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Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 1: Foundations of Psychiatric- Mental Health Nursing.

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Presentation on theme: "Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 1: Foundations of Psychiatric- Mental Health Nursing."— Presentation transcript:

1 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 1: Foundations of Psychiatric- Mental Health Nursing

2 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mental Health Difficult to define No single, universal definition Many components influenced by factors Dynamic, ever-changing state Influencing factors: –Individual (personal) –Interpersonal (relationship) –Social/cultural (environmental)

3 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mental Illness Mental 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mental Illness (contd) General criteria for diagnosis –Dissatisfaction with characteristics, abilities, accomplishments –Ineffective or unsatisfying relationships –Dissatisfaction with ones place in the world –Ineffective coping with life events –Lack of personal growth

5 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR: taxonomy of American Psychiatric Association Purposes: –Standardize nomenclature, language –Identify defining characteristics or symptoms –Assist in identifying underlying causes

6 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins DSM-IV-TR Classification Axis I: major psychiatric disorders except mental retardation, personality disorders Axis II: mental retardation, personality disorders Axis III: current medical conditions potentially relevant Axis IV: psychosocial, environmental problems Axis V: Global Assessment of Functioning

7 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: The definition of mental health is standardized and universally accepted.

8 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False There is no single universal definition of mental health, which has many components and is influenced by myriad factors.

9 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Historical Perspectives Ancient times –Sickness as displeasure of gods; punishment for sins; view as demonic or divine –Aristotle and imbalances of the four humors (blood, water, yellow and black bile); balance restoration via bloodletting, starving, purging –Early Christians view as possession by demons

10 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Historical Perspectives (contd) Period of Enlightenment (1790s) –Creation of asylums; moral treatment –Dorothea Dix Sigmund Freud: scientific study, treatment of mental illness

11 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Historical Perspectives (contd) Psychopharmacology (1950s): development of psychotropic drugs Community mental health movement –Deinstitutionalization –Legislation for disability income –Changes in commitment laws

12 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mental Illness and the 21st Century Current state –More than 26% of Americans 18 and older have diagnosable mental disorder (NIMH, 2008) –15 million adults, 4 million children and adolescents with impaired daily activities –Economic burden exceeds that by all types of cancer

13 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mental Illness and the 21st Century (contd) Current state –Leading cause of disability in United States Canada for those years of age –1 in 4 adults and 1 in 5 children and adolescents getting care needed

14 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mental Illness and the 21st Century (contd) Issues and concerns: –Revolving-door effect due to deinstitutionalization –Shorter hospital stays, decompensation, rehospitalization, dual diagnoses

15 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mental Illness and the 21st Century (contd) Issues and concerns: –Homelessness ( estimated to have serious mental illness; over ½ with substance abuse problems) –Lack of adequate community resources ACCESS to address needs of full- or part- time homeless persons with mental illness

16 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which statement best reflects the current state of mental health and mental illness? A.Mental health care costs exceed the costs for cancer care. B.Most adults and children receive adequate mental health care. C.Community resources for the homeless with mental illness are adequate. D. Deinstitutionalization has reduced the revolving door effect.

17 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A.Mental 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Objectives for the Future Healthy People 2010 objectives –Increase number of people identified, diagnosed, treated, helped to live healthier lives –Decrease rates of suicide, homelessness –Increase employment for those with serious mental illness –Provide more services for incarcerated persons with mental health problems

19 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Community-Based Care Lack of appropriate number of community mental health centers to provide services Development of community support programs –Availability, quality of services highly variable –Inaccurate anticipation of extent of peoples needs –Despite flaws, positive aspects making them preferable for treatment

20 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cost Containment and Managed Care Managed care movement (early 1970s) Development of utilization review firms/managed care organizations (1990s); case management Separation of mental health care from physical care for insurance coverage

21 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cost Containment and Managed Care (contd) Mental health care management through privately owned behavioral health care firms –If no private insurance, reliance on counties of residence for payment HCFA: Medicare, Medicaid Mental health parity, insurance coverage

22 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Considerations Culturally diverse population Cultural differences influencing mental health, treatment of mental illness Changes in family structure

23 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false: Community-based programs are preferable for treating many people with mental illness.

24 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Although there are flaws in the system, community-based programs have positive aspects that make them preferable for treating many people with mental illness.

25 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychiatric Nursing Practice Linda Richards: first American psychiatric nurse McLean Hospital, Belmont MA: site of first training for nurses to work with persons with mental illness Expansion of role with development of somatic therapies

26 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychiatric Nursing Practice (contd) First psychiatric nursing textbook (Nursing Mental Diseases) published in 1920 Johns Hopkins: first school of nursing to include psychiatric nursing course (1913) National League for Nursing (1950) requiring schools to include psychiatric nursing experience

27 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychiatric Nursing Practice (contd) H. Peplau: therapeutic nurse-client relationship; interpersonal dimension (foundation for current practice) J. Mellow: focus on clients psychosocial needs, strengths American Nurses Association and Standards of Care (see Box 1.3) Psychiatric-Mental Health Nursing Phenomena of Concern (see Box 1.2)

28 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychiatric Nursing Practice (contd) Basic-level functions –Counseling –Milieu therapy –Self-care activities –Psychobiologic interventions –Health teaching –Case management –Health promotion, maintenance Advanced-level functions –Psychotherapy –Prescriptive authority for drugs –Consultation, liaison –Evaluation

29 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Student Concerns and Psychiatric-Mental Health Clinical Experience Saying the wrong thing Knowing what to do Being rejected or not talking to student Asking personal questions Handling bizarre, inappropriate, or sexually aggressive behavior Handling feeling unsafe

30 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Student Concerns and Psychiatric-Mental Health Clinical Experience Seeing someone known on the unit Dealing with similar problems or backgrounds

31 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Johns 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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Self-Awareness Issues Everyone with unique or different values, ideas, beliefs Possible conflict between personal values/beliefs, those of client Need to accept differences, view each client as worthwhile regardless of opinions or lifestyle Self-awareness through reflection


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