Psychiatric Mental Health Nursing Introduction to Psychiatric Mental

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Psychiatric / Mental Health Nursing Introduction to Psychiatric Mental Health Nursing Chapter 1 &

Psychiatric / Mental Health Nursing Introduction to Psychiatric Mental Health Nursing Chapter 1 & 2 West Coast University NURS 204

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

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

Factors Influencing Expectations Media Other? Upbringing Expectations Culture Life experiences

Factors Influencing Expectations Media Other? Upbringing Expectations Culture Life experiences

Psychiatric Mental Health Clients Psychiatric mental health clients are everyday, ordinary people.

Psychiatric Mental Health Clients Psychiatric mental health clients are everyday, ordinary people.

Factors Impacting Mental Health and Mental Illness Biological Mental Illness or Mental Health Social

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

Mental Disorder Characteristics Distress Disability Risk

Mental Disorder Characteristics Distress Disability Risk

DSM-IV-TR Identifies Standardizes Categorizes

DSM-IV-TR Identifies Standardizes Categorizes

Deviance Is it bad? Bizarre in one cultural context; acceptable in another? Deviant political,

Deviance Is it bad? Bizarre in one cultural context; acceptable in another? Deviant political, religious, or sexual behavior Mental disorder- yes or no?

What do these terms mean? Crazy? Berserk? Weird? Wacky? Insane? Lunacy? Nervous Breakdown? Melancholy?

What do these terms mean? Crazy? Berserk? Weird? Wacky? Insane? Lunacy? Nervous Breakdown? Melancholy?

History Understanding and approaches to “madness” throughout history were influenced by: Social attitudes Philosophic

History Understanding and approaches to “madness” throughout history were influenced by: Social attitudes Philosophic viewpoints

Historical Approaches Era of Magico-Religious Explanations Superhuman forces Violation of taboos Neglect of rituals

Historical Approaches Era of Magico-Religious Explanations Superhuman forces Violation of taboos Neglect of rituals Loss of soul Witchcraft Era of Organic Explanations Imbalance in the body’s humors (Hippocrates, 4 th century BCE) Era of Alienation Social exclusion Imprisonment “Ships of fools” “Lunacy” The exception: Arab belief was that the insane were divinely inspired.

A ward in Bethlehem Hospital about 1745. A patient is being chained in the

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

Historical Approaches continued Era of Confinement Confined Beaten and tortured Enormous asylums: Hôpital Général

Historical Approaches continued Era of Confinement Confined Beaten and tortured Enormous asylums: Hôpital Général St. Mary of Bethlehem Era of Moral Treatment Emergence of reform Reform leaders: William Cullen Philippe Pinel William Tuke Benjamin Franklin Benjamin Rush “Father of American Psychiatry”

Historical Approaches continued Era of Psychoanalysis Sigmund Freud Contemporary Developments Social dimensions Brain dysfunction

Historical Approaches continued Era of Psychoanalysis Sigmund Freud Contemporary Developments Social dimensions Brain dysfunction Neurochemical Medication therapy

21 st Century Research Bases for mental disorders Psychotropic medications Role of nutrients, biology,

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

Mental Disorder Statistics High incidence with physical illness Account for 47% of all disability

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

Prevalence Rates for Various Mental Disorders

Prevalence Rates for Various Mental Disorders

Leading Causes of Mental Disability Worldwide

Leading Causes of Mental Disability Worldwide

Mental Health Studies Epidemiologic Catchment Area (ECA) Global Burden of Disease (WHO) U. S.

Mental Health Studies Epidemiologic Catchment Area (ECA) Global Burden of Disease (WHO) U. S. Surgeon General’s Report Healthy People 2010

Healthy People 2010 Adolescent suicide rate Homeless adults with serious mental illness (SMI) Relapse

Healthy People 2010 Adolescent suicide rate Homeless adults with serious mental illness (SMI) Relapse with eating disorders Mental health screening Treatment issues: Children and adults

Healthy People 2010 - continued Screening in juvenile justice Jail diversion programs for SMI

Healthy People 2010 - continued Screening in juvenile justice Jail diversion programs for SMI Cultural competence issues Services for older adults: crisis intervention, screening, treatment Employee stress in the workplace

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

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

Psychiatric-Mental Health Nurses - continued Psychiatric-mental health nursing promotes mental health through: Assessment, diagnosis,

Psychiatric-Mental Health Nurses - continued Psychiatric-mental health nursing promotes mental health through: Assessment, diagnosis, and treatment of human responses to mental health problems and psychiatric disorders (ANA, APNA, ISPN, 2007)

