Psychiatric Nursing: History and Roles

• This handout will define Psychiatric Nursing by exploring its history, roles, qualities, interdisciplinary teams, their composition, and mental health illness continuum.

Psychiatric Nursing

• It involves a professional nurse practitioner assisting individuals, families, and communities in promoting mental health.
• It helps prevent or cope with mental illness and suffering, and to find meaning in these experiences.
• It is a specialized nursing area using human behavior theories as its science and purposeful self-use as its art, according to the American Nurses Association.
• Its purpose is to help patients accept themselves, promote good relationships, and function independently.
• Mental health involves adapting to internal or external stressors, shown by age-appropriate thoughts, feelings, and behaviors aligned with local and cultural norms.

Evolution of Psychiatric-Mental Health Care

• Mental health care evolution has shifted from driving out evil spirits to confinement, and now to community-based primary care.
• Historically, the treatment of the mentally ill has depended on the cultural and religious beliefs of the civilization.

Early History

• Insanity was linked to sin and demonic possession, and mental illness was often seen as incurable.
• Treatment was sometimes inhumane and brutal, often involving demonic possession.

Middle Ages (14th Century)

• The insane, uncared for by families, were imprisoned or forced to live on the streets and beg for food.
• They relied on religious charity for alms, food, and rare almshouses or general hospitals upon admission.

15th-17th Centuries

• Skepticism persisted about the curability of mental illness.
• Asylums became places for long-term confinement of the chronically mentally ill, with deplorable conditions.
• Patients were seen as lacking feelings and understanding and were treated more like animals.
• They were poorly clothed, fed, often chained, caged, and deprived of heat and sunlight.

18th Century

• Dr. Benjamin Rush (1745-1813) was a forerunner in bringing attention to the plight of those with mental disorders.
• He emphasized the need for pleasant surroundings, diversional, and moral treatment for the mentally ill, and is considered the father of American psychiatry.

19th Century

• There was an evolution of the psychiatric nurse.
• In 1817, McLean Asylum in Massachusetts was the first US institution to provide humane treatment for the mentally ill, emphasizing understanding and promoting mental and physical health.

20th Century

• It was the era of psychiatry and scientific study.
• Theorists and researchers laid the groundwork for understanding and demystifying mental illness.
• Adolph Meyer: Focused on studying a person's environment to determine its impact on their total personality.
• He accepted that mental disease resulted from the individual's maladaptation to his or her environment.
• Clifford Beers: Provided a descriptive account of his experiences in mental institutions.
• Harry Stack Sullivan (1892-1949): Believed anxiety interfered with coping and communication, leading to mental illness, and could be reduced through meaningful interpersonal relationships.

Roles and Functions of a Psychiatric Nurse

• Peplau (1957) identified subroles within the nurse's role.

The mother-surrogate

• The nurse fulfills basic needs like bathing, feeding, dressing, and toileting, providing an opportunity to establish a relationship and communicate with the patient.

The technician

• The focus is on competent, efficient, and correct performance of technical procedures, such as administering needs, getting vital signs, giving bed baths, and assisting with ECT (electroconvulsive therapy).

The health teacher

• The nurse identifies learning needs and gives info to the patient or family.
• The nurse's tone of voice or attitude may impact learning.

The socializing agent

• The main function involves participating in social activities with the patient, which can be stress-relieving.

The counselor or psychotherapist

• The nurse uses interpersonal techniques to help patients learn and adapt to life's difficulties by eliciting feelings.

The manager

• The nurse manages and manipulates the environment to improve conditions for patient recovery.
• The nurse needs to survey needs, organize, record, plan, and evaluate patient care.

Interdisciplinary Team

• It involves team members from various disciplines collaborating with a shared goal, making decisions, and sharing resources and responsibilities.
• The team may include physicians, social workers, psychologists, occupational therapists, and physical therapists.

The Mental Health Illness Continuum

• Mental health is the successful adaptation to stressors from the internal or external environment, evidenced by age-appropriate thoughts, feelings, and behaviors.

