Psychiatric-Mental Health
Nursing
Katherine Conlu-Bengan, RN
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
It takes some time to
realize that LISTENING
to what aches in the hearts
of patients may touch
them more profoundly
than back rub.
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.
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”
(USDHHS, 1999)
DEFINITION OF MENTAL HEALTH
I probably
A state of emotional,
have the
sanest
psychological, and social most
mind..hehe
wellness evidenced by
satisfying interpersonal
relationships, effective
behavior, 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

kcbengan/SACRNursing/2004
Social and Cultural factors
Sense of community
 Access to adequate resources
 Intolerance of violence
 Support of diversity among people

kcbengan/SACRNursing/2004
Interpersonal factors
Effective
communication
 Ability to help
others
 Intimacy
 Balance of
separateness and
connection

kcbengan/SACRNursing/2004
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
THERAPEUTIC COMMUNICATION
Hildegard Peplau

One-Dimensional Models
ONE CAUSE
 Multidimensional
MANY CAUSES
DISORDER
Models
Social
Influences
Biological
Influences
Behavioral
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
Therapeutic
Use of self
Communication
skill
Nursing Process
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 client’s strengths and assets, not on
his weakness and liabilities
• Accept the client as a human being who has value
and worth
• View the client’s behavior as designed to meet a
need or to communicate a message
• Potential for establishing relationship with clients
• Quality of the interaction
• View the client’s behavior as the best possible
adaptation
NURSING ROLES
Ward Manager Social Agent
Teacher
Counselor
Mother Surrogate Technical Role
Essential Qualities of the PsychiatricMental Health Nurse
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Therapeutic Use of Self
Genuineness and Warmth
Empathy
Acceptance
Maturity and Self-Awareness
The Mental Health Team
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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)