Summary

This document is a lecture preliminary for NCM 117, outlining a historical overview of psychiatric nursing. The document covers the evolution of psychiatric care, examining different historical periods and significant figures, emphasizing the progression of treatment and approaches. Important topics like the 18th century and its figures like Benjamin Rush are mentioned.

Full Transcript

NCM 117 LECTURE PRELIM INTRODUCTION AND HISTORY OF PSYCHIATRIC ​ Benchmarks in psychiatric history NURSING ○​ Rosenblatt’s ABC of community A.​EVOLUTION OF PSYCHIATRIC-MENTAL HEALTH response:...

NCM 117 LECTURE PRELIM INTRODUCTION AND HISTORY OF PSYCHIATRIC ​ Benchmarks in psychiatric history NURSING ○​ Rosenblatt’s ABC of community A.​EVOLUTION OF PSYCHIATRIC-MENTAL HEALTH response: CARE -​ ASSISTANCE (least restrictive) - provided food and money and often 1.​ EARLY HISTORY enabled the family to -​ Associated with sin and demonic maintain its integrity as a possession unit -​ Perceived as incurable -​ BANISHMENT - wandering -​ Treatment was inhuman and brutal band of “lunatics… living no one cared how and dying no 2.​ MIDDLE AGES one cared where” -​ Not cared by families -​ CONFINEMENT (most -​ Often imprisoned or live on the restricted) - chained streets -​ Hospital of St. Mary of Bethlehem 4.​ THE 18TH CENTURY -​ Refuge for the destitute and afflicted -​ French and american revolutions -​ Campaigns for the abolition of 3.​ 15th - 13th CENTURY slavery through championing of -​ Skepticism about the curability was equal rights for women rampant -​ Care for the impoverished -​ Thought to have no feelings -​ Believed to lack understanding a.​ Benjamin Rush (1745 - 1813) -​ Treated like animals -​ Father of American Psychiatry -​ Men and women not given -​ Emphasized need for pleasant separated quarters surroundings -​ Care administered by attendants -​ Diversional and moral treatment -​ Witch-hunts and executions -​ Inducement of fright cause culminated the deeply rooted ideas mentally ill to regain their sanity about mental illness -​ Credited with inventing the -​ FORM OF TREATMENT: tranquilizer chair and the Gyrator -​ Ice bath = pampagising daw but causes hypothermia b.​ Philippe Pinel (1745 - 1826) -​ Bleeding = possible -​ advocated kindness and moral magkaroon ng hypovolemic treatment shock -​ placed in charge of a large hospital in La Bicêtre and the Salpêtrière -​ releasing the insane from chains NCM 117 LECTURE PRELIM -​ reformation of societal attitudes -​ the psychiatric nursing role had not toward those suffering from yet been established mental illness -​ mental conditions became deplorable c.​ William Tuke (1732 - 1822) -​ need for reform was urgent -​ advocated humane treatment of -​ Linda Richards – first noted the mentally ill; Psychiatric Nurse -​ Human dignity was upheld. -​ The asylum movement was 6.​ THE 20TH CENTURY: THE ERA OF developed - protection, social PSYCHIATRY support, or sanctuary from the -​ Improved social attitudes promoted stresses of life sensitivity toward the mentally ill -​ raises money to establish homes a.​ Adolph Meyer (1866 - 1950) d.​ Franz Anton Mesmer (1734 - 1815) -​ Focused on physical and emotional -​ renewed the art of suggestive maturational changes healing -​ Emphasized the need to study the -​ a form of hypnotism person’s whole environment -​ animal magnetism "mesmerism” -​ Introduced the concept of common (old term for hypnotism) sense psychiatry PERIOD OF ENLIGHTENMENT b.​ Dorothea Lynde Dix (1802 - 1887) ​ Philippe Pinel (France) and William -​ led the crusade about the inhumane Tuke (England) treatment and conditions of ​ Tuke - established the York Retreat mentally ill patients that led to ​ The insane were no longer treated proliferation of the state hospitals as less human. ​ Human dignity was upheld. c.​ Clifford Beers (1876 - 1943) ​ The asylum movement was -​ contributed to preventive care developed – protection, social through his classic work, A Mind support, or sanctuary from the that Found Itself, published in 1908 stresses of life. -​ a descriptive account of his tormenting experiences 5.​ THE 19TH CENTURY: THE EVOLUTION OF -​ established the Mental Hygiene THE PSYCHIATRIC NURSE Movement, in promoting the early -​ first psychiatric hospital in America detection of mental illness at Williamsburg, Virginia, in 1773 -​ McLean Asylum, the first U.S. d.