Chapter 1 Roles and Functions of PsychiatricMental Health

Chapter 1 Roles and Functions of Psychiatric-Mental Health Nurses: Competent Caring Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

History of Psychiatric Nursing Before 1860 attendants hired for custodial care Linda Richards (1873) “First American psychiatric nurse” Ø Developed better nursing care in psychiatric hospitals Ø Organized nursing services and educational programs in Illinois state mental hospitals Ø Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Developments in Early 1900 s In 1913 Johns Hopkins was first school of nursing with fully developed psychiatric course In 1930 s nursing education recognized importance of psychiatric knowledge in nursing care for all illnesses In 1930 s insulin shock therapy, psychosurgery, and electroconvulsive therapy (ECT) developed In 1947 eight graduate programs in psychiatric nursing had been started Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Developments in 1950 s NLN required accredited schools of nursing to provide experience in psychiatric nursing Hildegard Peplau published Interpersonal Relations in Nursing Major tranquilizers developed Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Nurse-Patient Relationship Described by Tudor in 1952 Peplau defined nursing as “significant, therapeutic process” Evolved role of psychiatric nursing and was considered “Mother of Psychiatric Nursing” Ø Based clinical competence on interpersonal techniques and use of nursing process Ø Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Developments in Somatic Therapies Insulin shock therapy Psychosurgery ECT All required medical-surgical skills of nurses Helped control behavior and made patients more open to psychotherapy Ø Showed need for improved psychological treatment for nonresponsive patients Ø Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Psychotropic Drugs Developed in early 1950 s More patients became treatable Fewer restraints and locked doors needed More personnel needed to provide therapy Roles of psychiatric practitioners and nurses expanded Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Evolving Nursing Functions Dealing with patient problems of attitude, mood, interpretation of reality Exploring disturbing or conflicting thoughts Using positive feelings from relationships to bring about psychophysiological homeostasis Counseling patients in emergencies Strengthening “well part” of patients Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Developments in 1960 s Focus began to shift to primary prevention, care, and consultation in community Community Mental Health Centers Act of 1963 Federal money available to states for planning, construction, staffing Ø Treated people in the community and prevented hospitalization if possible Ø Formed multidisciplinary treatment teams Ø Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Developments in 1970 s Psychiatric nurses pacesetters in specialty nursing practice: Developed first standards and statements on scope of practice Ø Established generalist and specialist certification Ø Psychiatric concepts valued and blended into nursing education as “psychosocial nursing” Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Developments in 1980 s Exciting scientific growth with new focus Brain-imaging techniques Ø Neurotransmitters and neuronal receptors Ø Psychobiology of emotions Ø Understanding the brain Ø Molecular genetics related to microbiology Ø Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Challenges Faced in 1980 s Integrating expanding bases of neurosciences into psychiatric nursing education and practice Understanding that knowledge of the specialty is based on integration of biological, psychological, spiritual, social, and environmental realms of the human experience Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Psychiatric Nursing Defined “A specialized area of nursing practice committed to promoting mental health through the assessment, diagnosis, and treatment of human responses to mental health problems and psychiatric disorders. ” “[It] employs a purposeful use of self as its art and a wide range of nursing, psychosocial, and neurobiological theories and research evidence as its science. ” American Nurses Association (ANA) Scope and Standards of Psychiatric-Mental Health Nursing Practice (2007) Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Contemporary Practice: Nurse-Patient Partnership Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Contemporary Practice: Domains of Activities Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Psychiatric Nursing Activities Make culturally sensitive biopsychosocial health assessments Design and implement treatment plans for patients and families with complex health problems and co-morbid conditions Organize, access, negotiate, coordinate, and integrate services and benefits for individuals, families Provide “health care map” to guide them to community resources Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Psychiatric Nursing Activities Promote and maintain mental health, managing effects of mental illness through teaching, counseling Provide care for patients with both physical and psychological problems Manage and coordinate systems of care, integrating needs of patients, families, staff, regulators Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Levels of Performance: Qualifications Basic level: psychiatric-mental health registered nurse cares for mental health patients in various settings and roles Advanced level: advanced practice RN - psychiatric-mental health (APRN-PMH) has master’s degree or higher and experience, knowledge of theory and practice, competence in advanced skills Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.

Practice Settings Psychiatric facilities Community mental health centers Psychiatric units in general hospitals Residential facilities Home health care Primary care is emerging focus of care Ø Clinics, schools, industry, HMOs, prisons, managed care settings, home health, nursing homes, emergency departments Mosby items and derived items © 2013, 2009 by Mosby, an imprint of Elsevier Inc.