
Chapter 1

History of Psychiatric Nursing

Evolution of PsychiatricMental Health Nursing

Early History

Insanity associated with sin and demonic possession

People believe that any sickness indicated displeasure of the gods and in fact was punishment for sins and wrongdoing

Treatment of mentally ill was sometimes inhumane and brutal

Viewed as divine- worshipped and adored

Viewed as demonic- ostracized, punished and sometimes burned at the stake

Evolution of PsychiatricMental Health Nursing

Early History

Rituals, herbs, ointments and precious stones used to try to extract demons

Mental illness thought to be incurable

Early “Treatments” for Mental Illness

ARISTOTLE (382-322 BC)

Attempted to relate mental disorders and developed his theory that the amounts of blood, water and yellow and black bile in the body
controlled the emotions

These 4 substances or humors corresponded with happiness, calmness, anger and sadness.

Imbalances of the 4 were believed to cause mental disorders

Treatment was aimed at restoring balance through blood letting, starving, purging. (up to 19th century)

Early history- Trepanning

In ancient times trepanning was performed on live patients suffering from fractured skulls, convulsions, and insanity. Disks of bone from
the skulls of cadavers were often carved and used as religious amulets in ancient Egypt and

EARLY CHRISTIAN TIMES (1-1000 AD)

All diseases were again blamed to demons

Mentally were viewed as possessed

Priests performed exorcisms to rid of evil spirits

When that failed, they used more severe and brutal measures, such as incarceration in dungeons, flogging and starving


Flogging-beat somebody very hard: to hit a person or animal very hard using something such as a whip, strap, or stick

Evolution of PsychiatricMental Health Nursing
The Middle Ages

No actual treatment

Mentally ill were homeless, begged for food on the streets, or imprisoned

Charity of religious groups provided food, shelter, and ran almshouses

Evolution of PsychiatricMental Health Nursing

The Middle Ages

People with mental illness were distinguished from criminals in England

Harmless- allowed to wander the countryside or live in rural communities

“Dangerous lunatics”- thrown into prison, chained and starved

Evolution of PsychiatricMental Health Nursing

Evolution of PsychiatricMental Health Nursing

The Middle Ages

Hospital of St. Mary of Bethlehem built in London, England during the 14 th century


First mental asylum provided safe refuge for the mentally ill from which the term bedlam was coined
In 1547, the Hospital of St. Mary of Bethlehem was officially declared a hospital for insane

Evolution of PsychiatricMental Health Nursing

The Fifteenth through the Seventeenth Centuries

Skepticism was rampant

Conditions of asylums were deplorable

Deprived of heat, sunlight, often chained or caged

Evolution of PsychiatricMental Health Nursing

The Fifteenth through the Seventeenth Centuries

Insane were treated like animals

Thought not to have feelings

Were believed to lack understanding

Men and women not given separate quarters



Poorly clothed and fed

Evolution of PsychiatricMental Health Nursing
The Eighteenth Century

In 1775, visitors at the institution were charge a fee for the privilege of viewing and ridiculing inmates who were seen as animals,
less than human

During the same period in the colonies (later US), the mentally ill were considered evil or possessed and were punished

Witch hunts were conducted and offenders were burned at the stake


Violent inmates were placed with those convalescing or tranquil
The Eighteenth Century
Evolution of PsychiatricMental Health Nursing

Benjamin Rush (1745-1813)

“Father of American Psychiatry”

Forerunner in highlighting plight of mentally ill

Emphasized moral treatment

Medical Inquiries and Observations upon the Disease of the Mind (1812)


Evolution of PsychiatricMental Health Nursing

The Eighteenth Century

Benjamin Rush (1745-1813)

Therapy include blood letting and administration of cold and hot baths, harsh purgatives, and emetics were considered
controversial

Felt that inducement of fright or shock would regain their sanity

Was credited with inventing the tranquilizer chair and the gyrator

The idea was to increase cerebral circulation, the major focus of Rush theories and therapies

Evolution of PsychiatricMental Health Nursing

Evolution of PsychiatricMental Health Nursing

The Eighteenth Century



Authoritative work on mental disorders for several decades
Phillippe Pinel in France(1745-1826)

