Intro-Concept

• Psychiatric Mental Health Nursing involves the diagnosis and treatment of human responses to actual or potential mental health problems
• Mental health is a positive state in which one is responsible, display self-awareness, is self-directive, is reasonably worry free, and can cope with usual daily tensions
• Mental health is the ability to solve problems; fulfill one’s capacity for love and work; cope with crises without assistance beyond the support of family or friends; and maintain a state of well-being by enjoying life, setting goals and realistic limits, and becoming independent, interdependent, or dependent as the need arises without permanently losing one’s independence.
• Mental illness is an illnesses or syndrome with psychological or behavioral manifestations and/or impairment in functioning as a result of a social, psychological, genetic, physical/chemical, or biologic disturbance.
• Historically, mental illness was viewed as demonic possession, sin, weakness, and people were punished accordingly.
• Period of enlightenment and creation of mental institutions (1970s)

  • asylum
  • insane asylum
• Treatment of mental disorders (theorists):

  Sigmund Freud (1856-1939) - view human beings objectively
• Treatment of mental disorders (theorists):

  Emil Kraepelin (1856-1926)- classification of mental disorders based on symptoms
• Treatment of mental disorders (theorists):

  Eugene Bleulur (1857-1939) - schizophrenia
• Development of psychopharmacology

  • chloropromazine (thorazine) - antipsychotic
  • lithium - antimanic
  • benzodiazepines
• move toward community mental health (1963):

  Deinstitutionalization - a deliberate from institutional care in state hospitals to community facilities
• Factors influencing mental health:

  individual or personal factors - biologic makeup, autonomy and independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardness, sense of belonging, reality orientation, and coping or stress management abilities
• Factors influencing mental health:

  interpersonal or relationship factors - effective communication, ability to help others, intimacy, and a balance of separateness and connectedness.
• Factors influencing mental health:

  Social/ Cultural or environmental factors - a sense of community, access to adequate resources, intolerance of violence, support of diversity among people, mastery of the environment, and a positive, yet realistic, view of one’s world.
• Role of Psychiatric Nurses:

  Assessment - collects comprehensive health data that is pertinent to the patient's health or situation
• Role of Psychiatric Nurses:

  diagnosis - analyzes the assessment data to determine diagnosis or problems, including level of risk
• Role of Psychiatric Nurses:

  outcomes identification - identifies expected outcomes for a plan individualized to the patient or to the situation
• Role of Psychiatric Nurses:

  Planning - develops a plan that prescribes strategies and alternatives to attain expected outcomes
• Role of Psychiatric Nurses:

  implementation - implements the identified plan
• Role of Psychiatric Nurses:

  coordination of care - coordinates care of delivery
• Role of Psychiatric Nurses:

  health teaching and health promotion - employs strategies to promote health and a safe environment
• Milieu Therapy - provides structures, and maintains a safe and therapeutic environment in collaboration with patients, families, and other healthcare clinicians
• Pharmacological, biological, and integrative therapies - incorporates knowledge of pharmacological, biological, and complementary interventions with applied clinical skills to restore the patient's health and prevent further disability
• prescriptive authority and treatment (APRN only) - uses prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations
• psychotherapy (APRN only) - conducts individual, couples, group, and family psychotherapy using evidence-based psychotherapeutic frameworks and nurse-patient therapeutic relationships
• consultation (APRN only) - provides consultation to influence the identified plan, enhance the abilities of other clinicians to provide services for patients, and effect change
• standard evaluation - evaluates progress toward attainment of expected outocmes
• Qualities of psychiatric nurse:

  • Self-awareness
  • Self-acceptance
  • Accepting the patient 
  • Being sincerely interested in patient care
  • Being available
• Qualities of psychiatric nurse:

  • Empathizing with the patient
  • Reliability
  • Professionalism
  • Accountability
  • The ability to think critically
• The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) - A taxonomy published by the American Psychiatric Association and revised as needed
• The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) - The current edition made some major revision and was released in 2013. Describes all mental disorders, outlining specific diagnostic and research
• Purpose of DSM-F:

  • To provide a standardized nomenclature and language for all mental health professionals
  • To present defining characteristics or symptoms that differentiate specific diagnoses
  • To assist in identifying the underlying causes of disorders
• The classification system allows the practitioner to identify all the factors that relate to a person’s condition:

  • All major psychiatric disorders such as depression, schizophrenia, anxiety, and substance-related disorders
  • Medical conditions that are potentially relevant to understanding or managing the person’s mental disorder as well as medical conditions that might contribute to understanding the person
  • Psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders.
• Interdisciplinary (Multidisciplinary) Team 

  • Most useful in dealing with the multifaceted problems of clients with mental illness
• The Registered Pharmacist

  • a member of the interdisciplinary team when medications, management of side effects, and/or interactions with non-psychiatric, medications are complex.
• Psychiatrist 

  • Diagnosis of mental disorders and prescription of medical treatments
• Psychologist

  • has a doctorate (Ph. D.) in clinical psychology and is prepared to practice therapy, conduct research, and interpret psychological tests
• Psychiatric Nurse

  • has solid foundation in health promotion, illness prevention, and rehabilitation in all areas, allowing him or her to view the client holistically
• Psychiatric Social Worker

  • May practice therapy and often have the primary responsibility for working with families, community support, and referral.
• Occupational therapist 

  • Focuses on the functional abilities of the client and ways to improve client functioning, such as working with arts and crafts and focusing on psychomotor skills.