Introduction to Psychiatric / Mental Health Nursing Philosophy and Theories for Interdisciplinary Psychiatric Care Chapter 1, 2

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Introduction to Psychiatric / Mental
Health Nursing Philosophy and Theories for
Interdisciplinary Psychiatric CareChapter 1, 2
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• West Coast University
• NURSING 204

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Caring for Psychiatric Mental Health Clients

• Feelings, Concerns, QuestionsWhat Are
  They?
• Who Are
  They?

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People with Mental Illness
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Factors Influencing Expectations
Media
Other?
Upbringing
Expectations
Life experiences
Culture
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Psychiatric Mental Health Clients

• Psychiatric mental health clients are everyday,
  ordinary people.
• Removing the stigma of Mental Illness
• Definition of Stigma a mark of disgrace or
  infamy a stain or reproach, as on ones
  reputation
• Best defined as ignorance, prejudice and
  discrimination

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Factors Impacting Mental Health and Mental Illness
Biological
Mental Illness
or
Mental
Health
Social
Cultural
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What do these terms mean?
Crazy?
Berserk?
Wacky?
Insane?
Weird?
Lunatic ?
Nervous Breakdown?
Melancholy?
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Historical Approaches

• Era of Magico-Religious Explanations
• Era of Organic Explanations (4th Century)
• Era of Alienation (1300 1600)
• Era of Confinement (17th Century)
• Era of Moral Treatment (18th 19th Century)
• Reform leaders
• William Cullen
• Philippe Pinel
• William Tuke
• Benjamin Franklin
• Benjamin Rush Father of American Psychiatry

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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.
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Historical Approaches - continued

• Era of Psychoanalysis (19th to 20th Century)
• Sigmund Freud
• Contemporary Developments (mid 20th Century)
• Social dimensions
• Brain dysfunction
• Neurochemical
• Medication therapy

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21st Century Research

• Bases for mental disorders
• Psychotropic medications
• Role of nutrients, biology, and genetics

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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

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Mental Illness Characteristics

• Distress
• Disability
• Risks

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Prevalence Rates for Various Mental Disorders
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Leading Causes of Mental Disability Worldwide
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Mental Health Studies

• Epidemiologic Catchment Area (ECA)
• Global Burden of Disease (WHO)
• U.S. Surgeon Generals Report
• Healthy People 2020

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Healthy People 2020

• Reduce suicide rate
• Reduce the rate of suicide attempts by
  adolescents
• Increase services for homeless adults with
  serious mental illness (SMI)
• Reduce relapse with eating disorders in
  adolescents
• Increase mental health screening in primary care
  services
• Increase mental health services in children

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Healthy People 2020 - continued

• Screening in juvenile justice
• Track consumers satisfaction with mental health
  services
• Jail diversion programs for SMI
• Cultural competency
• Plan that address specialized mental health
  services for the elderly persons.
• Increase services for person with co-occurring
  substance abuse and SMI
• Employee stress in the workplace

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Psychiatric-Mental Health Nurses

• What do they do?

Chapter 2
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Standards

• Standards of Psychiatric-Mental Health Nursing
  Practice
• Guidelines for providing quality care
• Psychiatric-Mental Health Nursing Standards of
  Practice
• Assessment
• Diagnosis
• Outcomes Identification
• Planning

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Standards - continued

• Psychiatric-Mental Health Nursing Standards of
  Practice
• Implementation
• Coordination of Care
• Health Teaching and Health Promotion
• Milieu Therapy
• Phamacological, Biological, and Integrative
  Therapies
• Prescriptive Authority and Treatment (APRN only)
• Psychotherapy (APRN only)
• Consultation (APRN only)
• Evaluation

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Standards - continued

• Standards of Professional Performance
• Quality of Practice
• Education
• Professional Practice Evaluation
• Collegiality
• Collaboration
• Ethics
• Research
• Resource Utilization
• Leadership

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Psychiatric-Mental Health Nurses

• Generalist level
• Advanced practice level
• Prescriptive authority
• Psychotherapy
• Consultation

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Estimated Number of Mental Health Workers in the
United States
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The Mental Health Team
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Effective Mental Health Services
Client
Partnerships
PMH Team
Family
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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.