Advocate for humane patient treatment

1790-Emphasized atmosphere of kindness and understanding 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.
Evolution of PsychiatricMental Health Nursing
The Eighteenth Century

William Tuke (1732-1822)

Humanitarian efforts led to the establishment of York Retreat


Abhorred the deplorable conditions of several asylums including Bethlehem

His services were often sought in developing humane conditions in mental institutions

Descendants played major roles in increasing public awareness of the vile living conditions in mental institutions

Evolution of PsychiatricMental Health Nursing

The Eighteenth Century

Provided comfort, security and safety for mentally ill
Franz Anton Mesner (1734-1815)

Approach to treatment was mesmerism


Renewed the art of sugestive healing that stemmed from the ancient use of trances, which later became the basis of
hypnosis

Used a form of hypnotism- a dreamlike trance, to explore the basis of neurosis

Animal magnetism were used to effect cures
Mc Lean Hospital, Belmont, Massachusetts
America’s first trained psychiatric nurses: The first class of 15 women graduated from the Mc Lean Asylum Training School for Nurses in 1886.

Evolution of PsychiatricMental Health Nursing

The Nineteenth Century: The Evolution of the Psychiatric Nurse



US (1802-1887) Dorothea Dix

began a crusade to reform the treatment of mental illness after a visit to Tuke’s institution in England

Plight of mentally ill recognized by legislative community
Evolution of PsychiatricMental Health Nursing
The Nineteenth Century: The Evolution of the Psychiatric Nurse

Dorothea Lynde Dix (1802-1887)

Led to establishment of state hospitals

Provided mainly custodial care

She was instrumental in opening 32 state hospitals that offered asylum to the suffering

Dix believed that society was obligated to those who were mentally ill and promoted adequate shelter, nutritious food,
and warm clothing

Dorothea Lynde Dix

Evolution of PsychiatricMental Health Nursing

The period of enlightenment was short lived

Within 100 years after establishment of the first asylum, hospitals were in trouble

Attendant were accused of abusing the residents

The rural location of the hospitals were viewed as isolating patients from their families and homes

And the phrase insane asylum took on a negative connotation

Evolution of PsychiatricMental Health Nursing

The Twentieth Century: The Era of Psychiatry

Adolph Meyer (1866-1950)

Initiated psychobiological theory

Dynamic concept of psychiatric care

Emphasizes on considering the total individual from all points of view (holism)


Study the person’s whole environment to determine its effects on the total personality
Evolution of PsychiatricMental Health Nursing

The Twentieth Century: The Era of Psychiatry


Focused on physical and emotional maturational changes

Accepted the concept that mental disease resulted from the from the individual’s maladaptation to his/her environment

Introduced the concept of common sense psychiatry, which was based on ways that clients could realistically improve
life situations

Evolution of PsychiatricMental Health Nursing
Clifford Beers(1876-1943)

Contributed to preventive care through his classic work , A Mind that Found Itself (1908)

His work provided a descriptive account of his tormenting experiences in mental institutions

Played a major role in establishing the Mental Hygiene Movement in New Haven, Connecticutin 1908 and promoting
early detection of mental illness

Evolution of PsychiatricMental Health Nursing
The Twentieth Century: The Era of Psychiatry



The Twentieth Century: The Era of Psychiatry


Adolph Meyer (1866-1950)
Emil Kraepelin (1856-1926)

Began classifying mental disorders according to their symptoms

Work shifted from an emphasis on research in the pathobiological laboratory to the observation and research in
conditions known as preacox dementia and mania

Evolution of PsychiatricMental Health Nursing
The Twentieth Century: The Era of Psychiatry

Eugene Blueler (1857-1939)

Blueler coined the term SCHIZOPHRENIA


4A’s- apathy, associative looseness, autism and ambivalence

“Dementia Praecox or Group of Schizophrenias” delineated the complexity of Schizophrenia

Evolution of PsychiatricMental Health Nursing
The Twentieth Century: The Era of Psychiatry

Sigmund Freud (1856-1939)