​ Emil Kraepelin (1856 - 1926) institution to provide humane -​ devised a classification of mental treatment disorders NCM 117 LECTURE PRELIM -​ emphasis on the observation and PERIODS OF SCIENTIFIC STUDY research in conditions known as ​ Freud emphasized the importance of early praecox dementia and mania. life experiences in shaping mental health ​ Kraepelin developed classification of mental e.​ Eugene Bleuler (1857 - 1939) illness -​ coined the term Schizophrenia ​ Bleuler was optimistic about treatment -​ included the 4A's (apathy, autism, ​ Humans could be studied, and that study ambivalence, looseness of held promise for treating and curing mental association) health problems. ​ The study of the mind and treatment f.​ Sigmund Freud (1856 - 1939) approaches flourished. -​ credited with the development of ​ "Decade of the Brain" (Kraepelin) psychoanalysis, psychosexual theories, and neurosis 7.​ THE 21ST CENTURY -​ popularized the term catharsis, -​ neuroscience and genetics opportunities dream interpretations, and -​ understanding of the link between behavior explanations for hysteria and emotions, brain, and genes -​ established the basis of psychoanalytic technique a.​ Information Systems: The Internet and Cyberspace g.​ Carl Gustav Jung (1875 - 1961) -​ Ex. Telemedicine or Telemental -​ founded analytic psychology Health Care -​ proposed and originated the concepts of extroverted and b.​ Complementary therapies introverted personality -​ Ex. Aromatherapy, acupuncture, -​ focused on the creative impulse and massage therapy, biofeedback, spirituality of the individual herbs, and nutritional approaches h.​ Karen Horney (1885 - 1952) B.​MENTAL HEALTH TEAM (INTERDISCIPLINARY -​ neuroses stem from cultural factors TEAM) and impaired interpersonal relationships a.​ Psychiatrist -​ serves as the leader of the team i.​ Harry Stack Sullivan (1892 - 1949) -​ responsible for making diagnoses and -​ postulated the hypothesis of prescribing treatment interpersonal theory -​ stimulated the development of b.​ Clinical Psychologist multidisciplinary approaches to -​ involved in administering and interpreting psychiatric and milieu therapy psychological testing -​ provide psychotherapy and behavioral modification NCM 117 LECTURE PRELIM i.​ Dietician c.​ Psychiatric Social Worker -​ plans nutritious meals for all clients -​ primarily involved in identifying and dealing with social issues that affect clients and j.​ Chaplain their families -​ assess, identifies, and attends to the -​ gather psychological data on admission spiritual needs of clients and their family -​ provide crisis intervention and members psychotherapy C.​TRENDS IN PSYCHIATRIC-MENTAL HEALTH d.​ Psychiatric clinical nurse specialist NURSING -​ presents educational programs for nursing staff -​ influenced by the social and economic -​ provides consultation services to nurses climate of the times who require assistance in the planning and -​ 1960s and 1970's changes within health implementation of care for individual clients facilities paralleled the deinstitutionalization of mental health care e.​ Psychiatric nurse -​ 1980s there was an enormous growth in -​ provides ongoing assessment of the client freestanding psychiatric facilities that condition resulted in client abuse and misuse of -​ administers medication health care to fill empty beds -​ assists clients with therapeutic activities as -​ decrease in the number of psychiatric required admissions and eventual closure of -​ focus is on one-to-one relationship psychiatric units and hospitals development -​ increase loss of job -​ Evidence-based health care is the driving f.​ Occupational Therapist force behind treatment approaches -​ primarily involved in providing an array of -​ Future trends, demands of advanced activities that enable the client to gain skills technology to perform ADL creative activities and -​ Research therapeutic relationship skills are used -​ New lifestyle pattern g.​ Mental Health Worker or Psychiatric Aide -​ functions under the supervision of the Mental Health and Mental-Illness Continuum psychiatric nurse -​ provide direct care to clients Mental health -​ refers to the ability of people – couples, h.​ Internist or Primary Care Provider families, and communities – to respond -​ co-occurrence of medical problems and adaptively to internal and external conditions stressors. -​ necessitates collaboration -​ being at peace with oneself, with others, with nature, and with GOD. NCM 117 LECTURE PRELIM e.