Introduction to Psychiatric / Mental
Health Nursing
Philosophy and Theories for
Interdisciplinary Psychiatric Care
Chapter 1, 2 & 5
West Coast University
NURSING 204
Caring for Psychiatric Mental Health Clients
Feelings, Concerns, Questions—What Are They?
Who Are They?
People with Mental Illness
Factors Influencing Expectations
Media
Other?
Upbringing
Expectations
Culture
Life
experiences
Psychiatric Mental Health Clients
 Psychiatric mental health clients are everyday, ordinary
people.
 Removing the stigma of Mental Illness
 Definition of Stigma: a mark of disgrace or infamy; a stain
or reproach, as on one’s reputation
 Best defined as ignorance, prejudice and discrimination
Factors Impacting Mental Health and Mental
Illness
Biological
Mental
Illness
or
Mental
Health
Social
Cultural
What do these terms mean?
Crazy?
Berserk?
Wacky?
Insane?
Weird?
Lunatic ?
Nervous
Breakdown?
Melancholy?
Historical Approaches
 Era of Magico-Religious Explanations
 Era of Organic Explanations (4th Century)
 Era of Alienation (1300 – 1600)
 Era of Confinement (17th Century)
 Era of Moral Treatment (18th – 19th Century)
 Reform leaders:
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William Cullen
Philippe Pinel
William Tuke
Benjamin Franklin
Benjamin Rush “Father of American Psychiatry”
A ward in Bethlehem Hospital about 1745. A patient is being chained in the
foreground, and in the background are two Sunday visitors on an
entertainment outing. Source: Philosophical Library.
Historical Approaches - continued
 Era of Psychoanalysis (19th to 20th Century)
 Sigmund Freud
 Contemporary Developments (mid 20th Century)
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Social dimensions
Brain dysfunction
Neurochemical
Medication therapy
21st Century Research
 Bases for mental disorders
 Psychotropic medications
 Role of nutrients, biology, and genetics
Mental Disorder Statistics
 High incidence with physical illness
 Account for 47% of all disability in economically
developed countries
 Account for 28% of all disability worldwide
Mental Illness Characteristics
 Distress
 Disability
 Risks
Prevalence Rates for Various Mental Disorders
Leading Causes of Mental Disability Worldwide
Mental Health Studies
 Epidemiologic Catchment Area (ECA)
 Global Burden of Disease (WHO)
 U.S. Surgeon General’s Report
 Healthy People 2020
Healthy People 2020
 Reduce suicide rate
 Reduce the rate of suicide attempts by adolescents
 Increase services for homeless adults with serious
mental illness (SMI)
 Reduce relapse with eating disorders in adolescents
 Increase mental health screening in primary care
services
 Increase mental health services in children
Healthy People 2020 - continued
 Screening in juvenile justice
 Track consumers’ satisfaction with mental health services
 Jail diversion programs for SMI
 Cultural competency
 Plan that address specialized mental health services for the
elderly persons.
 Increase services for person with co-occurring substance
abuse and SMI
 Employee stress in the workplace
Psychiatric-Mental Health Nurses
What do they do?
Chapter 2
Standards
 Standards of Psychiatric-Mental Health Nursing
Practice:
 Guidelines for providing quality care
 Psychiatric-Mental Health Nursing Standards of
Practice
1. Assessment
2. Diagnosis
3. Outcomes Identification
4. Planning
Standards - continued
 Psychiatric-Mental Health Nursing Standards of
Practice
5. Implementation
A. Coordination of Care
B. Health Teaching and Health Promotion
C. Milieu Therapy
D.Phamacological, Biological, and Integrative Therapies
E. Prescriptive Authority and Treatment (APRN only)
F. Psychotherapy (APRN only)
G.Consultation (APRN only)
6. Evaluation
Standards - continued
 Standards of Professional Performance
7. Quality of Practice
8. Education
9. Professional Practice Evaluation
10.Collegiality
11.Collaboration
12.Ethics
13.Research
14.Resource Utilization
15.Leadership
Psychiatric-Mental Health Nurses
 Generalist level
 Advanced practice level
 Prescriptive authority
 Psychotherapy
 Consultation
Estimated Number of Mental Health Workers in the United States
The Mental Health Team
Effective Mental Health Services
Client
Partnerships
PMH Team
Family
Lessons on Collaboration
 “Know thyself”
 Value diversity
 Know that conflict is natural
 Share your power with others
 Master communication skills
 Think life-long learning.
 Embrace interdisciplinary situations.
 Appreciate spontaneity.
 Balance unity with autonomy.
The Role of the Psychiatric-Mental Health Nurse
Custodial
Multifaceted
Psychiatric-Mental Health Nursing (1940-1990)
 Nurses begin to educate nurses.
 Psychiatric theory includes interpersonal and emotional dimensions.