Studied psychiatry and the diagnosis and treatment of mental illness

Freud challenged society to view human beings objectively

He studied the mind, its disorders, and their treatment

Evolution of PsychiatricMental Health Nursing

The Twentieth Century: The Era of Psychiatry

Sigmund Freud (1856-1939)

Psychoanalysis

Psychosexual theories

Neurosis

Evolution of PsychiatricMental Health Nursing

The Twentieth Century: The Era of Psychiatry

Carl Gustav Jung (1875-1961)

Founded analytic psychology

Proposed and originated the concepts of extroverted and introverted personality

Holistically treated individuals

He integrated spiritual concepts, reasoning, ancestral emotional trends, and mysticism, and the created notions of
human beings.

Evolution of PsychiatricMental Health Nursing

The Twentieth Century: The Era of Psychiatry

Karen Horney(1885-1952)

Objected to Freud’s notion that neurosis and personality development were based on biological drives

Her theory suggested that neuroses stem from cultural factors and impaired interpersonal relationships

Evolution of PsychiatricMental Health Nursing

The Twentieth Century: The Era of Psychiatry

Harry Stack Sullivan (1892-1949)

Interpersonal theory

Emphasized milieu therapy and multidisciplinary approach

Believed that anxiety interfered with the ability to cope and communicate effectively resulting to mental illness

Surmised that anxiety could be reduced through a meaningful interpersonal relationship that stresses the process of
effective communication

Evolution of PsychiatricMental Health Nursing

The Twentieth Century: The Era of Psychiatry

Hans Selye(1956)

Proponent of stress syndrome and general adaptation syndrome

Evolution of PsychiatricMental Health Nursing

The Twentieth Century: The Era of Psychiatry

American Psychiatric Association

1952 published Diagnostic and Statistical Manual of Mental Disorders (DSM)

This manual provided a new and comprehensive classification of mental disorders

Evolution of PsychiatricMental Health Nursing

The Twentieth Century: The Era of Psychiatry

Hildegard Peplau

Published Interpersonal Relations in Nursing: A Conceptual Framework for Psychodynamic Nursing (1952)

“Therapeutic use of self” in psychiatric nursing

Evolution of PsychiatricMental Health Nursing

The Twentieth Century: The Era of Psychiatry

Hildegard Peplau

First theoretical framework for psychiatric-mental health nursing

Defined nursing as an interactive, exploratory, caring and health promoting process

4 overlapping phases of the nurse client relationship


Asserted that all nurse client interactions are opportunities to build a mutual understanding and to identify goals that
have impact on client outcomes and responses

Evolution of PsychiatricMental Health Nursing

Advent of somatic therapies

Hypoglycemic shock (1930s)

Electroshock

Psychosurgery

Evolution of PsychiatricMental Health Nursing

Advent of somatic therapies


Orientation, identification, exploration, resolution
Psychotropic medications (1950s)

Thorazine (chlorpromazine) -antipsychotic

Tofranil (imipramine)

Lithium –antimanic
Following 10 years

Monoamine oxidase inhibitor- antidepressant

Haloperidol (Haldol)- antipsychotic

Tricyclic antidepressants

Antianxiety agents- benzodiazepines

DEVELOPMENT OF PSYCHOPHARMACOLOGY

For the first time, drugs actually reduced agitation, psychotic thinking and depression

Hospital stay were shortened, many people were well enough to go home

The level of noise, chaos, and violence greatly diminished in the hospital

Evolution of PsychiatricMental Health Nursing
INSULIN SHOCK THERAPY (Hypoglycemic shock (1930s))




A procedure where a series of hypoglycemic shocks are introduced by injections of insulin. (Vienna, Sakel, 1933)

PURPOSE: treatment for schizophrenia

EXACT EFFECT – not known

DESIRED EFFECT- hypoglycemia -coma
BEFORE PROCEDURE

dress- sleeping attire

No breakfast

Check vital signs

Allow the patient to void before the treatment
Evolution of PsychiatricMental Health Nursing
DURING PROCEDURE

Insulin is given deep IM

Initial dose- 5-10 units. Observe for hypersensitivity or allergic reaction.

