Foundations of Psychiatric Mental Health Nursing

Foundations of Psychiatric-Mental Health Nursing

• Mental health is challenging to define and lacks a single, universal definition
• It involves many components and is influenced by various factors
• Mental health is a dynamic and ever-changing state
• Mental health is influenced by individual, interpersonal, and sociocultural factors

Factors of Mental Health

• Genetic makeup, autonomy, independence, self-esteem, resilience, sense of belonging, and coping abilities are all individual factors
• Effective communication, intimacy, and the balance of separateness and connectedness are interpersonal factors
• Nonmedical factors like education, environment, employment, income, and support of diversity are social determinants
• Mental health is adapting successfully to stressors from the internal or external environment
• Mental health results in thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms

Mental Illness #1

• Mental illness includes disorders affecting mood, behavior, and thinking
• Mental disorders often cause substantial distress and/or impaired functioning
• Individuals may feel dissatisfied with themselves, relationships, and have ineffective coping mechanisms
• Incomprehensibility is the inability of general population to understand motivation behind an individuals behavior
• Cultural relativity impacts understandability

Mental Illness #2

• Factors contributing to mental illness can be individual, interpersonal, or social/cultural
• Individual factors: biologic makeup, intolerable or unrealistic worries/fears, inability to distinguish fantasy from reality
• Interpersonal factors: ineffective communication, inadequate social support
• Social/cultural factors: unwarranted negative view of the world, discrimination, such as stigma, racism, and classism

DSM-5-TR

• The DSM-5-TR is a taxonomy published by the American Psychiatric Association
• Its purposes are to standardize nomenclature and language, present defining characteristics/symptoms, and assist in identifying underlying causes of disorders
• The DSM-5-TR classification allows practitioners to identify all factors related to a client's condition
• These factors include major psychiatric disorders, medical conditions, and psychosocial and environmental problems

Historical Perspectives

• In ancient times, sickness was viewed as displeasure of gods, punishment for sins, or demonic/divine influence
• Aristotle attributed imbalances in the four substances (blood, water, yellow, and black bile)
• Restore balance via bloodletting, starving, and purging
• Early Christians viewed mental illness as possession by demons
• The Renaissance period started distinguishing people with mental illness from criminals
• The Hospital of St. Mary of Bethlehem was officially declared a hospital for the insane
• By 1775, visitors were charged a fee to view and ridicule the inmates, who were seen as less than human animals
• The period of enlightenment occurred in the 1790s
• Philippe Pinel (France) and William Tuke (England) created asylums as a safe refuge for the mentally ill
• Dorothea Dix began a crusade and opened 32 state hospitals offering asylum
• Sigmund Freud initiated scientific study and treatment of mental disorders including studying the mind
• Emil Kraepelin categorized mental disorders bases on symptoms
• Eugen Bleuler coined the term schizophrenia
• Psychopharmacology (1950s) led to the development of psychotropic drugs
• Deinstitutionalization shifted from hospital care to community mental health centers

Mental Illness in the 21st Century

• Currently 51.5 million adults in the United States have a mental illness
• Only 23 million received treatment within the past year
• Nearly 11 million children and adolescents are diagnosed with a mental disorder
• The economic burden of mental illness exceeds that of all types of cancer
• Only 1 in 4 adults and 1 in 5 children and adolescents are treated
• Deinstitutionalization has issues and concerns like the “revolving door” effect
• Patients are often "boarded" in the emergency department while awaiting inpatient beds
• Issues continue: shorter hospital stays, decompensation, rehospitalization
• Homelessness affects about one-third of people who have severe mental illness or a chronic substance use disorder
• There is also a lack of adequate community resources

Community-Based Care & Cultural Considerations

• Community support programs focus on rehabilitation, vocational needs, education, socialization, medication, and symptoms management
• The availability and quality of services is highly variable but positive aspects make community care preferable treatment
• Nurses must be prepared to care for a culturally diverse population with changing family structures

Psychiatric Nursing Practice

• Linda Richards was the first American psychiatric nurse
• McLean Hospital in Belmont, MA, was the site of the first nurse training program
• Care was primarily custodial care: nutrition, hygiene and activity
• The first psychiatric nursing textbook (Nursing Mental Diseases) was published in 1920
• Johns Hopkins was the first school of nursing to include psychiatric nursing course (1913)
• The National League for Nursing (1950) required schools to include an experience in psychiatric nursing
• H. Peplau was an early nursing theorist who defined the therapeutic nurse-client relationship
• She also defined the interpersonal dimension which formed the foundation for current practice
• Basic-level functions include counseling, milieu therapy, self-care activities, psychobiologic interventions, health teaching, case management, health promotion, and maintenance
• Advanced-level functions include psychotherapy, prescriptive authority for drugs, consultation and liaison, evaluation, program development/management, and clinical supervision

Areas of Student Concern

• Saying the wrong thing
• Knowing what to do
• Being rejected or refused when trying to talk
• Asking personal questions
• Handling bizarre, inappropriate, or sexually aggressive behavior
• Physical safety
• Encountering someone known
• Dealing with similar problems or backgrounds

Self-Awareness

• Self-awareness is gaining recognition of one's own feelings, beliefs, and attitudes
• Recognizing and understanding your own beliefs and attitudes, is an important part of care for patients
• Everyone has unique and different values, ideas, and beliefs
• There is a need to accept differences and view each client as worthwhile regardless of opinions or lifestyle
• Self awareness comes through reflecting how you feel and what you value

Points to Consider for Self Awareness

• Keep a diary or journal that focuses on experiences and related feelings
• Talk with someone you trust about your experiences and feelings
• Seek alternative points of view
• Do not be critical of yourself or for others, for having certain values or beliefs

The Roles of the Mental Health Nurse

• Stranger
• Resource Person
• Teacher
• Leader
• Surrogate
• Counselor
• Patient Advocate
• Case Manager
• Researcher