Historical significance of care of mentally ill:
Ancient Man- good/bad spirits “possess”, demonic force
to act in bizarre ways as punishment
Greeks
-Hippocrates-organic, body fluids responsible
-Plato-organic, moral & divine; soul made of rational,
libidinal, spirited
-Aristotle-organic; humors & biles
Romans
-Asclepiades-acute vs chronic;
illusions/delusions/hallucinations; designed humane tx
-Aretaeus-mania & depression; role of pre-morbid
personality
-Galen-organic; psychic fxns; causes of mental illnesshead injury, fear, alcoholic excess, shock, adolescence,
disappointment in love, menstrual changes
Medieval Man- “Epidemics of Craziness”- possession
by demons; flagellants; trantism (bite of
tarantuladancing mania); lycanthropy (belief one is an
animal); cure is exorcism
Witchcraft- bizarre behavior “will of God”, psychotic
individuals victims of religious persecution (in league w/
devil or seized as punishment for sins); tx-exorcism
(prayer, incantation, sheep dung wine, noise making,
shrines), flogging, starvation, immersion in hot water,
“ship of fools”
16th-17th Centuries- reason above science, philosophy &
religion; mentally ill less id’d w/ devil more a social
problem- placed in prison, tx’d by laymen, tx designed
to shock out of illness
-hospitals- lg houses for societies unwanted; seen as zoo
of people; most fit (prostitutes) cared for others
Important Figures
Weyer (Fr)-Father of Modern Psychiatry; humane tx,
tx’d by dr’s not priests
Pinel (Fr)- asylums in Fr- rejected punishment “took the
chains off”, daily rounds; OT, rec therapy
Tuke (Eng)- York Retreat; took out of asylums, “gently
religious atmosphere”; humane tx; OT & rec therapy
Rush (Am)-Father of Am Psychiatry; created tx’s for
mentally ill
Mesmer- Suggestive healing, hypnotism
Dix (Am)- 32 state mental hospitals; institutionalized
Meyer- Psychology; mind-body relationship
Beers- A Mind that Found Itself
Kraepelin- Classifications of Mental Disorders (now the
DSM-IV)
Bleuler- 4 A’s of Schizophrenia
Seizures create period of clarity Malarial Fever cure,
Metrazol, glucose, ECT
5 signs of mental health:
-control over behavior
-happiness
-appraisal of reality
-effectiveness in work
-healthy self-concept
Analyze role of nursing theory in MH nursing:
-Nightingale- Notes on Nursing
-Peplau- Interpersonal Theory of Nursing
Psychodynamic- Freud: Id/Ego/SuperEgo (transference,
countertransference, free association, symptom
substitution); defense mechanisms to avoid anxiety
Interpersonal- Sullivan: self-system (prevents
individual from experiencing anxiety); somnolent
detachment, apathy, selective inattention, dissociation,
consensual validation
Cognitive Behavior – active, direct, time limited;
correct distorted thinking; focus on now, provide
tools/skills to cope
behavior models of therapy- Pavlov (positive
reinforcement), Skinner (negative deference)
Specify components of MH continuum of biologically
based mental illneses (chart pg 12 “History of Mental
Illness” ppt)
DSM-IV-TR dx vs nursing dx
Influence of cultural norms in accurate dx: different
perception; disease seen as lack of harmony;
communication barriers; culture-bound illnesses;
differences in pharmacodynamics; culturally
inappropriate psychometric instruments & diagnostic
tools
Relationship between dominance of Am cultural
values & type of care needed to accommodate
cultural diversity: Western Tradition, ones identity
found in one’s individuality; mind-body two separate
entities, disease considered to have specific, measurable
& observable cause
Therapeutic relationship- requires nurse to maximize
communications kills, understanding of human
behaviors & personal strengths in order to enhance
person growth in client
Phases: orientation (establish relationship, round rules,
expectations, schedule, termination, confidentiality);
working phase (implement plan; interventions, support
groups); termination (end relationship)
Mental status exam
Purpose- evaluate client’s current cognitive processes
Personal Info- age; sex; marital status; religious
preference; race; ethnic background; employment; living
arrangement
Appearance- grooming & dress; level of hygiene; pupil
dilation or constriction; facial expression; ht, wt,
nutritional status; presence of body piercing or tattoos,
scars
Behavior- excessive or reduced body movements;
peculiar body movements; abnormal movements; level
of eye contact
Speech- rate; volume; disturbances; cluttering