​ The nurse explores the client's behavior for VARIABLES AFFECTING MENTAL HEALTH: the need it is designed to or the message it 1. BIOLOGICAL FACTORS is communicating -​ Prenatal f.​ The nurse views the client's behavior -​ During pregnancy (depression, hormonal nonjudgmentally while assisting him to imbalance) learn more effective adaptations -​ Postnatal (postpartum depression) g.​ The quality of the interaction in which the -​ Physical health (mga disease; cancer, stroke nurse engages with the client will be etc) directed to a more satisfying interpersonal 2. SOCIOCULTURAL FACTORS relationship -​ Family, stability, religious influences, values 3. PSYCHOLOGICAL FACTORS THEORIES OF HUMAN BEHAVIOR -​ Family trauma etc 1. Psychoanalytical Theory THE ROLE OF PSYCHIATRIC NURSE AS A TEAM -​ Sigmund Freud: The Father of MEMBER Psychoanalysis 1.​ Ward manager – monitors operations -​ believed that personality is formed during 2.​ Socializing agent – helps to recognize and early childhood, particularly the first 6 years cope stress of life 3.​ Counselor – emphatic listener 4.​ Parent surrogate a.​ Personality 5.​ Patient advocate -​ sum total of the individual 6.​ Teacher – focused on acquiring SKA -​ refers to all that the individual is, 7.​ Technician feels and does consciously and 8.​ Therapist – uses the principles developed unconsciously; manifested as through the practice of psychotherapy interaction in his environment 9.​ Reality base – help client make decision 10.​Health role model b.​ Divisions of the Mind: 1.​ Consciousness/Conscious LEVELS OF PRACTICE -​ all memories that remain Guiding principles: within an individual's a.​ The nurse views the client as a holistic being awareness b.​ The nurse focuses on the client's strengths -​ thought to be under the and assets, not on his weaknesses and control of the ego liabilities 2.​ Unconsciousness c.​ The nurse accepts the client as a unique -​ all memories, conflicts, human being who has value and worth experiences, and material exactly as he is that have been repressed d.​ The nurse has a potential for establishing a and cannot be recalled at will relationship with most if not all clients NCM 117 LECTURE PRELIM 5. Humanistic 3.​ Pre/Subconsciousness -​ focuses on a person's positive qualities, his -​ all memories that may have or her capacity to change, and the been forgotten, can be promotion of self- esteem recalled to consciousness with some effort 6. Interpersonal Theory -​ believed that one's personality involves c. Structures of Personality more than individual characteristics, 1.​ Id-pleasure principle particularly how one interacts with others -​ meeting demands through the use -​ identified 3 components of the self-system: of fantasies and images -​ "good me", "bad me", "not me" 2.​ Ego-reality principle -​ comprises of rational, logical 7. Biophysiological Theory thinking and intelligence -​ it has been suspected that heredity and 3.​ Superego - "The Conscience" environment are more closely interwoven -​ Inner control, concerned with right or wrong 8. Socio-cultural -​ the community and the cultural setting, the Superego is composed of: wider social forces that shape and color the A. Ego Ideal - reward patient's life, take center stage B. Conscience - more on punishment -​ It is important to note that the rewarding NURSING PROCESS ON CLIENTS WITH and punishing of the superego is based on MALADAPTIVE PATTERNS OF BEHAVIOR: the internalized standards of right and wrong and not on reality A. The Nursing Process -​ is a 6-step problem-solving approach to 2. Behavioral Theory nursing that also serves as an organizational -​ emphasis is on the behaviors of the person framework for the practice of nursing -​ a person is best understood by observing what he or she does in a particular situation B. General Assessment -​ A process which include the collection, 3. Cognitive Theory organization and analysis of data or -​ emphasize the mental processes involved in information about the client knowing -​ This is also called psychosocial assessment which include mental assessment 4. Cognitive-Behavioral Model -​ cognitive framework is often related to the behavioral framework NCM 117 LECTURE PRELIM C. Principles and Techniques of Psychiatric Nursing ANXIETY RESPONSES Interview Alterations in Patterns of Health 1. Basic Principles Anxiety Response and Anxiety Disorders a.