Concepts of Mental Health

• A positive attitude towards oneself starts with an objective view, knowledge, and acceptance of strengths and weaknesses, including a strong sense of personal identity and security.
• Growth development and self-actualization correlates with successful milestones.
• Success boosts motivation to achieve higher potential.
• Integration/Integrative capacity focuses on equilibrium among life processes, adaptively responding to the environment, and developing a life philosophy to manage anxiety during stressful situations.

Autonomy/Autonomous behavior

• Refers to the ability to act independently and be self-directed.

Perception of reality

• Encompasses perceiving the environment without distortion, as well as empathy and social sensitivity, showing respect and concern for others' needs.

Environmental mastery/ Mastery of one's environment

• Indicates that one has achieved a satisfactory role within their group, society, or environment.
• The ability to love and accept love from others is also essential.
• Successfully strategizing, deciding, and adapting to life leads to personal satisfaction.

Ways to Maintain Mental Health

• Interpersonal Communication: is the process by which people exchange information, feelings and meaning through verbal and non-verbal messages
• Face to face communication: Interpersonal communication helps a person communicate well and interact with others effectively within the workplace.
• Defense Mechanism/Coping Mechanism: People handle difficulties and pain differently, using healthy or unhealthy coping mechanisms depending on the situation.
• Normal and abnormal: people use defense mechanisms to be free from anxiety
• Cognitive Distortions: used by the person in order to control the situation.
• Significant others or support person: a person who is important to one's well being; especially a spouse or one in a similar relationship
• Group of people: with common experiences or concerns encourages, comforts, and advises
• Friends: are really important, help each other whenever we can, so it is a 2-way street and supports.

Mental Illness

• Characterized by psychological or behavioral manifestations and/or impaired functioning due to social, psychological, genetic, physical/chemical, or biological disturbances.
• Causes of Mental Disorders:

Predisposing cause

• A condition makes the individual susceptible to the later effect
• Heredity: the natural process by which physical and mental qualities are passed from a parent to a child
• Age: there are 3 periods in life when persons appear to be constitutionally vulnerable to mental disorder.
• Periods: - Adolescence: peer pressure; heightened emotion - Menopause/ Child bearing: post partum depression (an extreme mood disorder); menopause (due to hormone level changes) - Senile period: during this period the body undergoes physiological changes
• Sex-if does not predispose one or protect one against mental disorder but statistics show more incidence in women especially during child bearing and menopause periods
• Environment and Social factor-mores and customs of one's culture may become a problem; financial depression; family member separation and health situation.
• Occupation-may predispose one to mental disorder both directly and indirectly contact with certain chemical such as carbon bisulfide found in the manufacture of cellophane and lead that can severely affect the mental capacity of the individual.
• Previous attack-one attack of mental illness may predispose a person for second attack and additional attacks

Precipitating cause

• Is best described as the exciting cause of psychiatric disorder
  • Include, the sudden or unexpected death of a loved one, personal failure, divorce, or financial losses

Psychic cause-neurotransmitter disturbances

• Neurotransmitter: a chemical substance by the neuron that aid in the transmission of information throughout the body
• A substance in the body that carries a signal from one nerve cell to another

Substances include

• Dopamine: controls complex movements, motivation, cognition, and regulates emotional response.
• Serotonin: function is inhibitory and plays a role in anxiety and mood disorder
• Controls: food intake, sleep and wakefulness, temperature regulation, pain control, sexual behaviors, and regulation of emotions.
• Histamine: controls alertness, gastric secretions, cardiac stimulation, and peripheral allergic responses.
• GABA (Gamma-amino butyric acid): it's function is inhibitory and modulates other neurotransmitters.
• Epinephrine and Norepinephrine: controls fight or flight response, and causes changes in attention, learning and memory, sleep & wakefulness and mood.

General Criteria to Diagnose Mental Disorder

• Dissatisfaction with one's characteristics, abilities, and accomplishments.
• Ineffective or unsatisfying interpersonal relationship - unable to establish a meaningful relationship
• Dissatisfaction with one's place in the world
• Ineffective coping pattern -unable to cope avoids problems rather than coping with them or not attempting to solve them.