a “cushie” job??! (Noooo…, not really)
 You need to know how to interact therapeutically
 You need to have skill interpersonally
 You need to know how medications work
 You need to think on your feet – sometimes pretty fast. Not to
perform a physical skill, necessarily. But your words have never
been so important as they will be in this area of nursing.
 Students' Concern about Psychiatric Nursing
Exposure
 What If I say the wrong thing?
 What will I be doing?
 What if no one will talk to me?
 Am I prying when I ask questions?
 How will I handle bizarre or inappropriate behavior?
 What happens if a client ask me for a date?
 Is my physical safety in jeopardy?
 What if I encounter someone I know being treated?
 What if I recognized that I share similar problems or back
ground with the clients?
 Myths of Mental Illness
 Mental illness is caused by bad parenting.
Fact: Most diagnosed individuals come from supportive
homes.

 The mentally ill are violent and dangerous.

Fact: Most are victims of violence.

 People with a mental disorder are not smart.

Fact: Numerous studies have shown that many have
average or above average intelligence.
 So what kinds of skills…? (Basic)
 Know how to use and apply the nursing process
 Develop counseling skills and interventions
 Utilize milieu therapy (all the time!)
 Be willing and able to teach and role-model self care.
 Be able to recognize psychobiologic interventions and use
them in collaboration
 Be a good teacher!
 Be a good organizer. You may be case managing.
 Areas of practice
 Counseling
 Milieu therapy
 Self care activities
 Psychobiologic
 Health teaching
 Case management
 Health promotion and maintenance
Advanced Practice Psych Nurses
 Do psychotherapy

 Prescribe

 Consult

 Evaluate
 Nurse and Therapist
 Empathetic
 Warm
 Genuine
 Respectful
 Concrete
 Immediate
 Confrontive
 Able to disclose self appropriately.
The Essence of Psychiatric/mental Health
Nursing
 Lies not in tasks performed or with the presenting
illness but in the relationship that develops with
clients and families and their responses to the illness,
including the impact that the illness has on their lives.
 The essence is in establishing a ‘therapeutic
partnership’, a connectedness, between the nurse and
client which is based on empathy and trust.
 Similarities & Differences
SIMILARITIES
 Work in close contact with people from a wide variety of
backgrounds
 Provide CARE for people with a wide variety of illnesses
 Involved in health promotion and illness prevention
 Nursing philosophy of benevolence
 Similarities & Differences
SIMILARITIES
 Education: must meet required level of knowledge and
skills to attain registration/endorsement
 Governed by the Nurses Codes –
Professional Conduct & Ethics
 Structure of work hours, salary, benefits
 Similarities & Differences
DIFFERENCES
Core focus of Psychiatric Mental Health Nursing
 Therapeutic relationship
 Use of self as a therapeutic tool
 People-centred approach, engaging clients in
discourse, promoting change
 Less task orientated
 Less technical environment
 Professional autonomy
 Similarities & Differences
DIFFERENCES
 Clinical competence based on interpersonal techniques
Stuart & Laraia (2001)

 Less repetition in process & procedures due to client

individuality
 Philosophy of the Profession
Each individual:
 Has intrinsic worth and dignity and each person is
worthy of respect.
 Has the potential to change.
 Has common, basic human needs…
 Varies in their coping capacities

Centre for Psychiatric

Nursing
 Philosophy of the profession
Each individual(s):
 Behaviour is meaningful…
 Has a right to equal opportunity for adequate
health care.
 Has the right to participate in decision making
regarding their care.
 Has the right to self-determination…
The Knowledge, Skills & Attitudes of the
Psychiatric/mental Health Nurse
 Broad context of care
 Requires purposeful use of self as a therapeutic tool
 “Knowing you, Knowing me” (Awareness of self) Barker,
Jackson & Stevenson (1999)

 Requires great sensitivity to the social environment &

advocacy needs of clients/families
 Requires careful consideration of legal & ethical issues
The Knowledge, Skills & Attitudes of the
Psychiatric/mental Health Nurse
THERAPEUTIC NURSE-CLIENT RELATIONSHIP
• Physical dimension
• Safety dimension
• Social dimension
• Spiritual dimension
• Provision of treatment modalities
• Encouraging self-determination
• Provision of information
Cowman, Farrelly & Gilheany (2001)
 The Knowledge, Skills & Attitudes of
the Psychiatric/mental Health Nurse
 Milieu management
 Assessing, planning, implementing & evaluating care
 Pharmacological interventions
 Documentation/Administration
 Legal requirements
 Educating/supervision
 Coordination/Multidisciplinary team member
The Importance of Psychiatric/mental
Health Nursing Knowledge, Skills &
Attitudes
 Exposure to clients with mental health problems
or illness in any area of practice

 Skills will assist the nurse to provide comfort to

clients who may be experiencing a myriad of
emotions. I.e. grief, anxiety, anger, cognitive
deficits and subsequent behaviour, and diagnosed
mental illness
 The Importance of Psychiatric/mental
Health Nursing Knowledge, Skills &
Attitudes
 Mental state assessment skills

 Early intervention - reduced stays, improved recovery

rates. Improved client outcomes

 Nurse more comfortable, confident in working with clients

with mental illness
 The Team
 Collaborative!
 Interdisciplinary
 Roles of the MH team: Members include RN, LPN, SW, Psych
tech, Psychiatrist, Psychologist, Marriage, family, child
counselor, case managers, etc.
 Treatment is a team effort. They and their families are a
part of the team.
 Treatment modalities – see next class. Most professionals
are comfortable with an eclectic approach, but may have
areas of comfort or specialties.
 SELF AWARENESS
- Awareness of one’s feelings, beliefs, attitudes,
values and thoughts
- The goal is to know oneself so that one’s values,
attitudes, and beliefs are not rejected to the client,
interfering with nursing care.
 Why should I care?
 Because understanding of mental health issues
brings awareness to the community and our
surrounding environment.

 We will become a society that is accepting of

others who do not fit our idea of a perfect
population.
 Conclusion
Overall, mental health is an issue that
effects everyone.

And hopefully, throughout the years,

education will curve the sigma of
these brain disorders so that hate,
bias judgment and discrimination
will be gone.
LEARN
LOVE
LIVE
TILL NEXT……..