Affect & Mood- affect: flat, bland, animated, angry,
withdrawn, appropriate; mood-sad, labile, euphoric
Thought- process: disorganized, coherent, flightf ideas,
neologisms, thought blocking, circumstantiality; content:
delusions, obsessions, suicidal thought
Perceptual Disturbances- hallucinations, illusions
Cognition –orientation; LOC; memory; fund of
knowledge; attention; abstraction; insight; judgment
Transference- client projects emotions/feelings to RN
that are assoc w/ others; overidentifies (hostile-anger
because RN reminds client of someone who abused them
or dependant rx-RN reminds of loving, supportive
person so client becomes overattached)
Countertransference- RN projects to client
Therapeutic milieu- Importance-aim to help increase
clients’ self-esteem, decrease social isolation, encourage
appropriate social behaviors, educate in basic living
skills
ComponentsTherapeutic interview – content & direction led by
client
Communication concepts: setting, seating,
introductions, offering leads or statements of acceptance,
Avoid: arguing or challenging; praise or false
reassurance; interpret or speculate on dynamics of pt
problem; try to sell client on tx; join in attacks;
participate in criticism
Guidelines: speak briefly; when you don’t know what to
say, say nothing; when in doubt, focus on feelings; avoid
advice; avoid relying on questions; pay attention to
nonverbal cues; keep the focus on the client
Group: two or more people who develop an interactive
relationship & share at least one common goal or issue
Characteristics: size, defined purpose, degree of
similarity among members, rules, boundaries, climate,
apparent content & underlying process
Phases of group development:
initial- purpose of group is stated, get to know one
another
working- leader encourages members to cooperate,
group revolves around issues of power & control
mature- leader keeps group focused, group develops
functional norms & sense of group identity
termination- leader acknowledge contribution of each
member, group prepare for separation & help each other
prepare for future
Task & maintenance roles of group members & ie’s
Autocratic leader- control over group, does not
encourage much interaction among members
Democratic leader- supports extensive group interaction
in problem solving
Laissez-faire leader- allows group members to behave in
any way they choose & does not attempt to control
direction of group
Therapeutic factors that operate in all groups
Instillation of hope- leaser shares optimism about group
tx, members share improvement
Universality- members realize they’re not alone w/
problems, feelings or thoughts
Imparting of information- participants receive formal
teach by leader or advice from peers
Altruism- members feel reward from giving support to
others
Corrective recapitulation of primary family groupmembers repeat patterns of behavior in group that they
learned in their families; w/ feedback from leader &
peers, learn about own behavior
Development of socializing techniques- members lean
new social skills based on feedback from others
Imitative behavior- members may copy behavior from
leader or peers & can adopt healthier habits
Interpersonal learning- members gain insight into
themselves based on feedback fromothers. Comples
process that occurs later in group after trust established
Group cohesiveness- powerful factor arises in mature
group when each member feels connected to other
members, leader & group as whole; members can accept
positive feedback & constructive criticism
Catharsis- intense feelings, as judged by member, are
shared
Existential resolution- members learn to accept painful
aspects of life that affect everyone
Facilitating factors used by group leader: advice or
information sharing; clarification; confrontation;
questioning; reflection; repetition or paraphrase;
summarization; support
Group intervention for
silent member: leader needs to exhibit patience but also
encourage active participation; offered in supportive
manner; makes observation w/o putting client on
defensive
monopolizing member: leader asks members why they
have permitted monopolizer to go on & on; allows
member to take responsibility for being victimized &
takes therapist out of authoritative position
groups commonly led by basic level RN: medication
education group, sexuality groups, dual-diagnosis
groups, multifamily group, symptom management
groups, stress management groups