PSYCHIATRIC NURSING
The world of psychiatric and mental health.
This unit introduces you to parts of this world that may
be new to you. It will help you explore how patients
think, feel, and behave.
It will suggest that you think about people in terms of
their overall functioning and adaptation rather than by
the symptoms of their specific illness.
Most importantly it will define for you the
responsibilities you have as a health care provider. I
hope you ready to begin your journey and I wish your
curiosity about human nature, openness to new ways of
thinking, and delight in the process of learning.
RECOMMENDATIONS FOR STUDENTS:
1. Avoid making assumptions about any clients medical
or psychiatric history.
2. Dont hesitate to approach your clinical instructors or
a staff members with questions about your assigned
clients need or plan of care.
3. Feel free to discuss with your instructor any feelings
that you have about your assigned client.
4. Take time to adjust to a slower pace.
5. Dont become frustrated with a client who refuses to
speak to you.
6. Be patient with a client who requires repeated
prompting to complete a task.
7. Recognize that listening, observing and self-
awareness are important tools that you must posses
when providing care.
PSYCHIATRY
branch of medicine dealing with the study,
treatment and prevention of mental disorders.
PSYCHODYNAMICS
understanding the reasons behind human behavior.
PSYCHOPATHOLOGY
part of psychodynamics dealing with understanding
abnormal human behavior
HISTORY OF PSYCHIATRIC NURSING:
Ancient Period
Historically, people believed that sickness was a
punishment for sins and wrongdoings. People with
mental illness were considered as either divine or
demonic, depending on their presenting behaviors.
Those who were considered divine were
worshipped and those seen as demonic where
punished.
Aristotle developed a theory that explains that
mental disorders are related to physical disorders.
According to him, imbalance of the 4
substances/humors (blood, water, yellow and black bile)
cause mental disorders because these 4 humors control
emotion. Treatment is aimed at restoring the balance by
bloodletting, starving and purging.
Mentally ill human beings are banished and/or
confined.
Priest performed exorcisms to take away evil spirits.
When they failed, they used more severe and brutal
measures, such as imprisonment, battering and
starving.
During Renaissance, people with mental illness but
harmless were allowed to wander the country side or
live in rural communities, but those who are dangerous
or harmful were put imprison, chained, and starved.
In 1547, the Hospital of St. Mary of Bethlehem was
officially declared a hospital for the insane. However,
inmates were treated as animals than human. Visitors
were allowed to view and ridicule the inmates for a
charge or fee.
Period of Enlightenment
ASYLUM= a place of safety or sanctuary; an institution
for the care of the mentally ill.
Philippe Pinel-Liberator of the Insane
William Tuke-established the York Retreat-a private
facility with moral treatment like occupational therapy
and they are living in a peaceful and familial
environment.
Period of Scientific Study
Sigmund Freud
-Austrian neurologist and psychiatrist
-Founder of psychoanalysis
-THEORY OF MOTIVATION (The psychological
feature that arouses an organism to action
toward a desired goal; the reason for the action;
that which gives purpose and direction to
behavior).
-He also developed a theory that dreams are an
unconscious representation of repressed
desires, especially sexual desires. In 1900 he
published his greatest work, The Interpretation
of dream.
Emil Kraepelin
-pioneer in the development of psychiatric as a scientific
discipline
-classification of Mental Disorder according to their
symptoms
-all mental illness has an organic cause.
Eugene Bleuler-coined the term Schizophrenia
Period of Psychotropic Drugs
Lithium (1950) =antimanic, first drug ever developed
Chlorpromazine (1950)=antipsychotic drug
Monoamine oxidase inhibitor (1952) =
antidepressant
Haloperidol (1957)= antipsychotic
Tricyclic Antidepressant (1958) =antidepressants
Benzodiazepines (1960) =)-miracle drug-antianxiety
Period of Community Mental Health
GOAL: Deinstitutionalization refers to the depopulating
of state mental hospital -a shift in the location of
treatment from large public hospitals to community
settings.
PSYCHIATRICNURSING PRACTICE
Linda Richards
The first American psychiatric nurse
Believed that the mentally sick should be at
least as well cared for as the physically sick.
Books:
