Concepts of psychiatric
and mental health
nursing
Mihaela E. Olson, APNC, PMHRNC
Family Nurse Practitioner
Associate Professor of Nursing
Chapter 1
Practicing the Science and Art of
Psychiatric Nursing
Psychiatric and mental health
nursing (PMHN)
 Focuses on the treatment of human
responses to mental health problems and
psychiatric disorders
 “ A core mental health profession,
employs a purposeful use of self as its
art and a wide array of nursing,
psychological and neurobiological
theories and research evidence as its
science.” (ANA, 2007)
Evidence based practice nursing
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Method for using treatment approaches to
medical and mental health illness that are
scientifically grounded or evidence based
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In psychiatry, this focus extends to treatment
approaches in which there is scientific evidence
for psychological and sociological treatment
approaches as well as for evidence related to
the neurobiology of psychiatric disorders and
psychopharmacology
Mental health recovery model
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Refers primarily to managing symptoms, reducing
psychosocial disability and improve role performance
(Pratt, et al., 2006)
Views recovery as personal journey of healing
Goal is to empower those with mental illness to find
meaning and satisfaction in their lives, realize personal
potential and function at their optimum level of
independence
Supportive relationships, social inclusion, attain coping
skills, recovery oriented services, and sense of hope for
future can lead to high quality of life with this illness
The science of nursing: finding the
evidence for practice

Florence Nightingale (1820-1910) founder of
modern nursing, her philosophy was a reflection
of evidence-based practice

Nightingale proposal (1860) resulted in the 1st
model for systemic collection of hospital data
using a uniform classification of diseases and
operations and was to form the basis of
“International Statistical Classification of
Diseases and Related Health Problems” used
worldwide today (Keith, 1988)
Hildegard Peplau (1909-1999)
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Considered the mother of psychiatric nursing
Former professor at Rutgers University
Developed the art and science of professional nursing
practice
Believed that a scientific approach was essential to
practice psychiatric nursing
Introduced the concept of advance nursing practice and
promoted professional standards and regulation
through credentialing among other significant
contributions to nursing (Tomey, 2006)
The 5 A’s of EBN

Multistep process of integrating evidence-based
practice into clinical practice
1.
2.
3.
4.
5.
Ask a question: identify a problem or need for change
Acquire literature: search literature for scientific studies
and articles that address the area of concern
Appraise the literature: evaluate and synthesize the
research evidence as to its validity , relevance and
applicability using criteria of scientific merit
Apply the evidence: Interventions based on best available
evidence with patient preference and needs
Assess the performance: Evaluate outcomes, use clearly
defined criteria, reports, and document results
Hierarchy of evidence and grading
of recommendations
Each recommendation has been allocated
grading that directly reflects the hierarchy
of evidence on which it has been based
 Hierarchy of evidence: includes level and
type of evidence
 Grading of recommendations: includes
level and type of evidence
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Guidelines for practice
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Mental Health Web Resources: focus on sites
maintained by professional societies or org
whose quality is evidenced based
Clinical Practice Guidelines; systematically dev
statements that identify, appraise and
summarize best evidence
Clinical Algorithms: step by step guidelines
prepared in a flowchart format
Clinical/critical pathways: usually specific to the
institution using them
The art of nursing: developing the
skills for practice
1.
Caring: involves how we relate to one another,
how we show concern in daily life
Evidenced by empathetic understanding , actions, and patience on
another's behalf
Caring for one another by actions, words, and being there leads to
happiness and touches the heart
Defined as giving of self while preserving the importance of self
A nurse must demonstrate a level of competence and the art of caring
Absence of caring can leave memorable scars and make pts feel
distrustful, disconnected, uneasy, and discouraged
The art of nursing: developing the
skills for practice
2. Attending: refers to the intensity of presence,
being there in tune with the pt
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When a human connection is made between the nurse and the pt,
the pt sense of isolation is minimized or eliminated
Attending behaviors include listening, touching, or giving attentive
physical care
Through active listening skills and effective communication we can
fully understand another persons immediate experience and
distressing fears, perceptions and concerns
The art of nursing: developing the
skills for practice
3. Patient advocacy: One who speaks up for another ‘s
cause , who helps another by defending and comforting
them, especially when the other lacks knowledge, skills,
ability to stand up for themselves
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Ethical role
Patient advocate in 1976 ANA Code of Ethics
Advocacy in nursing includes commitment to pts health, well-being,
and safety across the life span, the alleviation of suffering and
promoting a peaceful, comfortable and dignified death (ANA, 2001)
In order to become successful...
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“We must all suffer from one of two pains:
the pain of discipline or the pain of regret.
The difference is discipline weighs ounces,
while regret weighs tones.”
Jim Rohn,
motivational speaker