PowerPoint Presentation to Accompany Videbeck’s Psychiatric

Mental Health NursingThird Edition

Chapter 1Foundations of Psychiatric

Mental Health Nursing

Mental HealthMental Health

• WHO definition: state of complete physical, mental, and social wellness, not merely absence of disease or infirmity

• State of emotional, psychological, and social wellness evidenced by:

– satisfying interpersonal relationships

– effective behavior and coping

– a positive self-concept

– emotional stability

Factors Influencing a Person’s Mental HealthFactors Influencing a Person’s Mental Health

• Individual factors:

– biologic makeup, autonomy and independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardiness, a sense of belonging, reality orientation, and coping or stress management abilities

• Interpersonal factors:

– effective communication, ability to help others, intimacy, and a balance of separateness and connectedness

• Social/cultural factors:

– a sense of community, access to adequate resources, intolerance of violence, support of diversity among people, mastery of the environment, and a positive, yet realistic, view of one’s world

Mental IllnessMental Illness

•Historically viewed as possession by demons, punishment for religious or social transgressions, weakness of will or spirit, and violation of social norms

•Today seen as a medical problem, although some stigma from previous beliefs remains

Mental Illness (cont’d)Mental Illness (cont’d)

•Mental disorder is “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom” (American Psychological Association [APA])

The DSM-IV-TR is a taxonomy published by APA and is used by all mental health professionals. It describes allmental disorders according tospecific diagnostic criteria.

The DSM-IV-TR is based ona multiaxial classificationsystem:

Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision

Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision

► Axis I: all major psychiatric disorders except mental retardation and personality disorders

► Axis II: mental retardation, personality disorders, maladaptive personality features, and defense mechanisms

► Axis III: current medical conditions

► Axis IV: psychosocial and environmental problems, including problems with primary support group, social environment, education, occupation, housing, economics, access to health care, legal system

► Axis V: Global Assessment of Functioning (GAF) score

Historical PerspectiveHistorical Perspective•Ancient times: sickness represented

displeasure of the gods, punishment for wrongdoing; treatments included starving, urging, bloodletting

•Period of Enlightenment (1790s) saw the creation of asylums or safe havens to offer protection

•Sigmund Freud and others studied mental disorders scientifically by the 1900s

Historical Perspective (cont’d)Historical Perspective (cont’d)

•Psychotropic drugs first available in 1950

•Deinstitutionalization began with the Community Mental Health Centers Act of 1963

Mental Illness in the 21st CenturyMental Illness in the 21st Century

•56 million Americans have a mental illness (DHHS, 2002)

•Hospital stays shorter, but more numerous: revolving door

•Increased aggression among mentally ill clients

•An increased number of people with mental illness are incarcerated

Mental Illness in the 21st Century (cont’d)Mental Illness in the 21st Century (cont’d)

•Homeless population of persons with mental illness, including substance abuse, is growing

•Most health care dollars still spent on inpatient psychiatric care; community services not adequately funded

•Healthy People 2010 mental health objectives strive to improve care of mentally ill persons

Mental Illness in the 21st Century (cont’d)Mental Illness in the 21st Century (cont’d)

•Community-based care includes community support services, housing, case management, residential services outside the hospital (see Chap. 4)

•Cost containment efforts include utilization review, HMOs, managed care, case management

•Cultural considerations: diversity increasing in U.S. in terms of ethnicity and changing family structures

Psychiatric Nursing PracticePsychiatric Nursing Practice

•Psychiatric nursing practice emerged in 1873 when Linda Richards said, “The mentally sick should be at least as well cared for as the physically sick”

•1882 was first formal training of nurses in mental health

•First psychiatric textbook in 1920

•This is a relatively new field in comparison with other areas

Psychiatric Nursing Practice (cont’d)Psychiatric Nursing Practice (cont’d)

•Standards of Psychiatric-Mental Health Clinical Nursing Practice developed in 1973, revised in 1982, 1994, 2000

•Psychiatric Mental Health Nursing Phenomena of Concern: 12 areas of concern that mental health nurses focus on when caring for clients

Student ConcernsStudent Concerns

•Saying the wrong thing

•What student will be doing

•Fear of no one talking to student

•Bizarre or inappropriate behavior

•Physical safety

•Seeing someone known to the student

Self-Awareness IssuesSelf-Awareness Issues

•Everyone has values, beliefs, ideas; nurses need to know what theirs are, not to change them, but to prevent unknown or undue influence on their nursing practice

•Hints to increase self-awareness: keep a journal, talk to trusted coworkers, examine points of view other than one’s own