 National Mental Health Act of 1946
 Elimination of single-focus psychiatric nursing schools
 Period of role clarification
 Hildegard Peplau
 Gwen Tudor
 Frances Sleeper
 Community Mental Health Centers Act of 1963
 Psychiatric nursing journals
Psychiatric-Mental Health Nursing (1940-1990) continued
 Birth of clinical nurse specialists and nurse therapist role
 First standards of psychiatric-mental health nursing practice
 Increase role of nurses at national level
 Shift in psychiatric nursing toward humanistic interactionism
 Decrease in numbers of psychiatric nurses
 Decreased funding for training
 Psychiatric nursing diagnoses
Psychiatric-Mental Health Nursing (1990s) Decade of the Brain
 Psychobiologic concepts
 Nursing Psychopharmacology Project
 Health care delivery reform
 Outcome-based research
 Cultural diversity
 Integration of theoretical perspectives
Psychiatric-Mental Health Nursing (2000s) - The
New Millennium
 Standards of practice – revisions
 Knowledge explosion
 Renewed focus on physical health
 Single point of entry
 Advanced practice nurses
 Expansion of practice settings
Nursing Theories Impacting Psychiatric
Nursing
 Marjory Gordon – Functional Health Patterns
(1987)
 Hildegard Peplau – Interpersonal
Relationships (1952)
 Dorothea Orem – Self-Care Deficit (1959)
 Dorothy Johnson – Behavioral System (1968)
 Sister Callista Roy – Adaptation Model (1976)
Hildegard Peplau, PhD, RN, FAAN
Marjory Gordon ,PhD, RN, FAAN
Nursing Theories - Value
 Nursing practice vs. medical practice
 Caring vs. curing
 Interpretation of meaning
 Nurse-client relationship
 Advocacy of client dignity
 Advocacy of nurse authenticity
Application of Theoretical Frameworks
 Application of various theoretical frameworks leads to:
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Quality client-centered care.
Efficient use of resources.
Practice-oriented research.
Clinical judgments and actions that can be articulated and
taught to others.
Gordon's 11 Functional Health Patterns
Functional
Health Pattern
Pattern Describes
Examples
Health Perception/
Health Management
Client's perceived pattern of health and
well-being and how health is managed.
Compliance with medication regimen,
use of health-promotion activities such
as regular exercise, annual check-ups.
Nutritional-Metabolic
Pattern of food and fluid consumption
relative to metabolic need and pattern;
indicators of local nutrient supply.
Condition of skin, teeth, hair, nails,
mucous membranes; height and
weight.
Elimination
Patterns of excretory function (bowel,
bladder, and skin). Includes client's
perception of a “normal" function.
Frequency of bowel movements,
voiding pattern, pain on urination,
appearance of urine and stool.
Activity - Exercise
Patterns of exercise, activity, leisure,
and recreation.
Exercise, hobbies. May include
cardiovascular and respiratory status,
mobility, and activities of daily living.
Cognitive-Perceptual
Sensory-perceptual and cognitive
patterns.
Vision, hearing, taste, touch, smell,
pain perception and management;
cognitive functions such as language,
memory, and decision making.
Sleep-Rest
Patterns of sleep, rest, and relaxation.
Client's perception of quality and
quantity of sleep and energy, sleep
aids, routines client uses.
Gordon's 11 Functional Health Patterns
Functional
Health Pattern
Pattern Describes
Examples
Role-Relationship
Client's pattern of role engagements
and relationships.
Perception of current major roles sand
responsibilities (e.g., father, husband,
salesman); satisfaction with family,
work, or social relationships.
Sexuality-Reproductive
Patterns of satisfaction and
dissatisfaction with sexuality pattern;
reproductive pattern.
Number and histories of pregnancy
and childbirth; difficulties with sexual
functioning; satisfaction with sexual
relationship.
Coping / Stress Tolerance
General coping pattern and effective of
the pattern in terms of stress tolerance.
Client's usual manner of handling
stress, available support systems,
perceived ability to control or manage
situations.
Value - Belief
Patterns of values, beliefs (including
spiritual), and goals that guide client's
choices or decisions.
Religious affiliation, what client
perceives as important in life, valuebelief conflicts related to health, special
religious practices.
Self-Perception/
Self Concept
Client's self-concept pattern and
perceptions of self.
Body comfort, body image, feeling
state, attitudes about self, perception
of abilities, objective data such as body
posture, eye contact, voice tone.
Holistic Practice:
Expanded Role for Nurses (Chapter 5)
 Interactionism
 Individuals have purpose and control.
 Humanistic cast
 Interaction of psychology, psychobiology, and
sociocultural contexts
 Humanism
 Devotion to individual interests
 Spirit of compassion and caring
 Affirming of the joy, beauty, and value of living
Nursing Implications
 Humanistic Interactionism
 Interrelated physical and mental factors
 Holistic
 Expanded role for psychiatric-mental health nurses
 Client and family role includes negotiation and advocacy.
Nursing Implication
 Psychobiology
 Focus on biological, medical, and human aspects of
care.
 Holistic
 Integrative
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New knowledge
“High tech” and “high touch”
Nature and nurture
Biologic sciences and behavioral sciences
Medical-Psychobiologic
Theory
 Key concepts
 Emotional disturbance indicates illness or defect.
 Illnesses are located in the brain or central
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nervous system.
Illnesses have specific characteristics.
Mental diseases have a characteristic course.
Mental disorders respond to physical or somatic
treatments.
Psychobiologic explanations reduce stigma.
Comparison of Traditional
Psychiatric Theories
Psychoanalytic Theory
Sigmund Freud:
 All psychological emotional events can be understood.
 Childhood experiences → adult neuroses
 Goal of therapy is gaining insight.
Psychoanalytic
Theory
Levels of awareness in relation to id,
ego, and superego
Id: Present at birth. Serves to satisfy
needs and immediate gratification
Ego: Begins to develop at 4 – 6
months. Maintain contact with reality,
rational part of personality.
Superego: begins to develop at about
3 – 6 years. Serves as conscience
(sense of right or wrong)
Cognitive Concepts
Social–Interpersonal Theories
Social–Interpersonal Theories
Maslow: Self-Actualization and Hierarchy of
Needs