Presentation on theme: "Chapter 1: Foundations of Psychiatric-Mental Health Nursing"— Presentation transcript:
1 Chapter 1: Foundations of Psychiatric-Mental Health Nursing
2 No single, universal definition Many components influenced by factors Mental HealthDifficult to defineNo single, universal definitionMany components influenced by factorsDynamic, ever-changing stateInfluencing factors:Individual (personal)Interpersonal (relationship)Social/cultural (environmental)
3 Mental IllnessMental disorder: behavioral or psychological syndrome or pattern (clinically significant)Association with present distress or disability or increased risk of death, pain, disability or important loss of freedom
4 Mental Illness (cont’d) General criteria for diagnosisDissatisfaction with characteristics, abilities, accomplishmentsIneffective or unsatisfying relationshipsDissatisfaction with one’s place in the worldIneffective coping with life eventsLack of personal growth
5 Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR: taxonomy of American Psychiatric AssociationPurposes:Standardize nomenclature, languageIdentify defining characteristics or symptomsAssist in identifying underlying causes
6 DSM-IV-TR Classification Axis I: major psychiatric disorders except mental retardation, personality disordersAxis II: mental retardation, personality disordersAxis III: current medical conditions potentially relevantAxis IV: psychosocial, environmental problemsAxis V: Global Assessment of Functioning
7 QuestionTell whether the following statement is true or false:The definition of mental health is standardized and universally accepted.
8 AnswerFalseThere is no single universal definition of mental health, which has many components and is influenced by myriad factors.
9 Historical Perspectives Ancient timesSickness as displeasure of gods; punishment for sins; view as demonic or divineAristotle and imbalances of the four humors (blood, water, yellow and black bile); balance restoration via bloodletting, starving, purgingEarly Christians’ view as possession by demons
10 Historical Perspectives (cont’d) Period of Enlightenment (1790s)Creation of asylums; moral treatmentDorothea DixSigmund Freud: scientific study, treatment of mental illness
11 Historical Perspectives (cont’d) Psychopharmacology (1950s): development of psychotropic drugsCommunity mental health movementDeinstitutionalizationLegislation for disability incomeChanges in commitment laws
12 Mental Illness and the 21st Century Current stateMore than 26% of Americans 18 and older have diagnosable mental disorder (NIMH, 2008)15 million adults, 4 million children and adolescents with impaired daily activitiesEconomic burden exceeds that by all types of cancer
13 Mental Illness and the 21st Century (cont’d) Current stateLeading cause of disability in United States Canada for those years of age1 in 4 adults and 1 in 5 children and adolescents getting care needed
14 Mental Illness and the 21st Century (cont’d) Issues and concerns:“Revolving-door” effect due to deinstitutionalizationShorter hospital stays, decompensation, rehospitalization, dual diagnoses
15 Mental Illness and the 21st Century (cont’d) Issues and concerns:Homelessness (⅓ estimated to have serious mental illness; over ½ with substance abuse problems)Lack of adequate community resourcesACCESS to address needs of full- or part- time homeless persons with mental illness
16 QuestionWhich statement best reflects the current state of mental health and mental illness?Mental health care costs exceed the costs for cancer care.Most adults and children receive adequate mental health care.Community resources for the homeless with mental illness are adequate.Deinstitutionalization has reduced the revolving door effect.
17 Mental health care costs exceed the costs for cancer care. AnswerMental health care costs exceed the costs for cancer care.The economic burden of mental illness exceeds that for all types of cancer care.Only 1 in 4 adults and 1 in 5 children received the necessary mental health care. Community resources for homeless clients with mental illness are inadequate. Deinstitutionalization has led to the “revolving-door” effect.
18 Objectives for the Future Healthy People 2010 objectivesIncrease number of people identified, diagnosed, treated, helped to live healthier livesDecrease rates of suicide, homelessnessIncrease employment for those with serious mental illnessProvide more services for incarcerated persons with mental health problems
19 Development of community support programs Community-Based CareLack of appropriate number of community mental health centers to provide servicesDevelopment of community support programsAvailability, quality of services highly variableInaccurate anticipation of extent of people’s needsDespite flaws, positive aspects making them preferable for treatment
20 Cost Containment and Managed Care Managed care movement (early 1970s)Development of utilization review firms/managed care organizations (1990s); case managementSeparation of mental health care from physical care for insurance coverage
21 Cost Containment and Managed Care (cont’d) Mental health care management through privately owned behavioral health care firmsIf no private insurance, reliance on counties of residence for paymentHCFA: Medicare, MedicaidMental health parity, insurance coverage
22 Cultural Considerations Culturally diverse populationCultural differences influencing mental health, treatment of mental illnessChanges in family structure
23 QuestionTell whether the following statement is true or false:Community-based programs are preferable for treating many people with mental illness.
24 AnswerTrueAlthough there are flaws in the system, community-based programs have positive aspects that make them preferable for treating many people with mental illness.
25 Psychiatric Nursing Practice Linda Richards: first American psychiatric nurseMcLean Hospital, Belmont MA: site of first training for nurses to work with persons with mental illnessExpansion of role with development of somatic therapies
26 Psychiatric Nursing Practice (cont’d) First psychiatric nursing textbook (Nursing Mental Diseases) published in 1920Johns Hopkins: first school of nursing to include psychiatric nursing course (1913)National League for Nursing (1950) requiring schools to include psychiatric nursing experience
27 Psychiatric Nursing Practice (cont’d) H. Peplau: therapeutic nurse-client relationship; interpersonal dimension (foundation for current practice)J. Mellow: focus on client’s psychosocial needs, strengthsAmerican Nurses Association and Standards of Care (see Box 1.3)Psychiatric-Mental Health Nursing Phenomena of Concern (see Box 1.2)
28 Psychiatric Nursing Practice (cont’d) Basic-level functionsCounselingMilieu therapySelf-care activitiesPsychobiologic interventionsHealth teachingCase managementHealth promotion, maintenanceAdvanced-level functionsPsychotherapyPrescriptive authority for drugsConsultation, liaisonEvaluation
29 Student Concerns and Psychiatric-Mental Health Clinical Experience Saying the wrong thingKnowing what to doBeing rejected or not talking to studentAsking personal questionsHandling bizarre, inappropriate, or sexually aggressive behaviorHandling feeling unsafe
30 Student Concerns and Psychiatric-Mental Health Clinical Experience Seeing someone known on the unitDealing with similar problems or backgrounds
31 QuestionTell whether the following statement is true or false:The National League for Nursing required schools to include a psychiatric nursing experience before the first nursing school included a psychiatric nursing course in its curriculum.
32 AnswerFalseJohns Hopkins was the first school of nursing to include a course in psychiatric nursing in its curriculum; this was done in It was not until 1950 that the National League for Nursing required schools to include an experience in psychiatric nursing.
33 Self-Awareness Issues Everyone with unique or different values, ideas, beliefsPossible conflict between personal values/beliefs, those of clientNeed to accept differences, view each client as worthwhile regardless of opinions or lifestyleSelf-awareness through reflection
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