Raised welts around injection site, itching sensation- terminate treatment for the day

Continuing dose should be increasing.

Series of treatment – 50-60 times

Daily

5 days a week

Evolution of PsychiatricMental Health Nursing

Chief characteristics of coma


Loss of consciousness

Profuse perspiration

Flushing of the face
LEVELS

Deep coma

can not be aroused

Superficial reflexes disappear

Other pathological reflexes appear

Prolong deep coma- complete absence of all body reflexes

ELECTROCONVULSIVE THERAPY (ECT)

Involves application of electrodes to the head to deliver an electrical impulse to the temporal part of the brain to produce a grandmal
seizure

INDICATIONS



Major depression associated with

Non-response to an adequate trial of anti-depressants

High suicidal potential
ECT- INDICATIONS

Dehydration

Depressive stupor

Catatonia

Delusions

Prophylaxis of recurrent major depression ( maintenance ECT)

Severe mania not controlled by medications

Post-partum psychosis after non-responsive to medications

Schizophrenia-catatonic type when non-responsive to medications
ECT- INDICATIONS

Movement disorders refractory to treatment ( Parkinson’s disease, neuroleptic malignant syndrome, tardive dyskinesia

HOW ECT WORKS

Not clear how ECT works or why

A reasonable view suggests that ECT causes changes in monoamine neurotransmitters, similar to the changes caused by the
antidepressant drugs

ECT- TYPES
1.
Unmodified ECT

2.
No medications are given prior to treatment
Modified ECT

With medications prior to treatment

Medication Administered Prior To The Modified ECT

Atropine


ANTICHOLINERGIC

Inhibition of salivation and respiratory tract secretions to minimize aspiration

Vagal stimulation decreases the potential for cardiovascular depression resulting from ECT, succinylcholine, and/or methohexital

Prevents bradychardia

Medication Administered Prior To The Modified ECT
Methohexital ( Brevital)

SHORT ACTING BARBITURATE

Induces a light coma or anesthesia preceding delivery of ECT

Succinylcholine ( Anectine)

MUSCLE RELAXANT/NEUROMUSCULAR BLOCKER

Prevents musculoskeletal complications from induced convulsions

Results to inability to breathe resulting from paralysis of respiratory muscles

PREPARATION FOR ECT
1. The patient must have a pre-treatment evaluation

Physical examination

Laboratory work


Blood count

Blood chemistries

Urinalysis
Baseline memory abilities
2. A consent formed must be signed.

PREPARATION FOR ECT
3. The routine use of some psychotropic drugs ,benzodiazepines and barbiturates for nighttime sedation should be eliminated because of their ability
to raise the seizure threshold.

Lithium –may prolong the effect of succinylcholine

Benzodiazepine – may make it difficult to induce a seizure
4. A trained electrotherapist and an anesthesiologist should be available.

ECT- NURSING RESPONSIBILITIES

The patient should not be given anything by mouth for approximately 8 hours before ECT.

Vital signs should be taken.

Atropine should be given as ordered. Atropine can be given 1 hour before treatment or intravenously immediately preceding treatment.
Atropine reduces secretions and subsequent risk of aspiration.

The patient should be asked to urinate before treatment ( seizure-induced incontinence is common).

ECT- NURSING RESPONSIBILITIES

The following should be removed before treatment

hairpins

Dentures

Jewelries

eyeglasses

Hearing aids

Clothing must be loose & comfortable

The nurse should be positive about the treatment and attempt to reduce the patient’s anxiety.
NO PATIENT SHOULD SEE ANOTHER PATIENT RECEIVING OR IMMEDIATELY AFTER TREATMENT.

PROCEDURES DURING ECT
1.
An intravenous line is inserted.
2.
Electrodes are attached to the proper place on the head. Electrodes are typically held in place with a rubber strap.
3.
The bite-block is inserted.
4.
Methohexital (brevital) or another short-acting barbiturate is given intravenously.

The barbiturate causes immediate anesthesia, pre-empting the anxiety associated with the waiting for the “jolt to hit” & the anxiety
caused by succinylcholine.

Succinylcholine causes paralysis but not sedation, thereby leaving the patient conscious but unable to breathe.