1. Nursing Mental Diseases-by Harriet Bailey=first
nursing book.
2. Interpersonal Relations in Nursing by Hildegard
Peplau the most Influential book.
Hildegard Peplau:
-Described the therapeutic nurse-client relationship
-Wrote extensively about anxiety
-Interpersonal dimensions-forms the foundation of
practice today
June Mellow -Psychosocial needs and strengths
STANDARD OF CARE
ASSESSMENT
DIAGNOSIS
OUTCOME IDENTIFICATION
PLANNING
IMPLEMENTATION
EVALUATION
Mental Health - balance in a persons
internal life and adaptation to reality
-World Health Organization defines mental
health as "a state of well-being in which the
individual realizes his or her own abilities, can
cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a
contribution to his or her community
in contact with reality and the environment in
ways that are in accord with oneself and
possess the ability to love, work and resolve
conflicts within a framework of reasonability
-individual has psychobiological resilience
Elements of Mental Health
1. self-acceptance/self-esteem- characterized by a
positive evaluation of oneself and ones past
experiences; process which the nurse gains
recognition of his/her own feelings, beliefs, and
attitudes
2. personal growth - reflected in ones sense of
continued psychological growth and
development
3. sense purpose and meaning
4. positive relations with others
5. environmental mastery the capacity to manage
effectively in the surrounding world
6. autonomy-a sense of self-determination andthe
ability to control ones own life.
INFLUENCES OF MENTAL HEALTH
Individual factors include a persons biologic
makeup, sense of harmony in life, vitality, ability
to find meaning in life, emotional resilience or
hardiness, spirituality, and positive identity.
Interpersonal factors include effective
communication, ability to help others, intimacy,
and a balance of separateness and connection.
Social / cultural factors include a sense of
community, access to adequate resources,
intolerance of violence, and support of diversity
among people.
THE MENTAL HEALTH NURSE
Major role: advancing safe and quality care that
restores the clients level of function to a higher one
Primary prevention:
Identify high-risk groups
Provide health education
Secondary prevention
Client respond to interventions and health is
restored
Prevention of deleterious effects of mental
illness
Tertiary prevention
Prevent disability
 Promote rehabilitation and health maintenance Foundation of exploring nurses reactions to
specific clients and clinical situations.
I. ROLES OF A PSYCHIATRIC NURSE
1. Teacher MULTIDISCIPLINARY TEAM
2. Social Agent Psychiatrist
3. Ward Manager Internist or Primary care provider
4. Counselor Substitute Psychiatrist nurse
5. Mother Psychiatric social worker
Mental health worker or psychiatric Aide
II. ESSENTIAL QUALITIES OF MENTAL HEALTH NURSE Priest
1. THERAPEUTIC USE OF SELF: Occupational therapist
Forming a trusting relationship Clinical psychology
Provision of comfort, safety, and acceptance of
the client MENTAL HEALTH AND MENTAL ILLNESS CONTINUUM
Active listening, self-awareness, mutuality, and Adaptive: Healthy
effective communication.
Approaches with genuine interest and concern Adaptive coping
and continues throughout treatment.
Reality oriented
2. GENUINENESS :
Implies a sense of Openness, Realness and Interacts with real environment
lack of defensiveness.
Socially acceptable behavior
3.Warmth
Maladaptive
Associate with respect, acceptance, and
Maladaptive coping
positive regard for client in distress.
It imparts consistency, kindness, patience, and Psychotic
caring for the client.
Foster the expression of feelings and thoughts Hallucination / delusion
in distressed clients.
Bizarre behavior
4.Empathy
Share and experience the feelings of the
patient.
Conveys: I
Am with you, and I have a sense of what you
are experiencing .
Facilitates a deeper understanding of the
clients situation while it helps the client move
toward self-awareness, feelings, and their
meanings.

SYMPHATY
-blurs boundaries between the nurse and the client.
-feeling or sharing the identical concerns of another.
-encourages dependency.

5. Acceptance
Create environments that encourage
expression of feelings, thoughts, and
behaviors.
Suggest neither approval nor
disapproval but tolerance and appreciation of
the client.
Client attributes are received without
judgement.

6.Maturity

Ability to tolerate differences be

Denotes that the nurse is aware of personal
responses to given or potential uncomfortable
situations.
Be responsive to client needs.

7. Self-awareness