​ do not reinforce or argue on patient's hallucinations or delusions Definition: b.​ orient patient to time, person, and place c.​ do not touch patients without warning Anxiety them -​ is a complex combination of emotions that d.​ avoid whispering or laughing when patients includes FEAR, APPREHENSION, and WORRY, are unable to hear all of the conversations and is often accompanied by physical e.​ reinforce positive behaviors sensations such as palpitations, nausea, f.​ avoid competitive activities with some chest pain and/or shortness of breath patients g.​ do not embarrass patients FEAR and ANXIETY h.​ for withdrawn patients, start with -​ Fear anxiety can be differentiated into four one-to-one interactions domains; i.​ allow and encourage verbalization of 1.​ Duration of emotional experience, feelings 2.​ Temporal focus 3.​ Specificity of the threat, and 2. General Principles 4.​ Motivated direction a.​ be calm when talking to patients b.​ accept patients as they are but do not Characteristics: accept all behaviors ​ It is provoked by the unknown. c.​ keep promises ​ It therefore precedes all new experiences d.​ be consistent (entering school, moving to a new place, e.​ be honest starting a new job). ​ It is communicated interpersonally. NURSING DIAGNOSIS -​ Alteration in Health Maintenance Predisposing Conditions: -​ Altered Nutrition: Less than Body A.​ prolonged unmet needs of dependency, Requirements security, love and attention -​ Altered Nutrition: More than Body B.​ stress threatening security of self-esteem Requirements C.​ unacceptable thoughts or feelings surfacing -​ Anxiety to consciousness; e.g. rage, erotic impulses, -​ Body Image Disturbance flashbacks -​ Ineffective Family Coping: Compromised -​ Ineffective Individual Coping -​ Self-esteem Disturbances -​ Powerlessness -​ Sleep Disturbance NCM 117 LECTURE PRELIM LEVELS OF ANXIETY (Peplau) THEORIES OF ORIGIN: 1. FREUD 1. Mild/Alertness Level (+1) -​ It is due to the conflict bet the id and the ​ Associated with normal tension of everyday superego. The ego serves a battleground as life it tries to mediate the demands of the 2 ​ The individual is alert clashing personalities. ​ Perceptual field is increased ​ Produce growth and productivity 2. SULLIVAN ​ Increases learning -​ Believed that through the close emotional ​ Uses adaptive coping mechanisms to solve bond between the mother and the child, problems, rational, objective, and alleviate anxiety is first conveyed by the mother to anxiety the infant. -​ Anxiety in later life arises in interpersonal Psychological Response situation. ​ Wide perceptual field ​ Sharpened senses 3. WILL ​ Increased motivation -​ Believed that low self-esteem is related to ​ Effective problem- solving predisposition to anxiety. ​ Increased learning ability ​ Irritability 4. LEARNING THEORY -​ Parental influence affects how a child Physiological Response responds to anxiety. ​ Restlessness -​ The parents' appropriate emotional ​ Fidgeting response gives the child security and helps ​ GI "butterflies" him learn constructive ways of coping on his ​ Difficulty sleeping own. ​ Hypersensitivity to noise CONTINUUM OF ANXIETY RESPONSES Coping mechanisms used to relieve anxiety in stressful conditions: ​ Sleeping ​ Eating ​ Physical exercise ​ Smoking ​ Crying ​ Yawning ​ Drinking NCM 117 LECTURE PRELIM Coping mechanisms used to relieve anxiety in stressful conditions: ​ Daydreaming ​ Laughing ​ Cursing ​ Pacing ​ Foot swinging ​ Fidgeting ​ Nail biting ​ Finger tapping ​ Talking to someone with whom one feels comfortable NURSING INTERVENTIONS: 1.​ Recognize anxiety by statements such as "I notice you being restless today." 2.​ Explore causes of anxiety and ways to solve problems that cause anxiety by statements such as "Let's discuss ways to…” 2. Moderate/Apprehension Level (+2) -​ the response of the body to immediate danger and focus is directed to immediate concerns -​ narrows the perceptual field to pay attention to particular details -​ selective inattentiveness occurs -​ the increased tension makes this the optimal time for learning -​ increased muscular tension and restlessness are evident -​ the person uses palliative coping mechanisms

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