ECT- NURSING INTERVENTIONS

PRIOR TO PROCEDURE


1.
Explain- confusion disorientation upon awakening.
2.
NPO after midnight.
3.
Have consent signed.
FOLLOWING PROCEDURE
1.
Remain with the client until alert.
2.
Monitor vital signs.
3.
Reorientation.
4.
Reassure regarding memory loss & confusion.
5.
Assist the patient to eat breakfast.
6.
Administer oxygen/suction if necessary.
7.
ECT- NURSING INTERVENTIONS
AFTER PROCEDURE
1. The nurse or anesthesiologist mechanically ventilates the patient with 100% oxygen (due to interruption of breathing) until the patient can breathe
unassisted.
2. The nurse monitors for respiratory problems.
3. ECT causes confusion & disorientation.

standard operating procedure (SOP) – REORIENT patient (time, place, person)
4. The nurse may need to administer a PRN BENZODIAZEPINE.

ECT- NURSING INTERVENTIONS
5. Observation is necessary until the patient is oriented & steady.
6. All aspects of the treatment should be carefully documented for the patient’s record.
ELECTROENCEPHALOGRAM (EEG) - device used to monitor seizure activity

EEG OF GRANDMAL SEIZURE

OTHER TREATMENT MODALITIES
PSYCHOSURGERY

Prefrontal lobotomy

Surgical removal or destruction of sections of the brain in order to reduce severe and chronic psychiatric symptoms.

The original procedure was modified in 1937 to involve severing almost all the nerve tracts connecting the prefrontal
lobes with the rest of the brain.

PURPOSE:

to modify behavior /emotions

to achieve control of violent behavior or severe emotional illness

Does not alleviate hallucinations or delusions

OTHER TREATMENT MODALITIES
PSYCHOSURGERY

Prefrontal lobotomy

SIDE EFFECT: callus, no feeling tone

CONTROVERSIAL: Moral or legal- irreversible, used prior to advent of drugs

António Egas Moniz

António Egas Moniz (1874-1955), Portuguese neurologist and Nobel Prize winner who invented the form of brain surgery now known as
lobotomy, in which the connections joining the lobes in the front of the brain with the rest of the organ are severed as a treatment for
extreme forms of mental illness.

OTHER TREATMENT MODALITIES
NARCOTHERAPY OR SLEEP THERAPY, SODIUM AMYTAL INTERVIEW OR TRUTH SERUM

Involves the administration of THIOPENTAL OR SODIUM AMYTAL to produce a state of relaxation & allowed repressed
feelings, memories & conflict to be expressed

It will not let persons to tell the truth

INDICATIONS:



Dissociative Disorders, Amnesia, Panic anxiety
GOALS

Catharsis

Interpretation of client’s recollections
OTHER TREATMENT MODALITIES
ORTHOMOLECULAR THERAPY

Treatment with high doses of vitamins

INDICATIONS: Korsakoff Wernicke’s , Schizophrenia
Light therapy

Part treatment for seasonal affective disorder

OTHER TREATMENT MODALITIES

Evolution of PsychiatricMental Health Nursing

The Mental Health Movement (mid 20th century)

Depicted new perspectives on the civil rights of people including those with mental illnesses

Nation’s attitude towards mentally ill began to change-

exhibit increased sensitivity and optimism in support of mental health professions such as psychiatry, nursing, social
work, and psychology

Evolution of PsychiatricMental Health Nursing

The Mental Health Movement (mid 20th century)

Authority given to United States Public Health Service addressed mental health services

Nurse’s role changed from custodial care to active member of the multidisciplinary team

Primitive stage of confinement and brutality to one that emphasized the need for interpersonal relations

Evolution of PsychiatricMental Health Nursing

Legislation

National Mental Health Act (1946)

Commission on Mental Illness and Health (1961) established by President Eisenhower

Federal Community Mental Health Centers Act (1963)

Emphasized prevention ,primary care and rehabilitation

Evolution of PsychiatricMental Health Nursing

Legislation


National Mental Health Act (1946)

The National Mental Health Act launches the first national attack on a condition which was already acute, but which
the war dramatically emphasized. The problem reached national focus through the large number of Selective Service
rejections for mental disorders; through the psychiatric experience of our armed forces; and through the severe
overcrowding and understaffing of our civilian mental institutions.

