1. Introduction to Psychiatric / Mental Health Nursing Philosophy and Theories for Interdisciplinary Psychiatric Care Chapter 1, 2 & 5
West Coast University
NURSING 204

2. Caring for Psychiatric Mental Health Clients
Feelings, Concerns, Questions—What Are They?
Who Are They?

3. People with Mental Illness

4. Factors Influencing Expectations
Media
Other?
Upbringing
Expectations
Life experiences
Culture

5. 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

6. Factors Impacting Mental Health and Mental Illness
Biological
Mental Illness or
Mental
Health
Social
Cultural

7. What do these terms mean?
Crazy?
Berserk?
Wacky?
Insane?
Weird?
Lunatic ?
Nervous Breakdown?
Melancholy?

8. 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:
William Cullen
Philippe Pinel
William Tuke
Benjamin Franklin
Benjamin Rush “Father of American Psychiatry”

9. A ward in Bethlehem Hospital about 1745
A ward in Bethlehem Hospital about A patient is being chained in the foreground, and in the background are two Sunday visitors on an entertainment outing. Source: Philosophical Library.

10. Historical Approaches - continued
Era of Psychoanalysis (19th to 20th Century)
Sigmund Freud
Contemporary Developments (mid 20th Century)
Social dimensions
Brain dysfunction
Neurochemical
Medication therapy
19th century and early 20th century.

11. 21st Century Research Bases for mental disorders
Psychotropic medications
Role of nutrients, biology, and genetics

12. 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

13. Mental Illness Characteristics
Distress
Disability
Risks

14. Prevalence Rates for Various Mental Disorders.

15. Leading Causes of Mental Disability Worldwide

16. Mental Health Studies Epidemiologic Catchment Area (ECA)
Global Burden of Disease (WHO)
U.S. Surgeon General’s Report
Healthy People 2020

17. 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

18. 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

19. Psychiatric-Mental Health Nurses
What do they do?
Chapter 2

20. Standards Standards of Psychiatric-Mental Health Nursing Practice:
Guidelines for providing quality care
Psychiatric-Mental Health Nursing Standards of Practice
Assessment
Diagnosis
Outcomes Identification
Planning

21. Standards - continued
Psychiatric-Mental Health Nursing Standards of Practice
Implementation
Coordination of Care
Health Teaching and Health Promotion
Milieu Therapy
Phamacological, Biological, and Integrative Therapies
Prescriptive Authority and Treatment (APRN only)
Psychotherapy (APRN only)
Consultation (APRN only)
Evaluation

22. Standards - continued Standards of Professional Performance
Quality of Practice
Education
Professional Practice Evaluation
Collegiality
Collaboration
Ethics
Research
Resource Utilization
Leadership

23. Psychiatric-Mental Health Nurses
Generalist level
Advanced practice level
Prescriptive authority
Psychotherapy
Consultation

24. Estimated Number of Mental Health Workers in the United States

25. The Mental Health Team

26. Effective Mental Health Services
Client
Partnerships
PMH Team
Family

27. 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.

28. The Role of the Psychiatric-Mental Health Nurse
Custodial
Multifaceted

29. 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

30. 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

31. 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

32. 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

33. 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)

34. Hildegard Peplau, PhD, RN, FAAN

35. Marjory Gordon ,PhD, RN, FAAN

36. 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

37. Application of Theoretical Frameworks
Application of various theoretical frameworks leads to:
Quality client-centered care.
Efficient use of resources.
Practice-oriented research.
Clinical judgments and actions that can be articulated and taught to others.

38. Gordon's 11 Functional Health Patterns
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.

39. Gordon's 11 Functional Health Patterns
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, value-belief 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.

40. 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

41. 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.

42. Nursing Implication Psychobiology
Focus on biological, medical, and human aspects of care.
Holistic
Integrative
New knowledge
“High tech” and “high touch”
Nature and nurture
Biologic sciences and behavioral sciences

43. Medical-Psychobiologic Theory
Key concepts
Emotional disturbance indicates illness or defect.
Illnesses are located in the brain or central nervous system.
Illnesses have specific characteristics.
Mental diseases have a characteristic course.
Mental disorders respond to physical or somatic treatments.
Psychobiologic explanations reduce stigma.

44. Comparison of Traditional Psychiatric Theories

45. Psychoanalytic Theory
Sigmund Freud:
All psychological emotional events can be understood.
Childhood experiences → adult neuroses
Goal of therapy is gaining insight.

46. 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)

47. Cognitive Concepts

48. Social–Interpersonal Theories

49. Social–Interpersonal Theories

50. Maslow: Self-Actualization and Hierarchy of Needs