Standards of Psychiatric-Mental Health Nursing Practice: Guidelines for providing quality care Psychiatric-Mental Health Nursing

Standards of Psychiatric-Mental Health Nursing Practice: Guidelines for providing quality care Psychiatric-Mental Health Nursing Standards of Practice 1. 2. 3. 4. Assessment Diagnosis Outcomes Identification Planning

Standards - continued Psychiatric-Mental Health Nursing Standards of Practice 5. Implementation A. Coordination of

Standards - continued Psychiatric-Mental Health Nursing Standards of Practice 5. Implementation A. Coordination of Care B. Health Teaching and Health Promotion C. Milieu Therapy D. Phamacological, Biological, and Integrative Therapies E. Prescriptive Authority and Treatment (APRN only) F. Psychotherapy (APRN only) G. Consultation (APRN only) 6. Evaluation

Psychiatric–Mental Health Nursing Standards of Practice

Psychiatric–Mental Health Nursing Standards of Practice

Standards - continued Standards of Professional Performance Quality of Practice 8. Education 9. Professional

Standards - continued Standards of Professional Performance Quality of Practice 8. Education 9. Professional Practice Evaluation 10. Collegiality 11. Collaboration 12. Ethics 13. Research 14. Resource Utilization 15. Leadership 7.

Psychiatric–Mental Health Nursing Standards of Professional Performance

Psychiatric–Mental Health Nursing Standards of Professional Performance

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

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

The Psychiatric-Mental Health Team Psychiatric-mental health nurse Psychiatrist Clinical psychologist Psychiatric social worker Marriage

The Psychiatric-Mental Health Team Psychiatric-mental health nurse Psychiatrist Clinical psychologist Psychiatric social worker Marriage and family therapist Occupational therapist Recreational therapist Creative arts therapist Psychosocial rehabilitation worker

Estimated Number of Mental Health Workers in the United States

Estimated Number of Mental Health Workers in the United States

The Mental Health Team

The Mental Health Team

Effective Mental Health Services Client Partnerships PMH Team Family

Effective Mental Health Services Client Partnerships PMH Team Family

Lessons on Collaboration “Know thyself” Value diversity Know that conflict is natural Share your

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.

The Role of the Psychiatric-Mental Health Nurse Custodial Multifaceted

The Role of the Psychiatric-Mental Health Nurse Custodial Multifaceted

Early Psychiatric-Mental Health Nursing (19 th century) First school of nursing Florence Nightingale’s thoughts

Early Psychiatric-Mental Health Nursing (19 th century) First school of nursing Florence Nightingale’s thoughts American nursing schools “First American psychiatric nurse” Single-focused training schools Custodial, mechanistic, directed by psychiatrists

Psychiatric-Mental Health Nursing (1900 -1940) Psychiatric nursing curricula Psychiatric nursing texts Single-focus psychiatric nursing

Psychiatric-Mental Health Nursing (1900 -1940) Psychiatric nursing curricula Psychiatric nursing texts Single-focus psychiatric nursing schools

Psychiatric-Mental Health Nursing (1940 -1990) Nurses begin to educate nurses. Psychiatric theory includes interpersonal

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

Psychiatric-Mental Health Nursing (1940 -1990) continued Birth of clinical nurse specialists and nurse therapist

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

Psychiatric-Mental Health Nursing (1990 s) Decade of the Brain Psychobiologic concepts Nursing Psychopharmacology Project

Psychiatric-Mental Health Nursing (1990 s) Decade of the Brain Psychobiologic concepts Nursing Psychopharmacology Project Health care delivery reform Outcome-based research Cultural diversity Integration of theoretical perspectives

Psychiatric-Mental Health Nursing (2000 s) - The New Millennium Standards of practice – revisions

Psychiatric-Mental Health Nursing (2000 s) - 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

Nursing Theories Assist nurses to: Organize assessment data Identify problems Plan interventions Generate goals

Nursing Theories Assist nurses to: Organize assessment data Identify problems Plan interventions Generate goals and actions Evaluate outcomes

Nursing Theories Impacting Psychiatric Nursing Hildegard Peplau Dorothea Orem Martha Rogers Sister Callista Roy

Nursing Theories Impacting Psychiatric Nursing Hildegard Peplau Dorothea Orem Martha Rogers Sister Callista Roy Ida Jean Orlando Ernestine Wiedenbach Joyce Travelbee Paterson and Zderad Jean Watson Patricia Benner

Nursing Theories - Value Nursing practice vs. medical practice Caring vs. curing Interpretation of

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

Application of Theoretical Frameworks Application of various theoretical frameworks leads to: Quality client-centered care.

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.