Evolution of PsychiatricMental Health
Community Mental Health Centers Act 1963

Attempt to release chronically ill patients from long term stays in state institutions and place them back into community
rehabilitation settings


Evolution of PsychiatricMental Health Nursing
The focus of Community Mental Health is prevention

Prevention is done by identifying the high risk population and providing services before mental health is disrupted.

Services are meant to strike the balance between level of stressors and the available support.

Clientele in Community Mental Health focus on family, social and cultural milieu rather than the individual patient.

Evolution of PsychiatricMental Health Nursing

Gerald Caplan (1961)


Identifies the levels of prevention in psychiatric nursing

believed that using preventive measures, such as early case finding, diagnosis, and crisis intervention could minimize
the incidence and severity of mental illness
LEVELS OF PREVENTION FOR THE DEVELOPMENT OF MENTAL ILLNESS
1. Primary prevention

identify high risk groups and provide health education

Measures or interventions to counteract circumstances or conditions that are potentially harmful

Generates coping skills and reduce vulnerability to illness and promote health

Peer counseling

LEVELS OF PREVENTION FOR THE DEVELOPMENT OF MENTAL ILLNESS
2. Secondary prevention

can be initiated during an acute phase in inpatient settings, emergency departments, or homeless shelters

Measures or interventions used to curtail disease process

Medication maintenance, counseling

LEVELS OF PREVENTION FOR THE DEVELOPMENT OF MENTAL ILLNESS
3. Tertiary prevention

Prevent deleterious effects of mental illness

Measures that minimize relapse and chronic disability, and restore the clients to an optimal level of functioning

Counseling sessions,, support groups- Alcoholic anonymous(AA) , gamblers anonymous

After care programs such as social skills training or relapse prevention

LEVELS OF PREVENTION FOR THE DEVELOPMENT OF MENTAL ILLNESS
3. Tertiary prevention

Promote rehabilitation and health maintenance



Involved in education programs for the mentally ill and focus on social skills training, medication management and
adherence, dual diagnoses, stress management and coping skills training
Evolution of PsychiatricMental Health Nursing
Legislation

Amendments (1975) to the Community Mental Health Centers Act (1963)

Least restrictive care

Deinstitutionalization

Commitment process


Evolution of PsychiatricMental Health Nursing
1970- law changed- no treatment for mentally ill patients against his will

Community Mental Health Centers served smaller geographic catchment, or service, areas that provided less restrictive treatment located
closer to individual’s home, families and friends.

Emergency care

In-patient care

Out-patient services

Partial hospitalization

Screening services

education


DEINSTITUTIONALIZATION
Deinstitutionalization- deliberate shift from institutional care in state hospitals to community facilities

Decrease in admissions to hospitals

Development of community based services as an alternative to hospital care

Provide an income for disabled person (Supplemental Security Income) and (Social Security Disability Income)

Evolution of PsychiatricMental Health Nursing

Legislation

Mental Health Act (1980)

National Plan for the Chronically Ill (1981)

Centered on increasing remission and decreasing exacerbation symptoms by providing continuity of care in Us
communities and health care organizations

Presidents New Freedom Commission on Mental Health (2002)

Major goals:

Educate consumers about the importance of mental health within the scope of overall health

Evolution of PsychiatricMental Health Nursing

Legislation

Presidents New Freedom Commission on Mental Health (2002)

Major goals:



Provide client and family centered mental health care

Eliminate disparities in mental health services

Use primary prevention principles through early mental health screening, assessment, and referrals

Accelerate the use of research as a guide to excellent mental health services
Evolution of PsychiatricMental Health Nursing
Therapy

Movement away from long term psychoanalytic therapy

Broke away from long term psychotherapy and evolved in a decade in which people wanted variety and quick solutions to old
problems that put people “in touch with themselves”


Short term therapy focused on “here and now”

This decade reflected an era of theorists who asserted the relevance of mental health and self actualization and responsibility for
life long choices