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The Role of the Psychiatric-Mental Health Nurse
Multifaceted
Custodial
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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

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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

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Psychiatric-Mental Health Nursing (1990s) -
Decade of the Brain

• Psychobiologic concepts
• Nursing Psychopharmacology Project
• Health care delivery reform
• Outcome-based research
• Cultural diversity
• Integration of theoretical perspectives

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Psychiatric-Mental Health Nursing (2000s) - 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

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Nursing Theories Impacting Psychiatric Nursing

• Marjory Gordon Functional Health Patterns
  (1987)
• Hildegard Peplau Interpersonal Relationships
  (1952)
• Dorothea Orem Self-Care Deficit (1959)
• Dorothy Johnson Behavioral System (1968)
• Sister Callista Roy Adaptation Model (1976)

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Hildegard Peplau, PhD, RN, FAAN
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Marjory Gordon ,PhD, RN, FAAN
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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

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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.

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Gordon's 11 Functional Health Patterns
Functional Health Pattern Pattern Describes Examples
Health Perception/ Health Management Client's perceived pattern of health and well-being and how health is managed. Compliance with medication regimen, use of health-promotion activities such as regular exercise, annual check-ups.
Nutritional-Metabolic Pattern of food and fluid consumption relative to metabolic need and pattern indicators of local nutrient supply. Condition of skin, teeth, hair, nails, mucous membranes height and weight.
Elimination Patterns of excretory function (bowel, bladder, and skin). Includes client's perception of a normal" function. Frequency of bowel movements, voiding pattern, pain on urination, appearance of urine and stool.
Activity - Exercise Patterns of exercise, activity, leisure, and recreation. Exercise, hobbies. May include cardiovascular and respiratory status, mobility, and activities of daily living.
Cognitive-Perceptual Sensory-perceptual and cognitive patterns. Vision, hearing, taste, touch, smell, pain perception and management cognitive functions such as language, memory, and decision making.
Sleep-Rest Patterns of sleep, rest, and relaxation. Client's perception of quality and quantity of sleep and energy, sleep aids, routines client uses.
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Gordon's 11 Functional Health Patterns
Functional Health Pattern Pattern Describes Examples
Role-Relationship Client's pattern of role engagements and relationships. Perception of current major roles sand responsibilities (e.g., father, husband, salesman) satisfaction with family, work, or social relationships.
Sexuality-Reproductive Patterns of satisfaction and dissatisfaction with sexuality pattern reproductive pattern. Number and histories of pregnancy and childbirth difficulties with sexual functioning satisfaction with sexual relationship.
Coping / Stress Tolerance General coping pattern and effective of the pattern in terms of stress tolerance. Client's usual manner of handling stress, available support systems, perceived ability to control or manage situations.
Value - Belief Patterns of values, beliefs (including spiritual), and goals that guide client's choices or decisions. Religious affiliation, what client perceives as important in life, value-belief conflicts related to health, special religious practices.
Self-Perception/ Self Concept Client's self-concept pattern and perceptions of self. Body comfort, body image, feeling state, attitudes about self, perception of abilities, objective data such as body posture, eye contact, voice tone.
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Holistic PracticeExpanded Role for Nurses
(Chapter 5)

• Interactionism
• Individuals have purpose and control.
• Humanistic cast
• Interaction of psychology, psychobiology, and
  sociocultural contexts
• Humanism
• Devotion to individual interests
• Spirit of compassion and caring
• Affirming of the joy, beauty, and value of living

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Nursing Implications

• Humanistic Interactionism
• Interrelated physical and mental factors
• Holistic
• Expanded role for psychiatric-mental health
  nurses
• Client and family role includes negotiation and
  advocacy.

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Nursing Implication

• Psychobiology
• Focus on biological, medical, and human aspects
  of care.
• Holistic
• Integrative
• New knowledge
• High tech and high touch
• Nature and nurture
• Biologic sciences and behavioral sciences

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Medical-Psychobiologic Theory

• Key concepts
• Emotional disturbance indicates illness or
  defect.
• Illnesses are located in the brain or central
  nervous system.
• Illnesses have specific characteristics.
• Mental diseases have a characteristic course.
• Mental disorders respond to physical or somatic
  treatments.
• Psychobiologic explanations reduce stigma.

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Comparison of Traditional Psychiatric Theories
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Psychoanalytic Theory

• Sigmund Freud
• All psychological emotional events can be
  understood.
• Childhood experiences ? adult neuroses
• Goal of therapy is gaining insight.

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Psychoanalytic Theory

• Levels of awareness in relation to id, ego, and
  superego
• Id Present at birth. Serves to satisfy needs and
  immediate gratification
• Ego Begins to develop at 4 6 months. Maintain
  contact with reality, rational part of
  personality.
• Superego begins to develop at about 3 6 years.
  Serves as conscience (sense of right or wrong)

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Cognitive Concepts
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SocialInterpersonal Theories
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SocialInterpersonal Theories
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Maslow Self-Actualization and Hierarchy of Needs