Evolution of PsychiatricMental Health Nursing
Biological aspects of mental illness

Research focused on neurobiology, genetic studies, and treatment modalities

New medications-Following 10 years




Monoamine oxidase inhibitor- antidepressant

Haloperidol (Haldol)- antipsychotic

Tricyclic antidepressants

Antianxiety agents- benzodiazepines
Evolution of PsychiatricMental Health Nursing
1990s: Decade of the brain

U.S. Congress declaration based on the number of Americans (50 million) affected by brain disorders ranging from familial
illnesses to prenatal trauma to affective and addictive disorders

Increased study of the living brain through advanced technology like brain imaging

Computed tomography

Positron Emission tomography

Magnetic resonance imaging

Evolution of PsychiatricMental Health Nursing
1990s: Decade of the brain


Increased study of the living brain through advanced technology like brain imaging

Magnetic resonance spectroscopy

Diffusion tensor imaging

Single photon tomography
New psychopharmacologic agents developed

Evolution of PsychiatricMental Health Nursing

The Twenty-First Century: Neuroscience and Genetics

Information Systems: The Internet and Cyberspace

Telemedicine

Provides a forum for interviewing the client via a telemedicine set up or conversing with the video camera,
home monitoring, cell phones and interactive online treatment

Helpful in assessing client during a psychiatric emergency

Provides a venue for mental and physical assessment and triage

Evolution of PsychiatricMental Health Nursing

The Twenty-First Century: Neuroscience and Genetics



Telemedicine

Advantages:

Cost effective- curtails transportation expenses

Increases and provides access to clinical experts especially to those living in rural and remote areas

Enables the psychiatric nurse to establish therapeutic relationship while employing client – centered
intervention and quality health care similar to face to face visit

Evolution of PsychiatricMental Health Nursing
The Twenty-First Century: Neuroscience and Genetics


Information Systems: The Internet and Cyberspace
Information Systems: The Internet and Cyberspace

Telemedicine

Disdvantages:

High investment cost

Privacy and confidentiality issues (lacks visual or face to face contacts

They are likely to interfere with forming trusting interactions with the client and the family

Evolution of PsychiatricMental Health Nursing
The Twenty-First Century: Neuroscience and Genetics

Complementary therapies-promote sense of well being and health

Aromatherapy

Acupuncture

Massage Therapy

Evolution of PsychiatricMental Health Nursing

The Twenty-First Century: Neuroscience and Genetics

Cultural considerations

Cultural competency skills


Cultural competence -A process that entails cultural awareness and knowledge and application in all facets of
health care
Health disparities

Differences in disease prevalence or access to treatment based on gender, race, language, ethnicity,
socioeconomic status, sexual orientation, geographic locale, and education

Evolution of PsychiatricMental Health Nursing

The Twenty-First Century: Neuroscience and Genetics

The Future

Information technology

Social changes abroad

Societal demands

Access and cost of health care

Evolution of PsychiatricMental Health Nursing

Trends

Managed care

Evidence-based health care

Advanced technologies

Client advocacy groups

Evolution of PsychiatricMental Health Nursing

Concepts of practice

Integration of biological knowledge and concepts

Reacquaintance with care and caring

Evolution of PsychiatricMental Health Nursing

Directions for nursing education

Reconceptualize core psychiatric nursing content

Identify critical clinical competencies

Standardize measurable clinical outcomes

Establish a national research agenda

Evolution of PsychiatricMental Health Nursing

Societal changes

Deteriorating social structures

Global AIDS epidemic

Increased violence

Inadequate access to health care

Rising poverty levels

Evolution of PsychiatricMental Health Nursing

Health care trends

Diverse practice settings

Intensive community programs

Home health

Mobile crisis units

Therapeutic foster care

Respite care

Evolution of PsychiatricMental Health Nursing

Collaboration of nursing organizations

Coalition of Psychiatric Nursing

American Psychiatric Nurses Association

International Society of Psychiatric-Mental Health Nurses

Alliance of Psychiatric-Mental Health Nurses

Association of Child and Adolescent Psychiatric Nurses